NO MORE HEADACHES

Those arising out of neurological disorders are usually associated with symptoms like nausea, vomiting, blurred vision and fits. This type of headache may be a warning of increased intra cranial tension or intracranial tumours. Ophthalmic disorders like glaucoma and refractory errors may cause headaches. Dental caries and other disorders in the teeth may cause severe headache, which can mimic sinusitis. Migraines cause more trouble and are usually episodic associated with an aura. They are also one-sided.

Common cause

The commonest cause of headache, however, is Sinusitis. This may be associated with nasal obstruction, running nose, postnasal discharge, dry cough and other such factors. With the nose being subject to various environmental pollutants and infections, sinusitis has become an increasingly common problem.

Sinuses are normal spaces or cavities within our skull. Ventilation and drainage of their secretions is essential for proper functioning. Our nose acts as a common drainage point for all sinuses. When the sinus pathway is obstructed, secretions collect in sinuses leading to bacterial and fungal infections. The nasal obstruction may be caused by variations in the anatomy of the nose like deviation of the septum and formation of soft tissues like polyps.

Examination

Evaluation of patients with sinusitis requires a detailed examination. The advent of nasal endoscopes has revolutionised the treatment of sinusitis. This reveals the complex anatomy and the changes causing disease in the nose and sinuses. The patient can also see all this on the monitor. Blood tests, x-rays and a CT scan of the sinuses complement the endoscopy and play a vital role in evaluation.



The use of nasal endoscope has revolutionised treatment of sinusitis.

Patients are initially treated with appropriate antibiotic therapy. The use of nasal endoscopes has brought about a great change in the treatment of the disease and surgical aspects. The earlier surgical methods like puncturing and lavage, which did not establish adequate drainage, are all obsolete now.

The latest surgical procedure called Functional Endoscopic Sinus Surgery (FESS) uses the advanced nasal endoscope. This procedure precisely eliminates the blockage of natural pathways of the sinuses restoring the normal flow of secretions. It also has a cosmetic advantage in that it produces no external scar. The surgery can be performed as a day care procedure. Deviation of the septum, when present, is also corrected in the same sitting. There is no need for repetitions as in the older procedures.

Advanced surgical tools like Microdebrider help in adequate and efficient treatment making FESS a safe and advanced technique in the management of sinusitis. The use of Microdebrider provides good mucosal preservation, reduced complications like bleeding and hence good postoperative results. Microdebrider plays a vital role in polyp surgeries reducing the recurrence rate.

The nasal endoscope is also a great tool in performing other surgeries and its role in minimally invasive removal of orbital tumours and in neurosurgery has revolutionised these fields. With these advanced options available, sinusitis no longer needs to be a headache.

WE KNOW EARLY WARNINGS

THE tsunami that struck South Asia last December provided a salutary warning to all the countries around the Indian Ocean.

If only we had in place an effective early warning system, so many lives could have been saved. If we had been forewarned, I am sure people would not have suffered so much. Actually we were quite unprepared for the tragedy that struck us.

Similarly many medical tragedies can be prevented if we attune ourselves to the early warning signs that Nature gives us. Unfortunately, most of us are oblivious to these signs either due to ignorance or neglect. Among the tragedies that we can prevent or at least minimise are heart attacks, strokes and cancer.

Heart attack

A heart attack occurs because one of the coronary arteries (the blood vessels that carry blood to the heart muscles) gets blocked — whether by a sudden severe spasm or by a blood clot obstructing a narrowed vessel.

In an unfortunate few, the first indication that their arteries have narrowed is when they suffer a massive and fatal heart attack. Most people, however, get warning symptoms in the form of angina, which is the name for pain or discomfort originating from the heart muscle. This is usually felt as a tightening feeling in the centre of the chest, brought on by physical exertion, cold weather or severe emotion.

Angina is felt because the heart muscle gets less blood than it needs since enough blood is unable to reach it through the narrowed coronary artery.

Angina pain may not always be typical — some people describe it as heaviness in the chest, some feel the pain along the upper left arm or the throat but it is always an unusual symptom brought on by physical exertion or severe emotion.

If you experience such a symptom, there is no point in ignoring it or rubbing liniment in the belief that it is a muscle pain. See your doctor because central chest pain of this nature should be considered to originate from the heart unless proved otherwise.

Stroke

A stroke or a cerebrovascular accident (CVA) is a similar occurrence because the vessels supplying blood to the brain (cerebral arteries) are narrowed. A clot stuck in one of the important blood vessels can suddenly cut off blood flow to the brain.

Even if the area of the brain that has had its blood flow cut off suddenly is not large enough to cause death, strokes can damage the affected part of the brain resulting in paralysis, loss of memory, speech and other such problems.

Fortunately most people experience mini-strokes or Transient Ischaemic Attacks (TIAs) before they suffer a full-blown stroke. It is important that one knows the symptoms of a mini stroke so that it can be recognised for what it is — an early warning of imminent danger.

TIAs are felt as a momentary loss of brain function that lasts less than 24 hours — a slurring of speech. A feeling of paralysis in an arm or leg, an episode of blindness in one eye, numbness in a limb or loss of consciousness for a few minutes.

Risk factors

If you are at risk of a stroke — by virtue of age, smoking, high blood pressure, diabetes or if you have suffered a heart attack/stroke previously — then you should be aware of what a TIA feels like.

If you ever experience what feels like a mini stroke, see your doctor immediately and have a scan done so that effective preventive measures can be taken if it is proved that your cerebral arteries have narrowed.

Cancer is a group of diseases characterised by the abnormal rapid growth of cells and can affect various organs of the body. The symptoms can vary depending on the organ affected.

Symptoms

Any abnormal lump in the breast, testicle or surface of the body or a non-healing ulcer in the mouth, tongue or skin should be checked by the doctor. Do not hide the lump or ulcer hoping it will go away. If it is a cancer then it will grow and spread. Once a cancer has spread from the original site to other parts of the body, it is difficult to cure.

Unexplained weight loss is another symptom of cancer, which is often neglected. If you are not dieting, losing weight is a serious symptom as are tiredness and weakness.

Usually working too much, worrying too much or sleeping less than usual can explain being excessively tired. Not infrequently tiredness and malaise can also be caused by anaemia and blood loss resulting from a cancer in the bowel or stomach. Discuss any of these symptoms that you cannot readily explain with your doctor.

The important message is that we should recognise the warning signs and take preventive measures before we are struck down.

KNEE INJURIES

THE anterior crucaite ligament (ACL) is one of four ligaments that stabilise the knee. It runs within the joint cavity of the knee (intra-articular) from the top of the leg bone (tibia) to the thighbone (femur) in an outward direction. It prevents the leg bone from sliding off the thighbone during activities like running or climbing down stairs.

Bundle of collagen

The ACL is a bundle of collagen (connective tissue) about four cm long and one cm thick. It, perhaps, deserves to be termed as the most valuable piece of collagen in the human body as many a high-profile sportsperson's career can be jeopardised by injury to the ACL.

In the last 10 years, there has been tremendous growth of scientific literature on the management of this injury. It is common to sportspersons and in the West, women have a greater incidence than man. This has been attributed to the peculiar anatomy at the end of the thighbone. In India, there is an additional high incidence in men after accidents.

Although there are very few randomised trials concerning surgical management, there have been reasonable studies in the initial assessment, surgical techniques and rehabilitation. Public awareness of the impact of the injury has led many people to seek early surgical treatment.

This is called ACL reconstruction, as attempts to suture the torn ligament have been largely unsuccessful. In an ACL reconstruction, a piece of tissue from the neighbouring tendons and bone (graft) of the patient's own knee (auto graft) is borrowed and fixed with implants. The source of the graft is commonly the patellar (knee cap) or hamstring tendons.

Bone tunnels are drilled in the tibia and femur to site the graft; the graft is threaded through them and is fixed at both ends by some implant (metal or bio absorbable).

Surgical reconstruction is advised in young people who wish to remain active in sports and even in those in whom it is symptomatic even if they are not engaged in sports.

There is no strict age limit or any reason to withhold an ACL reconstruction in a symptomatic individual.

Accurate history

Even consultants miss many ACL injuries. An accurate history should be obtained from the patient. There will be a "popping" sound at the time of the injury.

Immediate swelling ensues after this injury (haemarthrosis or blood collection in the joint). A routine MRI study to support diagnosis in cases of suspected ACL injury is not justified.

MRI has been shown to be less sensitive and specific than an experienced examiner. A MRI is useful in chronic injuries to pick up associated resultant damage to the menisci (semi-lunar cartilages). Concomitant treatment of articular cartilage lesions can logically improve the long-term results after an ACL reconstruction.

