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| HEALTH TRIBUNE | Wednesday, March 7, 2001, Chandigarh, India |
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A prescription for hope Obesity-related
diabetes
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Headache in old age: kill the cause Headache is a common symptom complex in old age. One in every four, out of more than 16000 senior citizens who have visited our Senior Citizen's Health Care Centres at Lajpat Rai Bhavan, Chandigarh, the Day-care Centre, sector 15, Panchkula, and the Senior Citizens' Home, Sector 43, Chandigarh, have complained of headache, besides other ailments. When asked, how they manage this very annoying discomfort, "with one or two dispirins, aspros or tylenol (non-aspirin) a day" is the most common answer> Amazingly, many of them are living with this malady and self-prescribed remedy for a long time. Headache in old age, when it occurs occasionally, may be of no consequence. It may be due to the exposure to the cold morning breeze, when you are out for a morning walk, particularly without a headgear. Or, it may be due to fatigue and muscular spasm after an over-enthusiastic long walk in a gossipy group. The whole body may be stiff and aching. Or it may be due to a common cold and a running congested nose. It may also be a hangover of a couple of pegs too many the previous evening. In such cases, self-medication with analgesics and anti-spasmodics may perhaps be a successful remedy. However, persistent geriatric headache may be a tip-symptom of the iceberg of an organic ailment beneath. This should not be ignored. And no befooling with self-prescribed analgesic remedies. Fifty per cent of frequent headaches in old age may be due to high blood pressure. According to WHOnorms, a blood pressure of 140/90 mm/Hg is within the highest normal systolic-diastolic limits. Initially, a rise in BPto even 150/100 may give a heavy head. It may be relieved temporarily by an over-the counter-available analgesic. Gradually, the old man gets so used to it that a rise in BPto 160/105 may give him little or no headache at all. He has compromised to live with it, with an occasional analgesic. However, such a compensatory stage may not last for a long time. Gradual damage to the cardiovascular system, kidneys, eyes and brain is taking place progressively and painlessly. Ischaemic heart disease, angina, pain in the chest, breathlessness on exertion, a nasal bleed, gradual or sudden loss of vision due to retinal damage, intra ocular haemorrhage, kidney failure, myocardial infarction, brain haemorrhage, hemiplegia, etc, may be the tragic sequelae of uncontrolled hypertension. A high blood sugar (diabetes) and lipid profile are the twin factors closely associated with hypertension and its consequences. Together, they set up a vicious cycle not quite easy to disrupt. A low blood sugar level may also give a severe headache. Like hypertension, an abnormal rise in the intraocular tension(glaucoma, kala motia)is yet another important cause of an intrac-table head-ache, with or without the associated ocular symptoms. If ignored for long and suppressed with the thoughtless use of analgesics, it may result in a gradual peripheral visual field contraction, with the resultant central tubular vision and ultimately a total unilateral and even bilateral loss of vision. Ahyper-mature cataract may also, at times, increase the intraocular tension and glaucoma, when headache may be an associated symptom. The ear, nose and throat (ENT) play an important regional role in the genesis of headache. The nasal passages communicate with a labyrinth of cavities around the nose itself in the prominent bone of the cheek, in the forehead and at the base of the skull. These are respectively named as ethmoidal, maxillary, frontal and sphenoidal sinuses. All together, they are called the paranasal sinuses. These are commonly prone to congestion, inflammation and obstruction due to viral and bacterial infections and environmental pollutants of all types. Rhinitis and para-nasal sinusitis, acute or chronic, are important causes of headache and are often ignored in oblivion. The temporo-mandibular joint, the external auditory meatus, the middle ear and the prominent mastoid bone behind the ear are some more bugbears of headache due to deepseated infection and inflammation. These must be kept in mind both by the patient and the geriatrician during the assessment of headache. Herpetic viral infections are quite common in old age, due to lack of vitality and resistance. The orbital, the maxillary and the facial nerves are their quite common victims, and result in long drawn out headaches, besides other local and general discomforts. As there is a specific cure now available for these viral infections, they must be subjected to a vigorous regime of treatment at the earliest to be effective. No time should be wasted with analgesics only. Chronically dull and at times severe headaches with nausea and vomiting may be the only early symptom of a space-occupying lesion of the brain, due to vascular, neoplastic or infective/inflammatory pathology, in the substance of the brain itself. With ultra-modern imaging, therapeutic and neuro-surgical techniques now available, there is no cause for panic and loss of hope. Periodic migrainous neuralgia or cluster headache, though not so frequent, may start with a boring pain in the eye and spread to the frontal and temporal region. The cluster attacks may last for weeks and months before they subside gradually. ACTScan must be done in such cases to rule out a retro-orbital brain tumour. In a number of elderly patients with chronic pulmonary disease, the persistent headache may be traced to carbon dioxide retention, hypoxaemia, anaemia and intracranial vascular distention and dilation. Most elderly patients are on multi-drug treatment. Their toxicity and side-effects may be a very common cause of headache, usually lost sight of. Most importantly, headache may be the most common symptom of a disturbed psyche under the stress of domestic and economic tensions, aggravated by loneliness, lack of security and fear of impending death. In the worst cases, no amount of analgesics and transquillisers give sufficient relief. Such cases need reference to a clinical psychologist, a psychiatrist and a religious/spiritual person. It is always prudent to investigate the cause of recurrent or persistent headache in old age. A complete blood examination, including sugar estimation, a lipid profile, liver and kidney function tests, a haemogram and a urine examination, may be necessary. A thorough eye and ENT check-up and, where necessary, a CTScan or an X-ray examination may have to be done. Don't suppress your headache merely analgesically. Find out and kill its cause. Dr (Brig)M.L.Kataria, an honorary
consultant, is operating 14 health-care projects in urban, rural and
slum areas of Chandigarh and the adjoining states of Punjab and
Haryana for more than two decades.
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A prescription for hope Dr Ajit S. Puri, says Lord Walton of Detchant (Oxford), is a dedicated, enthusiastic and caring physician. He believes, properly, that clinical medicine is concerned not just with diagnosis and management but also with disease- prevention, and he emphasises the crucial importance of activities concerned primarily with community health. The great British physician recognises the fact that in Dr Puri's writing and clinical work, there is an element of genuine hope and faith. He has written the book, "How to Prevent Common Serious Diseases", in order to draw attention to important principles and guidelines relating to the early diagnosis and prevention of the commoner diseases which afflict mankind. His worry about the possibility of the occurrence of plague in earthquake-ravaged Gujarat is worthy of high regard. Health Tribune greets the direly needed book, which has been dedicated to the memory of Mother Teresa, with much appreciation.
— K.P.S.
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Obesity-related
diabetes The ever-expanding waistline of the population is no longer simply a cosmetic issue; diabetes rates rose a striking 6% among adults in 1999, according to a report from the Centres for Disease Control and Prevention (CDC) in Atlanta, Georgia. Currently, more than 16 million Americans have type 2 diabetes, the type most commonly associated with obesity. The new report, published in the February issue of Diabetes Care, is a sequel to a previous study published in September, which showed that from 1990 to 1998, diabetes rose a staggering 33% among US adults: from 4.7% to 6.5% overall. “This dramatic new evidence signals the unfolding of an epidemic in the United States,” Dr Jeffrey P. Koplan, director of the CDC, notes in a written statement. “If these dangerous trends continue at the current rates, the impact on our nation’s health and medical care costs in the future will be overwhelming,” he warns. “We expect diabetes rates to keep rising for a while,” the CDC’s Dr Ali H. Mokdad told Reuters Health. “We’ve seen a tremendous increase in obesity int he 1990s — that’s why we’re now seeing an increase in diabetes. We are going to see an increase for a while until obesity starts coming down,” he added. According to the 1999 survey, diabetes rates increased in every category examined, including in men, women, and all races and ethnic groups. The rates were highest in African Americans, whose rates increased from 8.9% to 9.9% in 1999. “Obesity is no longer a cosmetic issue, but a risk factor for serious illness,” Mokdad explained. “We need to change our behaviours to reduce many of the chronic diseases we are facing, not only diabetes.” According to Mokdad, “Obesity is defined as an excess of at least 20 pounds in an average person, but it varies depending on height. Losing 10 pounds would definitely decrease the risk of diabetes, along with exercise, he said.” “If we in the US only maintained our weight, event that would have a tremendous effect on public health,” Mokdad added. |