Surgical techniques have been refined over the last 10 years. Most knee surgeons now use Arthroscopic or minimally invasive technique. There is some debate about the best source of the graft — patellar tendon or hamstring tendon.

Advances

There is no one answer to this and surgeons should decide on the basis of the patient's needs. Patients whose occupations involve kneeling are not suitable for patellar tendon graft, as there is an increased incidence of anterior knee pain.

New forms of fixing grafts have been developed. These include bio absorbable fixation devices and screws. Early ACL reconstruction is advisable to avoid likelihood of damage to the cartilages of knee and osteo-arthritis.

Ten years ago, it was common practice to splint the knee after an ACL reconstruction. It is now considered unwise to protect the knee and an early return to normal activities is advocated.

Regaining the straight position of the knee is the first goal and regain flexion is the next goal to be achieved progressively. The exercise regime is in an "accelerated" nature and not "aggressive" to avoid strain on the graft.

The physiotherapist needs to supervise the rehabilitation process only on an intermittent basis.

IF SHE DISCOVERS A BREAST LUMP?

The discovery of a breast lump usually causes anxiety bordering on panic among many women. Most rush to the nearest doctor and plunge into a morass of illogical investigations and treatment, including surgery. Needless to say, many a woman regrets th is headlong rush at a later point of time.

Incomplete assessment and treatment, a false perception of cancer risk, a lifelong commitment to intensive and needless breast cancer screening, emotional and economic exhaustion are but a few fall outs that result from all this.
Lack of awareness

There are other women who in contrast are blissfully oblivious to the presence of a breast lump. A lack of breast awareness is often engendered by cultural inhibition and a conviction that once breast feeding is complete, the breasts are of no importance. Yet others do note the presence of a lump but assume rightly or wrongly that it will "go away". Often it requires a friend or family member to coax these women into seeing a doctor.

It is important to note that breast lumps are a common problem and the majority are benign. Lumps are usually discovered by the woman herself and only occasionally by doctors. A woman who is breast-aware tends to discover them early and obviously a painful lump is noted early in contrast to a painless lump.

What should a woman do if she discovers a breast lump? It is important not to panic. Approach a healthcare provider without loss of time. It is prudent at this stage to ask for a referral to a breast specialist (invariably a surgeon). This trend has become established in the developed countries after research showed significant benefits in outcome when a woman with breast disease is treated by a breast specialist.
Thorough examination

Next the patient will be subjected to a thorough examination by the surgeon to determine whether the woman truly has a lump. Often prominent breast tissue is mistaken to be a "lump". Breast imaging follows: mammogram in women over 35 years and an ultrasound scan in younger women. This is followed in the same sitting, if warranted, by an image guided needle biopsy of various levels of sophistication. On no account should a woman agree to bypass these steps and go straight for an open surgical biopsy. This can lead to serious repercussions in breast cancer management.

After comprehensive evaluation, (which may take four to five days) the treatment options can be discussed. With the dramatic and ongoing advances in the field of breast diseases, the emphasis is on individualised treatment. This may be in the form of clinical surveillance, medication or surgery according to the need. By and large there is no need for "emergency" surgery and even for cancers, a delay of a few days or even one or two weeks is of no medical consequence.
Don’t be short changed ?

The late 20th century saw a paradigm shift in the management of breast diseases, both benign disease and cancer. This came about due to two powerful influences: the women’s movement and mounting research evidence on the best methods to treat breast disease.

The First European Breast Cancer Conference held in 1998 issued the famous Florence statement: that all women (at least in western Europe) should have access to multidisciplinary breast clinics and that all breast related health services should have mandatory quality assurance. An important ground level consequence is that national guidelines were created in countries like the U.S., Canada, New Zealand, Australia to improve breast cancer outcomes. The impact was a fall in breast cancer death rates in these countries.

A powerful message of these guidelines is that only surgeons with a special interest in breast disease should treat patients with breast cancer and breast disease. The benefits are greater accuracy of diagnosis, better quality of treatment and a reduction in morbidity and mortality.
Indian situation

By contrast India is seeing rising incidence of breast cancer, high incidence of advanced breast cancer and shameful death rates. Indeed there are no national guidelines on how services should be organised, delivered and monitored within our socio economic constraints.

It is up to Indian women’s groups to push the medical profession and the Government to look at breast disease as a national issue.

Our women must assert their rights to get the best possible treatment and refuse to be short-changed as their western counterparts did nearly 50 years ago.

Spiralling costs

The advances in breast cancer medicine and surgery have been progressing at a prodigious rate. The crunch is that the best methods of diagnosis and treatment come at a cost.

In a highly specialised and evolving field such as breast cancer treatment, even diagnosis is an expensive business. A few thousand rupees need to be set aside just for assessment of the cancer. If in addition, genetic tests are required, the bill for this alone is about Rs. 50,000. But this elaborate evaluation helps individualise breast cancer treatment and enhances efficacy of treatment. Surviving a few years more without cancer is the direct result of this individualisation. It is indeed a balance between money and life.
Financial implications

Treatment in the form of surgery, chemotherapy and radiotherapy follows and is financially crippling. Families need a few lakhs of rupees to get the best in terms of the latest chemotherapy drugs of added efficacy or the latest machines for better and safer delivery of radiation.

Today we have special drugs such as anti-breast cancer antibodies, which can be given to selected patients to control the cancer remarkably well. The cost of these injections is approximately Rs.1,00,000 per dose. These drugs need to be given every three weeks for close to a year. To meet the bills, families have been known to reduce themselves to penury. The tragedy is that many do not survive.

Whom does one blame for this financial juggernaut: The government, the private sector or the multinational companies? Or the patient for asking to live in peace for a few more years?
Why see a specialist

• It gives better local control of cancer.

• It improves the survival of the patient significantly.

• The patient has greater satisfaction with the treatment.

• The patients receive greater psychosocial support.

• The patients have improved quality of life after treatment.

• It is cost effective to be treated by breast specialists in the long run.
If you discover a lump

• Ask to be referred to a breast specialist.

• Undertake investigations as per specialist advice.

• Wait for the full evaluation.

• Heed the specialist’s advice.

• Do not seek multiple medical opinions, particularly from "non specialists".

• Be reassured that the majority of breast lumps are benign.

• Even if you have a cancer, do not lose heart. It can be controlled effectively.
Tips to contain costs

• Ask to be referred to a breast specialist early.

• Do not undertake investigations without professional guidance.

• Adhering to international treatment guidelines contains costs in the long run.

• Be part of a breast cancer support group, on going information helps contain costs.

BALANCED DIET MEANS ?

Surviving the seduction of miracle-promising weight-loss programmes, fad-diets and food-fads is tough. After all, these are times when we have deep concerns about fitness for cosmetic and health reasons. Tougher still is making sense of their conflicting claims on the best ways to get fit.

However, doctors and nutritionists say the secret to lasting good health is not a quick weight-loss plan, fad-diet, or gorging on ‘super-foods’ but building Good Eating Habits. This means consistently watching what you eat –– planning each meal and its timing, following simple, golden rules.
Balance check

A balanced meal sounds simple but most times we slip up eating more of one food over the other because it’s our favourite or easier to source and/or cook. Result: nutritional imbalances.

Suja Mathai, nutritionist, Soukya, Bangalore, says: "Ensure your meal incorporates the five food groups: cereals and grains; pulses and legumes; fruits and vegetables; milk and meat products; nuts and oilseeds/oil."

Dr. Kalpagam Polasa, Deputy Director, National Institute of Nutrition, Hyderabad, advises: "The largest servings must be cereal-based; followed by vegetables and fruits; milk and milk products; pulses/non-veg protein; and lastly fat, oils and sugars."

Drink two litres of water daily to maintain body’s water-balance, flush out toxins, prevent dehydration and build-up of kidney stones, etc.

Go Organic. Avoid foods bred on artificial pesticides and fertilizer. Organic products are difficult to source, but make that effort. Or grow a kitchen garden.

Trim portion size. It’s directly proportional to waist-size. Moderation is the key to healthy eating.

Though, says Suja, moderation is a subjective term; one man’s moderation may be another’s excess. Therefore, each person should determine for himself or in consultation with a nutritionist, how much they need to add or cut down and of what, given their current constitution.

General rule: cut down first on fat intake (butter, cheese, oil, nuts, fried food), and then carbohydrates (rice/wheat, potatoes, mango, sapota, banana).
When good becomes bad

Limit portions even of healthy foods. Olive oil is healthy but an olive-oil drenched vegetable/pesto-sauce isn’t.

Vitamin tablets are beneficial but overdosing on certain varieties is counterproductive, causing health problems. Salad is great but not one smothered with mayonnaise.

Eat plenty of greens. They provide iron, fibre, calcium, and prevent indigestion, constipation.

Minimalism is in. Cook using minimum oil/ghee/butter. Unfortunately, some ruin that effect by smearing that dry roti or roasted papad with oil/butter/ghee or adding dollops of ghee to steamed, starch-drained rice.

You can’t do away with oil, ghee and butter; some of it’s actually healthy. Only, minimise their use. Steaming, broiling, roasting and poaching are healthy alternatives to deep-frying, shallow-frying, sautéing in lots of oil/ghee.
Don’t recycle oil

Avoid recycled oil or ghee. It’s rich in cancer-causing carcinogens. Sadly, many Indian homes, restaurants and street-food vendors repeatedly recycle cooking-oil/ghee. Seen that deadly brackish oil in simmering woks at street-food peddlers?

Homemakers and singles who celebrate today’s easy availability of sweets/snacks at condiment shops or supermarket shelves could be trading in convenience for ill-health. Ideally, home-cook these if you must have them.

Dr. Polasa explains: "Oils heated repeatedly at high temperatures for long time result in formation of peroxides and other chemicals, which are mutagenic (can cause changes in RNA, DNA); and of heart-damaging transfatty acids."

Go Natural. Fresh fruits and vegetables (including garlic, onion) are weapons against cancer, digestive ailments, heart disease. And wherever possible, with their fibre-rich peels on. Fruits and veggies prevent clotting tendency and protect arterial walls, says Prof. K. Srinath Reddy, eminent Delhi-based cardiologist and WHO consultant.

Conversely, limit foods high in cholesterol, saturated fat, transfat, salt and added sugar; like creamy pastries, cakes, chocolates, doughnuts, cheeseburgers, French fries, soft drinks, namkeens, sweets; Reddy adds.

Vitamin tablets are health-aids but your natural diet is the better source, says Mumbai-based physician Dr. Gireesh Mansukhani.
Travel discipline

The high-flying professional travelling 20 days a month often complains of lack of control over diet. Actually, she/he’s not that helpless. For example, from bread-baskets in planes choose multigrain or brown bread over transfat-rich croissants. At restaurants, order salad and fruits with each meal. Check menus for low-calorie options/health foods.

Or, design your own meal. For a snack, ask for a sandwich of multigrain/brown bread with filling of spinach and low-fat cheese; eaten with fresh-fruit juice/yoghurt.

A meal could be soup; dry rotis; steamed veggies/grilled fish; salad; skimmed-milk yoghurt; and fresh-fruit dessert.

Most hotels will give you customised meals if informed in advance. Carry bottled water when leaving the hotel and ensure you have downed two one-litre bottles by the end of the day. Best of all, ask your family doctor who knows your body-type and medical history, for a list of healthy-meal combos to order when travelling.
Regular timings

Adhere to regular meal-timings. Else, your body is thrown off-balance attempting to compensate. Also, eat a good breakfast, followed by a moderate lunch and light dinner, advises Dr. Polasa. "High-fatty meals are particularly to be avoided at dinner as there is little physical activity after consumption, so unused excessive calories are converted into fat stored in the body."

Go slow. "Chewing slowly," says Dr. Polasa, "prevents excess intake as satiety is reached 10 to 15 minutes after commencing food intake."

Finally, when it comes to the overall good-health menu, eating right is a major but not the only item. For best results, include: Regular exercise; regular check-ups. no -smoking; a package of positive thinking; yoga; and meditation.

HOW CAN ONE PREVENT STYES?

Boils on the eyelids (styes) are due to bacterial infection of glands present at the root of the eyelashes.

Treatment comprises hot water fomentation — hold a towel soaked in hot water over the area for five minutes — and using antibiotic drops or ointment for a week. Pain relievers are also prescribed. Oral antibiotics are held in reserve for those with severe infection that may lead to an abscess.

Tarsal cysts or chalazions are formed when vertically placed oil glands (meibomian glands) in the tarsal plates of the lids get blocked at their openings in the lid margins. This results in a pooling of the secretions, which usually increases with time. Occasionally this may get infected, resulting in a boil. A large chalazion requires a minor surgical procedure with a niche only on the inner side of the lid rendering aesthetic satisfaction of the patient.

Persistent boils tend to occur conventionally in diabetics, those with refractive errors, itchy eyes (those who frequently rub eyes) or are associated with lid margin infection called blepharitis.

Further questioning revealed that his working hours were 8.00 a.m. to midnight and that he could snatch only a four-hour nap. He was advised to sleep at least seven hours to build up immunity to combat the staphylococcal germs normally present around the lids.

The most common cause for repeated eruptions of boils on the eyelids is lack of adequate or quality sleep. Any prescription for infection of lids also includes control of blood sugar or correction of power.

STAY ON YOUR FEET

Inseam, hip and waist measures are critical in buying a pair of jeans, once the decisions on brand, style and price have been sorted. A trial room and mirror helps. Similarly, fit, size, cushioning and arch support are key in the choice of a running shoe and often override brand, price and style.

All new shoes feel great, but an inappropriate shoe leads to problems, sometimes over the years. It’s important to know whether you are flat-footed or have a high or a normal arch, and also understand if you over-pronate or under pronate

"Ouch, these guys just stopped writing in English!" Let me try and explain:

When you run

When you run, the outer part of your heel strikes the ground first. The middle part of your foot then begins to make contact with the ground, while it rolls inwards by around 4-5 degrees at the arch (or pronates).

This is the body’s means of natural shock absorption. The entire foot is in contact with the ground for a fraction of a second before the ball of the foot (the part just next to the five toes), kicks off, with the help of the toes. And we have lift off.


Here are some simple ways to understand your feet better.

The wet test: Wet both your feet, step onto a sheet of paper, and view the wet pattern.

If the imprint shows your whole foot, then you are flat footed and, perhaps, over-pronate i.e. when your foot hits the ground your arch collapses a bit more than needed (over-pronates).

You need a shoe that has a much firmer middle, a stability shoe or if you are severely over pronating or are a heavier runner (over 75kgs) then a motion control shoe.

If you see some of your foot and a curved arch, a normal arch, the best shoes are those that provide stability (as above).

A thin line connecting your heel to the ball of your feet and your toes means you have a high arch (the foot most probably supinates or turns outwards.

You need a shoe with a soft middle to absorb the shock of every foot strike.

The old shoe test: Flip your old running shoes over (or if you don’t have one, examine the soles of your old shoes).

If the inside of the sole is more worn out, then you are most likely flat-footed and over-pronate. If the outer sides of your soles are worn out, you are likely high-arched and under-pronate (or supinate)

The walk test: Walk towards a full length mirror and then away from it, and observe your feet motion. Also, just watch other people jogging or walking in the park or on a treadmill and see if the inners of their shoes are getting most of the wear.

Then you can tell if they are over-pronating or under-pronating. About 80 per cent of the population have structural problems in their feet that cause abnormal walking pattern
Basic shopping tips

Feet swell during the day. Shop in the afternoon or evening.

If you run longer distances (10km or more) buy a size larger than normal to allow for foot expansion. You should be able to stick in a finger between your heel and the shoe. Don’t ever fall for the sales talk (it will loosen out). While that could happen with a leather shoe, it’s the wrong answer for a running shoe purchaser to hear.

Most of us, strange as it may sound, have one foot longer that the other. So measure the shoe size of each foot and try out the shoe size for the bigger foot.

Wear socks during the try out.

Visit multiple stores, try multiple brands and models, ask questions and learn more, before you buy. This will be your most important investment, as problems with arches often travel up the skeletal system to the ankles, shins, knees, hips and finally the lower back.

Do not assume that the most expensive shoe is the best for you. Many in the Rs. 2,500 to Rs. 4,000 range could be just right for you.

So just like you would never buy a 40inch waist DKNY jeans just because they are the latest, don’t end up buying the latest and most expensive shoes and assume that they are the best for you.

If you are serious about running, keep two shoes and alternate them so that they get a day or more to breathe, and spring back to provide your feet the support they need.

Enjoy the run, and enjoy your running shoes even more than your jeans! Now you, like Fauja Singh, can run marathons in your nineties.

RUN LONG RUN STRONG

RUN LONG RUN STRONG

The incredible benefits of running go beyond the realm of health. The second in a series on running and living. Every run is a gift. Run long. Run strong.