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HEALTH BULLETIN Cell-suicide mechanism A breakthrough may lead to new methods of fighting cancer by making tumour cells kill themselves. The UK researchers showed that it was possible to harness the body's natural cell-suicide mechanism to destroy targeted cells. If applied to cancer, it could provide a way of wiping out tumour cells without causing any detrimental side-effects. Programmed cells death — apoptosis — has a vital function clearing out damaged and dangerous cells and helping to shape tissue development. The new approach employs a well-tried method of cell targeting using antibodies, immune-system substances that bind on to specific protein molecules. Researchers at the Medical Research Council's Laboratory of Molecular Biology in Cambridge, eastern England, fused a cell-suicide trigger, an enzyme called Caspase 3, to an antibody to form a "warhead" that could be guided to selected cells. Faster fibre communication Light pulses transmitted by fibre optics to transmit information can now dispatch the entire Encyclopaedia Britannica from London to New York in one second. These can be of great use in the medical field. The latest advances in the communications revolution will see one single optic-fibre carrying the entire population of the world's telephone conversations (assuming everyone was speaking at once). But, impressive as these advances are, the new transmission system still only uses a tiny fraction of the full potential of optical fibres. To exploit the potential extra capacity, scientists at London's Imperial College are working on a new discovery called the "optical soliton" along with the erbium doped fibre amplifier (EDFA) which energises the information pulses on their way through fibre-optic communications systems. The optical soliton is a short pulse of picosecond duration that propagates along an optical fibre with constant velocity colliding with other
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Dr Sharda Ranjan Answers Readers' Questions Food fats Q How much fat is essential in human diet? A One gm per day. (About one third of a teaspoon) Q You mean man can practically do without fat in the diet! A Yes. Apart from the 1 gm of fat containing essential fatty acids. Each cell of our body needs fat in its outer membrane and a tiny bit inside some cells. Many organs, particularly the brain, have large amounts of fat. We also need "storage fat" for bad times. But we have an excellent biochemical machinery which can convert ingested carbohydrate and proteins (these, of course, are essential) in the diet into any type of fat the body requires. Q If fats are so inessential, why do human beings crave for them? A There are three reasons: (i) Fats make food tasty. (ii)Fats are concentrated sources of energy. Each gm of fat produces 9 calories of energy while 1 gm of carbohydrate produces only 4.5 calories. For living beings with high caloric needs fats are an economical way of eating. Meat-eating animals, which incidentally also eat a lot of fat, like the lion, needs to eat only once in three or four days. Vegetarian animals, like rabbits or monkey, get little fat in their diet. They have to eat every hour of their waking lives. (iii) Fats give a sense of fullness. After a fatty meal, one can think of things other than food. Q What are these essential fatty acids and why are they essential? A To understand this a little biochemistry is unavoidable. A fat is a triglyceride. One glycerol molecule is attached to three fatty acids. Fatty acids have the following general formula — HOOC-CH2-CH2-CH2-CH2-CH2-CH2-CH2-CH3. A lot of -CH2 between — COOH and CH3. The glycerol attaches to the -COOH (carboxyl) end, one glycerol to three fatty acids to make triglyceride which is fat. The carbon atoms in the chain are attached to each other by single bonds most of the time. If each C atom of a fatty acid is attached to the other by a single bond (and to 2 Hatoms in addition), that fatty acid is said to be saturated (i.e saturated with hydrogen). At times, however, there are double bonds between some adjacent C atoms (in which case each C atom of the pair is attached to only one-H atom). Fatty acids with one or more double bonds are called unsaturated fatty acids. If there is only one double bond in a fatty acid, it is called mono-unsaturated; if there is more than one double bond it is called polyunsaturated. The biological activity of a fatty acid depends on: (1) The length of the CH2 chain(short chain, medium chain, long chain fatty acids). (2) The presence and the number of double bonds (monounsaturated or polyunsaturated). (3) The position of the first double bond in the unsaturated fatty acids. The C atoms are numbered from the methyl end and the first atom of C is termed omega, 1, the second omega 2 and so on towards the — COOH end. To be concluded |