Running tends to release endorphins (indigenous morphine produced by the body). Sounds great, right? Takes you on a trip and it’s free! Running in the outdoors in particular has been known to cause this runner’s high, which can last for long periods of time — even days. I have felt unbelievably ‘high’ for a few days after a marathon, on several occasions.
Effects on the brain

Running has also been used by many, over the years, to treat clinical depression. After a study in 2007, scientist said, "Exercise clearly has effects on the brain" and they are both direct and indirect. It’s possible, he explained, that the current findings reflect a direct effect of exercise on nerve cells in the hippocampus, or more general changes in the brain, like better blood flow or increased hormonal activity.

A natural compound (epicatechin) and exercise boost memory in mice and may help protect against cognitive decline in aging, says newly published research. "This effect increased further when mice also exercised regularly. The compound, epicatechin, is one of a group of chemicals known as flavonols and has previously been shown to improve cardiovascular function in people and increase blood flow in the brain. Flavonols are found in some chocolate."

Okay, so eat chocolate and exercise. I am sure this is now finally beginning to sound more palatable to you.
To manage jet lag

Now that may sound far fetched, but it isn’t. Believe me, in my last assignment at Motorola I had to travel a lot — 200,000 miles a year — so managing jet lag was important. I found that maintaining a regular regimen of running even a short distance, starting the day or morning after landing in a new time zone, helped me remain energised and perky, even without generous doses of coffee.

Most importantly, running is a great way to make yourself incredibly positive and optimistic, as you measure your progress, and see yourself achieve some things that you never thought possible of yourself. At 40, I could barely run one km without being exhausted and out of breath. Over a six-month spell of winter in Chicago, I found I could run five km without stopping, and then I felt I could achieve anything. It gave me that supreme sense of confidence. I then went on to run my first marathon that year and have done 22 more since! And I am no athlete.
Team up

While you run you make new acquaintances in the park, in a gym, on the road. As you greet them, they tend to reciprocate and, then all of a sudden, you have a few more friends. Or if you are running with people you know, you find soon enough that you are starting to bond on a different plane too.

It’s a great way to build teams in companies, being the most egalitarian sport, as CEOs rub shoulders with new recruits and so on. Try it!

Talking about running getting you to bond with others on a different plane brings me to Warren Kay, chair of the Department of Religious Studies in Andover, Massachusetts U.S., where he teaches a class on the Spirituality of running. He has written a book on sweating yourself to enlightenment: Running: The Sacred Art.

So whether you want to get younger by nine years, or attain Nirvana, all you have to do, is run, run! I hope that’s a succinct sales pitch, and you are running, and I can curl up in bed and have my chai and paratha, and I will chat with you next week. Go ahead and start.

Moving quote

In case, I haven’t convinced you yet, I would like to end with a moving quote from the blog of a cancer-fighting runner. "Oh how I do love running. I love the feel of wind in my air, the dull thud of running shoes against the packed dirt. The crunch of the gravel. The running endorphins enhancing my senses, and how alive I feel at the end of a run. Running is freedom. I hope I can run forever. Every run is a gift. Run long. Run strong."

PSYCHOLOGY OF EXERCISE

It is important to keep changing your routine and set new goals. This prevents monotony and gives one something to work towards.

Exercising regularly is not the easiest thing in the world. Not all of us have the good fortune of actually "liking" exercise. Having said that, it is possible however to train your self to enjoy it (well, at least for the most part). It is all in the mind!

There has been so much media hype about it (and rightly so), that it is hard to find an educated person today who is unaware of the benefits of regular exercise. Whether they act on it is another story altogether.

Why this complacency when the writing is on the wall? Maybe a sense of invincibility smothers us. Like the smoker who believes he will never fall victim to lung cancer, most of us think we can bypass that responsibility for the day without repercussions.
One step at a time

There is a psychology behind learning to exercise regularly. To begin with, focus on goals, both short term and long term. Visualise the positive changes in your body (both internal and external) while you go through the motions. Envision a healthier, slimmer, stronger you.

Don’t get discouraged by the gym rat or by slow progress. One step at a time, as you begin to feel better every day, and you really will, when the endorphins start kicking in.

I encourage people to see this as time alone for themselves. Most people multi-task trying to make ends meet. Rarely do they even have the opportunity to connect with themselves during the course of the day. Use this as a time to contemplate, unwind and de-stress.

How does one de-stress while breathless on the treadmill? The mere act of the repetitive, structured movement of the extremities diverts the mental stress to the physical action and actually creates alpha waves in the brain that generate a calm state of mind.

As you continue to work the cardiovascular system, the endorphins released give you the elevated mood and improved moral.

When this is repeated frequently enough, you start to look forward to that very activity that causes the "high". It feels great when it’s completed and the results are indisputable. This is reason enough to keep at it.
Making it a habit

According to the transthoretical model of change, an individual goes through a series of stages before the act of exercise becomes a habit. This could take as long as five years of regular exercising for you to fall into the category where "Fitness" is part of your lifestyle.

During the course of this process there may be many an occasion that can challenge your resolve and you may find yourself sliding backwards. But there is always the option of getting back on the wagon.

Initial rapid weight loss can be exhilarating. Inspiration in itself. Then comes the plateau. During the plateau phase it is important to find something other than your weight to keep you motivated. The compliments slow to a crawl and the scale doesn’t move. Keeping the weight off is just as hard work and you need to compliment yourself on that.

Take up other projects in the meantime and stop obsessing about the scale. This is a time when exercise can wane and inspiration runs low but persistence invariably pays off and the plateau gives way to a new horizon.
Maintenance phase

Then comes the maintenance phase where you have achieved your goals, but have to sustain it. Or improve your already excellent condition. Although not as hard as the earlier phases, there can be a sense of complacency that may result in return to earlier habits and weight gain.

I believe it is important to keep changing your routine and set new goals. This prevents monotony and gives one something to work towards. There’s always place for improvement.
Feel good

Emotional eating, stress, fatigue, travel, lack of sleep can all interfere with good intentions. Feel good about yourself, including the body you are in now.

Sometimes it may be required to lay off a little with the exercise or indulge in your favourite treat.

Keeping things in perspective and priorities right will get you the results you want and try and have fun while doing it.

HOW TO CONTROL ASTHMA ?

It is easy to put the blame on the patient for non-compliance in the use of steroid inhalers. The causes for this lie both with the patient and those managing the disease — the physician, hospitals and the policy makers.

Patient's attitude

The first is the attitude of the patient. Many think that asthma is a serious one-time disease, which if treated well will not recur. This attitude is so deep-rooted that it will take time to change it. Most awareness campaigns on asthma are directed towards increasing compliance in using steroid inhalers rather than stressing that asthma is a problem whose management depends on long-term strategies rather than short-term gains. By short-term gains, I mean rapid cure for asthma, alternative therapies, complementary therapies and so on. Surprisingly some people are not aware that they have asthma and are not averse to taking regular treatment if advised. Many times asthma that was undiagnosed is picked up when the patient is admitted for some other problem or for surgery.

The idea of a long-term strategy for asthma control is to make the patient understand that asthma, like diabetes or hypertension, needs regular and long-term management. The symptom-free periods do not mean complete cure but only control of asthma, which needs to be maintained. The symptom-free periods are possibly the biggest disadvantage of asthma management. For example, when a patient is discharged after an asthma attack with discharge advice and a follow up, it is hardly followed because neither the patient nor the physician thinks about long-term management. Nor is there a discussion about the disease during discharge.

In this situation, a self-management plan is considered the best. The usual argument in our country about this strategy is that our country is poor, literacy rate is poor and comprehension capacity is poor. All this has been proved wrong by one study.

Study results

The Respiratory Research Foundation of India and Glaxo Smith Kline distributed a questionnaire called the Asthma Control Test to patients suffering from asthma. The study results came as a surprise, as many people were enthusiastic and clear about the disease and could understand the disease better and plan their treatment accordingly. The reassuring aspect was the interest shown by participants and also the regularity of use of steroid inhalers.

So it is clear that self-management strategies would work if the patient were given details about the disease. This should be done in the first sitting. The ACT forms can be translated into languages other than English and distributed to people who cannot follow English. Illustrations in the form can help people who are not educated understand the problem than didactic lectures.

The need of the hour is to educate the patient about asthma, the consequences of non-control and also help the patient create a self-management plan that teaches control without frequent visits to the physician's office.

SPORTS FOR HEALTH LIFE

SPORTS are a part of modern life and the zest for conquest makes a sportsperson prone to injuries. Prevention of injuries is crucial for a long injury-free career. A healthy diet, general body warm up and stretching are absolutely essential for every sportsperson.

While most people realise and understand the need for regular exercise, many are unaware of the importance of stretching or relaxation. Exercise, stretching and relaxation go together. Exercising without stretching can lead to pain and disability.

Why is flexibility important?

Flexibility is important for optimal athletic performance and for prevention of injury. Different sports have different flexibility requirements. Stretching is the best way to enhance flexibility.

What causes muscle cramp?

Muscle cramps are caused by the depletion of essential electrolytes in the body or due to improper coordination between opposing muscle groups. Tight clothing can also cause cramps due to decreased blood flow to active muscle tissue. In case of cramps, increase intake of water. Follow it up with an attempt to stretch the muscle involved. Then gently rub down and do mild exercises that require the use of that particular muscle.

What should be done immediately after sustaining an injury?

The best treatment is prevention. When any activity causes discomfort or chronic irritation, you need to treat the cause either by switching activities or by using better equipment. The standard method of treatment on the field is application of a cold compress if possible and elevation of the body part. This decreases blood flow to the injured part and minimises swelling. Do not hesitate to seek medical advice if you have any doubts regarding the nature or seriousness of the injury.

How can we tell if the injury is serious?

When there is obvious deformity as in fractures and dislocation, application of cold compress is the best provided there is no open wound. Never try to reset the fracture or dislocation by yourself as this may cause greater damage to the muscles, ligaments and nerves. Treatment of these injuries should always be left to specialised medical personnel. In other cases, seek medical advice if there is persistent pain, swelling or disability for more than 48 hours after the initial injury.

Will taking anabolic steroids help enhance performance?

First of all use of drugs for performance enhancement is against the spirit of fair and ethical competition. Almost all steroids and performance enhancing drugs cause various health hazards. Agitation and irritability are the most common side effects. Problems of addiction, dependency and withdrawal can occur in long-term users. Other adverse effects include, hair loss, impotency, hypertension, stroke, insomnia (sleeplessness), tremors, seizures, increased heart rate or tachycardia, cardiac arrest and death.

The right diet for athletes

FOOD is the fuel that will power a sportsperson's performance. A well balanced diet is the key to good health and successful weight control. Food is made up of carbohydrates, proteins and fat.

An athlete's diet should be high in carbohydrates and moderate in protein and fat. Another key element is water. The five golden rules for healthy eating are:

# Eat fresh foods. Avoid processed or readymade meals.

# Eat plenty of fibre-rich food like fresh fruit, vegetables, cereals, pulses and grains.

# Cut down on fats, especially saturated fats.

# Decrease intake of sugar and salt.

# Vary your diet to maximise your vitamin, protein and carbohydrate intake.

# Drink three to four litres of water every day. Drink about 400-600 ml of water before starting the game/event.

# During a game, players should ideally drink about 150-200 ml of water mixed with salt and glucose every 10-15 minutes.

# Sports drinks help athletes who exercise at high intensity for more than 90 minutes. They provide energy in situations where glycogen stores are likely to be depleted. Though many sports drinks are available, it is advisable to drink one with fluid, electrolytes and six to eight per cent of carbohydrate content. This helps regulate temperature and fluid balance.

FOR CLEAN AND HEALTHY TEETH

HEALTHY teeth and gums are the result of several factors ranging from oral hygiene to eating habits and genetic influences. Special children tend to be more susceptible to dental diseases.

The reasons for this lie in the altered physiological conditions in special children like poor oral hygiene, swallowing defects, macroglossia, lack of lip seal and bad habits.

Brush the teeth

Special children tend to maintain poor oral hygiene. This is due to not brushing the teeth properly. Accumulation of plaque in the long run turns into calculus and results in poor oral hygiene, thereby leading to development of gum disease and dental caries.

Another problem is that poor neuromuscular coordination of the tongue and pharyngeal muscles leads to defects in the swallowing mechanism. Drooling and dribbling of saliva paves the way for drying up of saliva leading to bad breath and dental caries.

In some cases, the tongue is enlarged; a condition known as Macroglossia, which results in the problems like protrusion of teeth and increased inter-dental spaces; dripping of saliva leading to a dry mouth, rampant caries and bad breath and lack of lip seal.

Lack of lip seal can occur in three ways: First as incompetent lips seen in case of children with short lips. The second is potentially competent lips in which children have normal lips that fail to form a lip seal, due to proclination of upper incisors.

The last is Everted lips where the lip muscles are weak and do not form a lip seal.

Bad habits such as sucking thumbs or fingers and thrusting the tongue out have a deleterious effect on the teeth and their supporting structures.

Other problems

Then there are other normal dental problems. Rampant caries is a widespread, rapidly burrowing type of caries that appears suddenly and is uncontrolled. Special children sometimes crave for sweets to overcome emotional disturbances, continuous tension, anxiety and fear. Too much sugar in the diet causes rampant caries.

Retained deciduous teeth are milk teeth that fail to shed and block the normal eruption of permanent teeth below it.

As a result, the permanent teeth are deflected from the normal eruption pathway causing irregular arrangement of teeth. Malocclusion is irregular teeth alignment, which occurs due to the any of the above factors.

The management of all these problems includes diet, use of fluoride, frequent examinations and hygiene. The children should be encouraged to eat raw vegetables like carrots, tomatoes, cucumber, radish, onion and gooseberry and also fruits like apples, pears and other seasonal fruits.

Fluoride application helps in prevention of caries. Dental examination in children is usually started in 12 to 14 months of age. Frequent dental examination helps to prevent the onset of diseases.

Good oral hygiene is also crucial to keep the teeth and gums healthy.

KNOW YOUR WEIGHT

Obesity is now considered as a "killer" lifestyle disease and has become the second leading cause of preventable deaths. It has become a disease that needs as much medical attention as any other health condition.

Obesity has become a widespread health problem across the globe. Severe obesity threatens one’s health and affects lifespan too. It also leads to development of life-threatening complications such as high blood pressure and Type 2 Diabetes.

In the Indian scene, even with the growing awareness about health and fitness, more than two per cent of the population is obese. Each year, this number is growing especially in urban areas due to changing lifestyles.
Causative factors

Environmental factors play an important role in the prevalence of this condition. Our increasing dependence on elevators and escalators, long hours at the computer, watching television, consumption of high calorie food sets the ground for the development of obesity.

Obese people develop complex and multi faceted problems such as discrimination at workplace, school and home;

Finding clothing, furniture incapacity in public places, bus, plane and personal hygiene. Depression rates are among the highest in the obese. Health risks like high blood pressure, diabetes mellitus, elevated cholesterol, arthritis, sleep apnea, gall stones, stroke, heart attack, are closely associated with obesity and lead to further complications.
Treatment

A simple calculation called Body Mass Index or BMI is used to classify the people as underweight, normal, overweight, obese and morbidly obese. BMI is calculated by dividing weight in kg by height in metres squared.

There are two accepted methods to treat obesity: Medical or Surgical. The first involves a diet low in calories, fat and carbohydrates; exercise of 40 minutes five times per week; behaviour modification, which involves eating three sensible meals a day and avoiding snacking. Additionally drugs like stimulants, appetite suppressants, antidepressants and medication to reduce fat absorption are prescribed. The disadvantages of this method is that most patients regain much of the lost weight and the average amount of weight loss is relatively small. Drug therapy may also be associated with side-effects and it is very difficult for most to maintain the programmes in the long term.
Surgery

According to National Institutes of Health (NIH), since many obese people can’t shed weight with diet and exercise alone, Bariatric Surgery has proven to be the most effective method to treat obesity. This can improve the person’s quality of life in many ways since significant amounts of weight is lost making the person more active. It also reduces the life threatening risk factors associated with obesity. Improving self-esteem gradually opens the doors for better work opportunities, friendships and relationships.

Patients with a BMI of 40 or greater who also suffer from severe medical conditions related to obesity (sleep apnea, diabetes, heart failure, high blood pressure) are the ones who can opt for bariatric surgery. Such patients must be willing to commit to the lifestyle changes that have to follow the surgery.

Patients with a history of substance abuse, eating disorder, or psychiatric problems; those who are too ill or women who may become pregnant within two years are not eligible for surgery.

CHRONIC OBSTRUCTIVE PULMONARY DISEASES

Almost every one knows that outdoor air pollution can damage one’s health and lungs in particular. But not many people are aware about indoor air pollution.

Your house, your office, school or college and your work environment, shops and restaurants all contribute in their own small way.

In other words about 80 per cent of our time is spent indoors without knowing that we are damaging our health.

Poor indoor air quality has been linked to lung diseases like allergic rhinitis, sinusitis, asthma, Chronic Obstructive Pulmonary diseases (COPD) and lung cancer. People who already have asthma and smoking-induced bronchitis suffer the most. Old people who are constantly indoors can also get pollution-related lung diseases. The following FAQs will throw some light on the indoor air pollution.

What is ventilation?

Entry of air into the house is ventilation. Air can enter the house in many ways: natural ventilation when we open the doors or windows or by infiltration through the cracks in the walls, floors or ceilings or through exhaust fans or air conditioners.

What do they cause?

These pollutants cause dry throat and cough in a very slow manner. One may forget that indoor air pollution may be the cause. Most of the unexplained cough or cough variant asthma result from these causes.

Whom does it affect the most?

Children seem to be more sensitive than adults. They are more sensitive to tobacco smoke while women suffer silently. Patients who are allergic to mites or moulds suffer most when they enter a room that has carpets, curtains and air conditioners. The effect can start in the womb if the mother or father smokes.

Is it possible to control indoor air quality?

Levels of outdoor pollution are measured although little action is taken from any one. Some countries have set guidelines for indoor air quality but setting them in India will be difficult. For example in a multi-storeyed residential complex one does not worry about petrol pollution, but the vehicle exhaust enters homes thanks to basement car parks!

Self-discipline, individual choice and control over what we use in our homes and how we ventilate them is the only way out. It is hard to control, check, establish and maintain good levels of air quality in schools, offices, shops and restaurants. However we can be aware of the risks and make an effort to reduce them. Only individual effort, not law, can make the earth pollution free.

WHEN YOUR WORLD SPINS

Vertigo, or dizziness, is a symptom, not a disease. The term vertigo refers to the sensation of spinning or whirling that occurs when balance (equilibrium) is disturbed. It also may be used to describe feelings of dizziness, light-headedness, faintne ss, and unsteadiness. The sensation of movement is called subjective vertigo and the perception of movement in surrounding objects is called objective vertigo.

Severe vertigo can be disabling and may result in complications such as irritability, loss of self-esteem, depression, and injuries from falls. Falls are the leading cause of serious injury in people over the age of 65.
Causes

Benign paroxysmal positional vertigo occurs when debris made up of calcium carbonate and protein (called otoliths or ear crystals) builds up in and damages the inner ear. Inner ear degeneration (usually occurs in elderly patients), head trauma, and inner ear infection (e.g., otitis media, labyrinthitis) can cause BPPV.

Some medications and environmental chemicals (lead, mercury, tin) can cause ototoxicity (ear poisoning), which may result in damage to the inner ear or the eighth cranial nerve (acoustic nerve) and cause vertigo. The damage can be permanent or temporary. Long-term use or high doses of certain antibiotics and antineoplastics can cause permanent ototoxicity.

Central vestibular disorders that may cause vertigo include the following: Cardiovascular disorders (bradycardia or slowed heart rate, tachycardia or rapid heart rate); Central nervous system (CNS) disorders like stroke or brain haemorrhage); Head trauma; Migraine; Multiple sclerosis (MS may occur when demyelination affects the brainstem or cerebellum).

It is important to diagnose the cause of vertigo, or dizziness quickly to rule out serious conditions such as cardiovascular disease, stroke, haemorrhage, or tumour. Diagnosis includes clinical history, physical and neurological examination, blood tests, and imaging tests (e.g., CT scan, MRI scan). The physician also needs to consider what triggers the vertigo; other symptoms; duration of dizziness and what improves or worsens symptoms.
Diagnosis

There are five cardinal steps in the approach to a patient with vertigo. The first is to identify whether it is true or false vertigo. True vertigo is the spinning sensation or sense of rotation that persists even when the patient lies down. On the contrary false vertigo remits on lying posture. The next step is to find out whether the reason for vertigo lies in the eye, ears, or neck. The third is to identify whether the vertigo is central or peripheral. The next step is to find the aetiology of vertigo. The last is to investigate the patient for causes. The main things to look for are raised blood sugar, raised blood pressure, elevated triglycerides and cholesterol and hypothyroidism. One should also look for upper and lower respiratory infections, gastrointestinal infections, diet, and drugs.

Treatment depends on identifying and eliminating the underlying cause. If a particular medication is responsible for the condition, lowering the dosage or discontinuing the drug may eliminate vertigo.

Vestibular Rehabilitation Therapy (VRT) aims to minimise dizziness, improve balance, and prevent falls by restoring the normal function of the vestibular system. The patient performs exercises designed to allow the brain to adapt to and compensate for whatever is causing the vertigo. The success depends on several factors including patient’s age and overall health; cognitive function; coordination and motor skills; physical strength. As the patient progresses, difficulty of the exercises increases until the highest level of balance is attained.

Ear infections caused by bacteria may be treated using antibiotics. Myringotomy is a surgical procedure that may be used to treat chronic ear infections. In this procedure, which is performed under anesthesia, an incision is made in the eardrum and a small tube is placed in the opening to prevent fluid and bacteria from building up inside the ear.

Benign paroxysmal positional vertigo may be treated with meclizine, an oral anti-emetic that can be taken up to thrice a day, or as needed. But it may cause drowsiness, dry mouth, and blurred vision. If this is ineffective, benzodiazepines or antihistamines may be prescribed. But these have side effects like drowsiness, lack of coordination, fatigue, and tremors.

Ménière’s disease may be treated by reducing salt intake and with diuretics. A short, tapered course of corticosteroids may be prescribed in the early stages to reduce inflammation and stabilise hearing. Antibiotics may be administered into the middle ear to treat severe vertigo caused by this disease.

Vertigo caused by migraine can often be treated with medication. Strokes, tumours, and multiple sclerosis may require treatment with medication, radiation, or surgery.
Prognosis

Prognosis depends on the cause and how well the underlying condition responds to treatment. Severe vertigo can be permanently disabling, especially in elderly patients. Peripheral vestibular disorders may cause progressive hearing loss. It is intellectually a lazy approach to do MRI or CT in every case as it is not justified in all cases. In clinical neurology, a good history and a thorough neurological examination are the two most important diagnostic tools.



Some patients describe a feeling of being pulled down or toward one side. Moving the head, changing position, and turning while lying down often worsen vertigo.The sudden onset of vertigo usually indicates a peripheral vestibular disorder (e.g., BPPV, Ménière disease, vestibular neuritis).

Peripheral vestibular disorders may also cause blurred vision; fatigue and reduced stamina; headache; palpitations; imbalance; inability to concentrate; increased risk for motion sickness; muscle ache (especially of the neck and back); nausea and vomiting; reduced cognitive function; sensitivity to bright lights and noise; sweating.

Vertigo caused by a central vestibular disorder usually develops gradually. In addition to vertigo, central vestibular disorders may cause symptoms like double vision (diplopia), headache (may be severe), impaired consciousness, inability to speak due to muscle impairment (dysarthria), lack of coordination, nausea and vomiting and weakness.



Vertigo is usually the result of a disorder in the vestibular system (structures of the inner ear, the vestibular nerve, brainstem, and cerebellum).

The vestibular system is responsible for integrating sensory stimuli and movement and for keeping objects in visual focus as the body moves. When the head moves, signals are transmitted to the labyrinth, an apparatus in the inner ear made up of three semicircular canals surrounded by fluid.

The labyrinth transmits movement information to the vestibular nerve, which carries the information to the brainstem and cerebellum (that control balance, posture, and motor coordination).

WHAT ARE PROBIOTICS?

Time for breakfast? Help yourself to a plate of hot steaming idlis, dosas or uttappams and dahi. These are not only nutritious but are safe, highly acceptable and packed with health benefits that are both protect ive and therapeutic against a wide range of disorders. They are all fermented foods i.e. they are subjected to the action of micro-organisms for a few hours causing desirable alterations in food quality. The process also preserves and predigests the food.

The bacteria that cause these changes are called "Probiotic bacteria". They are not destroyed by the acid in the stomach or by the enzymes in the intestinal tract.


Normally bacteria are considered harmful; but probiotic are good ones responsible for a variety of health benefits. Probiotics and probiotic foods have been used both as therapeutic and preventive supplements for many ailments including GI disturbances and cancers.

The two most recognised ones are lactobacillus and bifidobacteria. The probiotic bacteria found in yogurt belong to the streptococcus and the lactobacillus strains.

Those food ingredients that can promote the growth of probiotics are referred to as "prebiotics". These are not digested by the intestinal tract but stimulate the activity and growth of selective beneficial bacteria in the colon. Cereals like wheat, pulses including soya, onion, garlic, leek, banana and even tomatoes are prebiotics.

A food that is both prebiotic and probiotic is called "synbiotic". This combination can have a beneficial effect on the host by increasing the survival of the probiotics in the intestinal tract.

India probably has the most diverse variety of fermented foods — Idli, Dosa, Dhokla, Khaman, Batura, Kulcha and the traditional dahi. The commonest probiotic foods are fermented dairy products such as yogurt and buttermilk. Sauerkraut or pickled cabbage is an example of a fermented food widely consumed in the West.

Our digestive system contains many millions of bacteria. In a normal intestine there are some 500 different species. They are important for many health functions including those concerned with the digestive system and immunity.


These are mainly the good bacteria and there is a balance between the desirable and the pathogenic bacteria. However, use of antibiotics, a poor diet, alcohol, stress and other reasons can reduce the healthy bacteria and upset this balance.

An adequate intake of probiotic foods helps the desirable bacteria colonise the colon. Antibiotics are the biggest culprit, killing both the probiotic and the disease-causing bacteria. This is why a doctor recommends curds or probiotic supplements with antibiotic treatment.

Probiotics are involved in synthesising and enhancing the bioavailability of some nutrients.
Nutritional benefits

Fermenting the foods produces certain nutrients like an increase in the Bcomplex (folic acid and vitamin B12) and vitamin K. Probiotics also produce short-chain fatty acids, an important energy source for the colon. Some amino acids, growth factors, antioxidants and antimicrobial factors are also produced. Fermentation also destroys certain anti-nutrients like phytates and oxalates that interfere with the absorption of minerals like iron and calcium.

People with lactose intolerance are unable to digest lactose, the milk sugar, leading to bloating, flatulence and abdominal pain and diarrhoea. Consumption of fermented dairy products such as dahi and lassi helps in such cases because the bacteria produce the enzymes necessary to break down lactose. Probiotics also reduce intolerance symptoms such as diarrhoea.

Fermented foods, especially dairy foods, contain certain strains of bacteria that promote the health of the gastrointestinal tract. Prebiotics have also been studied for their beneficial gastrointestinal effects. A synbiotic combination is the best.

Probiotic bacteria prevent the proliferation of the pathogenic (disease-causing) micro-organisms in the gastrointestinal tract. When are ingested orally, such as through fermented foods, they produce antibiotic substances in the intestine, which can destroy the pathogens and also deprive pathogens of nutrients necessary for their growth. Probiotics can also enhance the immunity to microbial pathogens and thus exclude pathogens from the gut.

The microbes in most fermented foods are sensitive to heat and are destroyed by pasteurisation or processing. Some may be destroyed when cooked, which means that when you make idli or dosa it may not necessarily contain all the probiotic organisms originally present in the batter. A cup of yogurt will contain more live beneficial microflora than a cooked fermented product. Fermented dairy products are, therefore, a preferred delivery vehicle for probiotics.

Today probiotics are available as dietary supplements and are used to prevent and treat certain illnesses and also support good health. They provide higher levels of the beneficial bacteria than fermented foods.

Routine therapeutic interventions with probiotic strains may well become a reality soon. It is, however, wise to take them only under the guidance of a doctor. In the meantime go ahead with the fermented foods. They are totally safe and you can have them as much as you can. The fresher the product, the higher the count of good bacteria.

Are probiotic supplements safe? In most cases, yes. In some rare cases, a few side effects such as bloating of the stomach have been reported. However they are not recommended for persons with low immune status, premature infants or neonates.
Other benefits

There is enough evidence to show that administration of selected micro-organisms like lactobacillus is beneficial both in the prevention and treatment of certain intestinal and, perhaps vaginal, infections.

Probiotics may help reduce risk of rotavirus-induced diarrhoea and diarrhoea associated with intake of antibiotics and help treat infantile and, to a smaller extent, adult gastroenteritis.

They may be useful in treating constipation; specific strains of Lactobacilli may suppress the growth of and displace Helicobacter Pylori, which is associated with peptic ulcers.

Some studies suggest that prebiotics improve calcium and magnesium absorption from the human intestine. This may be associated with a change in peak bone density and mineral bone mass and a reduction in osteoporosis. Probiotics are useful in treating food allergy and inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease.

Some probiotic bacteria can break the milk protein casein into smaller units and provide relief from allergic manifestations such as intestinal inflammation. They may also prevent and possibly treat allergic conditions like eczema and allergic dermatitis.

Studies on infants have shown probiotic bacteria help increase Immunoglubulin (compounds that confer the ability to fight infections) levels.

Fermentation of milk is reported to produce certain peptides (chains of amino acids) that inhibit an enzyme which tends to increase blood pressure. Studies on humans indicate that fermented milk could help lower blood pressure when used on a daily basis.


Although the evidence is weak, some studies have reported a modest reduction in cholesterol levels after consumption of fermented milk products for two to four weeks.

Animal experiments have shown that probiotic bacteria reduce the risk of colon cancer. Some epidemiological studies suggest that consumption of fermented dairy products may have some protective effect against cancer of the large colon. Regular consumption of thayir sadam may be a simple way to lower the incidence of colon tumours.

Probiotics may be useful in preventing alcohol-induced liver damage, a common condition in many societies. Studies from Johns Hopkins Hospital in the United States suggest that orally administered probiotics could be superior to the conventional therapy in the treatment of hepatic encephalopathy, a common and dreaded complication of liver disease.

INJURIES IN ELDERLY PEOPLE

Many of us have experienced the anxiety of having to deal with an older member of the family or a friend who incurred an injury as a result of a fall.

Falls among older individuals have been accepted and viewed as unavoidable accidents. But this is not necessarily so. The physical and psychological damage done as a result of the fall can be averted if proper precautions are taken.

Hip, and fracture neck of femur are the most devastating, especially in older women with osteoporosis. Even if the physical injury is not debilitating, the damage to the psyche is tremendous, leading to fear and self imposed exile from any kind of activity which in itself leads to a decrease in health and fitness. It is like a self-fulfilling prophecy — they are afraid they will fall, restrict activity, incur muscle atrophy, loss of strength and balance and therefore fall once again when they try to get around even to navigate the most minor tasks.

Some of the most common causes for falls are: the immediate physical environment; poor fitness levels in terms of strength, balance, gait, agility and speed and reaction time; intake of sedating medication or anything that alters cognition; middle ear imbalance leading to vertigo and dizziness; vision problems; other medical problems like Parkinson’s, Diabetes, Multiple Sclerosis; and improper footwear
Simple modifications

Many of the above factors can be addressed by making simple modifications to the immediate environment and intervention to improve fitness levels, strength and balance

Use antiskid tiles wherever possible. Fix railings in the bathrooms for support. Steer clear of carpets that may be tripped on, sharp edges and corners, flimsy stools and chairs, wet areas, stairs without railings and poorly designed or ill fitting footwear.

Some forms of medication, like sedatives, antihistamines, some antihypertensives can lead to dizziness, postural hypotension and hence a tendency to lose balance.

Older individuals who have been active all their lives, participated regularly in fitness programmes and maintained their weight within the optimum range while also maintaining optimum muscle mass have a lower incidence of falls and injury when compared to the unfit, overweight, person.

This may be one reason to encourage people to keep exercising throughout their lives with alterations in routine depending on the age and their state of health.

An exercise programme for the elderly should include balance and strength besides a basic cardio routine. The "principle of specificity" of exercise indicates that in order to improve the condition of a particular system; the exercise should target that system.

"Use it or lose it". This is the dictum for any aspect of fitness including muscle mass/strength. Deterioration is evident with disuse and sedentary living. A strength training programme that targets the major muscle groups can improve leg and hip extensor strength. This improves ability to walk easier, climb stairs, arise from a seated position in a chair or on the floor or bend to pick up something from the floor.
Strength training

Upper body strength (which tends to diminish rapidly due to neglect) is required to perform simple tasks like lifting, reaching and carrying.

Strength training can be performed using resistance bands that are colour coded to differentiate levels of strength, or with other forms of external weights like ankle weights, wrist bands or even dumbbells under guidance.

Is muscle strength related directly to balance? Not necessarily so, according to some studies. Large bulky muscles and enormous strength do not directly translate to great physical balance.

However, weak muscles definitely render an individual more prone to falling down as a result of poor balance and the inability to support ones own body weight properly. Movements of the body mandate a certain level of equilibrium and the ability to accommodate this shift in centre of gravity.

For instance, getting up from a seated position changes the centre of gravity from a lower to a higher level from the floor, thereby decreasing stability. Adequate balance and strength of leg muscles will ensure that one doesn’t tip over during the process.

In order to improve balance, ensure good vision, absence of a vestibular problems and an optimum somatosensory system. This system enables the body to understand its position in relation to its environment through a sophisticated neuromuscular network. The body is constantly kept informed of its position and contact with other objects like the floor or a chair. If there is any compromise in this mechanism (and it has been found that the sensory system diminishes with age), balance may be affected.
Simple moves

Simple tasks like standing on one foot for as long as possible, standing with feet as close together as possible, with heel to toe, putting on pants while standing up, walking on a straight line, getting up from a chair and walking forward, turning and coming back to sit in the chair as fast as possible can be practiced to improve balance.

Specific tests are available to assess balance, strength and proprioception. Some examples of the tests include one leg balance test, "get up and go" test. These act as guidelines to structure the routine for the individual client.

Please note that older adults with poor balance should never be allowed to exercise or perform any of these moves unsupervised.


Some common causes

The immediate physical environment

Poor fitness levels in terms of strength, balance, gait, agility and speed and reaction time

Intake of sedatives, medication or anything that alters cognition.

Middle ear imbalance leading to vertigo and dizziness

Vision problems

Other medical problems like Parkinson’s, Diabetes, Multiple Sclerosis

Improper footwear

To improve balancce

Stand on one foot for as long as possible

Stand with feet as close together as possible, with heel to toe

Put on pants while standing

Walk on a straight line

Get up from a chair and walk forward

Turn and come back to sit in the chair as fast as possible

TIPS TO COPE ALZHEIMER’S

It was in 1907 that Alois Alzheimer described a devastating progressive disease presenting with memory loss and accelerated ageing; but even 100 years later, we have no real remedy for Alzheimer’s disease which is becoming increasingly common i n India too. Earlier it was thought that Alzheimer’s was "rare" in India; studies reported that multi-infarct dementia caused by reduced blood flow to the brain (very common in diabetics and hypertensives), infections of the brain like TB and cysticercosis, alcoholism and simple malnutrition were responsible for dementia in the elderly Indian rather than Alzheimer’s.

But recent studies, particularly from Kerala, have shown that about three per cent of the elderly over 65 years of age have dementia; and what is more, the majority of them qualify by a process of exclusion, to be stricken with Alzheimer’s disease. Unfortunately, there is no simple test to diagnose Alzheimer’s disease. A PET scan can detect the illness but extremely high cost and non-availability make it a non.-option.

Detection by exclusion

However, a good rule of thumb would be to subject the elderly who present with memory problems to other tests that could detect a treatable problem. A simple vitamin B12 assessment could pick up many treatable, reversible cases; a high BP or elevated blood sugar could point to other treatable causes and so on. By a process of exclusion one zeros in on Alzheimer’s disease. What next?

Pharmacotherpy for the associated behaviour problems such as delirium, anxiety, depression etc helps manage the patient better; but none of the drugs, including Donepezil, which is the one most widely used, are able to reverse the process.

However, there is a lot of evidence building up that nutritional supplementation helps in slowing the progression of Alzheimer’s disease. Though purists who practise only evidence-based medicine may not agree, commonsense dictates that one try out nutritional supplementation when one’s near and dear ones are stricken with the disease. The Net is replete with reports from highly reputed medical journals about the benefits of nutritional supplements. From the food and beverage angle, it seems wise to give these patients green tea and fresh apple juice. These contain anti-oxidants and flavonoids which help stem the progression of Alzheimer’s. Adding a lot of turmeric into curries cooked can help as curcumin present in turmeric has shown benefit in some studies. Supplementing B6, B12 and folic acid is a good idea as these help reduce harmful homocysteine levels; high homocysteine levels have been implicated as one of the causes of Alzheimer’s disease. In many studies, improvement has occurred with omega3 fatty acids. Ginkgo tea or proprietary ginkgo biloba preparations have been found to be useful. Lipoic acid and co-enzymeQ are two dietary supplements which have also shown benefit. Reducing calorie intake has also been found to help.
No side-effects

The plus point is that these simple dietary changes and supplementation are safe; they do not have the side-effects of Schedule-H drugs. In private practice one does not have the where-with-all for pukka scientific studies. But the elders I have seen in my practice have done well with addition of these simple measures. The ones who have benefited most are those with Mild Cognitive Impairment (MCI) rather than advanced dementia. .

Keeping the patient mentally active is crucial. Encourage reading, doing crossword puzzles, reciting slokas, singing... Listening to music that they used to listen to in their youth and middle age can help too, as musical memories are among the strongest.

IS SECOND-HAND SMOKE DANGEROUS ?

"Dad, please do not fill the room with dirty air. Please, give me a room to breathe."

Have you ever felt your child’s agony when you light up?

"I smoke in the balcony when my child is in the bedroom. I avoid smoking in front of my kids." This is the explanation I get from my educated patients.

But while they may smoke outside; how many wash their hands and clean their teeth before they hold their children.

"Okay I should not smoke at home. But tell me, is it possible to go out 20 times a day, especially in this cold?" argues a heavy smoker.

Yes, it is difficult to go out for a smoke every time. But are people justified in smoking inside homes, and exposing innocent people to thousands of poisons with every puff.

Many now work in "smoke-free offices" and since the government has also taken disciplinary action for "smoking in public places", smokers are cautious while lighting up in public places. But unfortunately, the situation at home needs to be addressed.

What is passive smoking?

First of all, we need to understand what passive smoking is. Passive smoke or environmental tobacco smoke (ETS) is a mixture of mainstream smoke (exhaled by smokers); and side stream smoke (freshly generated from a passively lit cigarette); as well as contaminants that diffuse through the cigarette paper and mouth end between puffs.

ETS contains more than 4,000 chemical compounds and is even more carcinogenic than active smoking. Second hand smoke is a major source of indoor air pollution.

Tobacco smoke is an irritant. Some of the immediate effects include eye irritation, headache, cough, sore throat, dizziness and nausea. Short-term exposure to tobacco smoke also has a measurable effect on the heart. Just 30 minutes is enough to reduce coronary blood flow.

Alarmingly, nearly 700 million children, almost half of all children worldwide, live in the home of a smoker. Infants of mothers who smoke have five times the risk of sudden infant death syndrome (SIDS). They also suffer from reduced birth weight and reduced lung functioning.

Effects on health

Passive smoking increases the risk of lower respiratory tract infections such as bronchitis, pneumonia and bronchiolitis in children; and is a risk factor for new cases of asthma.

Passive smoking is also associated with middle ear infection in children as well as possible cardiovascular impairment and behavioural problems. Passive smoking may also affect children’s mental development. A U.S. study found deficits in reading and reasoning skills among children even at low levels of smoke exposure

In the longer term, passive smokers suffer an increased risk of a range of smoking-related diseases. Even a short period can have immediate adverse effects on the cardiovascular system and interferes with the normal functioning of the heart, blood, and vascular systems in ways that increase the risk of a heart attack.

Non-smokers, who are exposed to passive smoking in the home, have a 25 per cent increased risk of heart disease and lung cancer. A major review by the Government-appointed Scientific Committee on Tobacco and Health (SCOTH) concluded that passive smoking is a cause of lung cancer and ischemic heart disease in adult non-smokers
Protect yourself

The UN Surgeon General says that the only way to fully protect yourself and your loved ones from the dangers of second hand smoke is through 100 per cent smoke-free environments. The single best way to create a smoke free environment is to Quit Smoking.

Quitting requires planning, and a strong will. Also, there are effective support systems to help in the process.

A Structured Tobacco Cessation Clinic will definitely help you as it combines intensive psychotherapeutic interventions, along with pharmacotherapy to reduce the withdrawal symptoms.

Nicotine Replacement therapy and pharmacotherapy are also available to make the process easier. New drugs promise greater success in managing the cravings effectively.

Everyone knows smoking is bad for smokers and their families. Everyone understands that cigarettes are smoking people to disease and death very fast. Still they continue to abuse their bodies.

Protect yourself and your family

Make your home and car smoke-free.

Ask people not to smoke around you and your children.

Make sure that your children’s day care center or school is smoke-free.

Choose restaurants and other businesses that are smoke-free.

Thank businesses for being smoke-free. Let owners of businesses that are not smoke-free know that second hand smoke is harmful to your family’s health.

Teach children to stay away from second hand smoke.

Avoid second hand smoke exposure especially if you or your children have respiratory conditions, heart disease, or if you are pregnant.

Talk to your healthcare provider about the dangers of second hand smoke.

Quit smoking.