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| HEALTH TRIBUNE | Wednesday, August 8, 2001, Chandigarh, India |
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Snakes are out SPECIAL
ARTICLE PUBLIC AWARENESS
QUESTIONS
& ANSWERS |
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Snakes are out THE snake is a unique reptile which creates fear on the one hand and charm on the other hand. The wishful turning of snakes into beautiful princesses or handsome princes and taking revenge are popular themes of many stories and films. The reptiles have been used as weapons against kings or their heirs by the jealous and the conspirators since time immemorial. Yet a snake is a symbol of love and a god of worship for many. The dichotomy of love and hate for snakes is attributed to the extremes of their behaviour. These are playful and also deadly creatures. Snakebites are generally innocuous but frequently serious and fatal. It is necessary to be careful and cautious. During the last six weeks of the previous month we in the Department of Pulmonary Medicine at the PGI successfully ventilated about a dozen snakebite patients who reported with the threat of imminent death due to respiratory paralysis. This is a large number in a short period by any standard! More patients with other problems, seen in different departments, are quite likely to have got themselves treated. There is a marked increase in the number of individuals with snakebites during the rainy season. Rain water fills the pits, forcing the snakes out of their holes. The increased ground activity results in more episodes of envenomation, especially in bushy and grassy areas. People walking barefoot or lying on the floor are more vulnerable. But this is not always so. Biting may happen indoors and in people sleeping comfortably in the beds! There are over 3500 species of snakes of whom only one tenth are poisonous. Cobra, coral, kraits and vipers are the more common varieties of poisonous snakes found in India. The Indian cobra (Naja naja), in particular, is a fanciful but extremely poisonous snake. The venom of a poisonous snake contains several toxins, enzymes and other proteins which are destructive for different body systems. The bites of different types of snakes may preferentially affect one or the other human system. The bite of a poisonous snake is generally painful. Severe burning, redness and swelling occur within minutes at the site of the bite. Local bleeding and gangrene, nausea, vomiting and general uneasiness appear very soon. Neuromuscular paralysis is the most fearful complication which may occur within the first 15minutes but may be noticed several hours later. The involvement of the respiratory muscles result in the cessation of breathing -- and death. This may happen in a period varying from a few hours to 48 hours. The duration depends upon the site of the bite, the amount of the venom and the age and fitness of the person who is bitten. Bites on face and the trunk are far more dangerous than those on the hands and feet. Pain and other local symptoms are almost negligible in the case of the bite of a coral snake. It is not unusual for the innocent victim to ignore the incidence until more sinister symptoms manifest themselves. Precious time is, therefore, lost before treatment is sought. Multiple fang-marks and other circumstantial evidence should be considered in all suspicious cases. Other than neurological failure and respiratory paralysis, the organs which get involved frequently include the muscles, the blood and the kidneys. The destruction of different blood cells, bleeding from multiple sites and kidney failure may occur within the first few hours. Most victims can be saved if an early detection is made and the appropriate treatment instituted. Unfortunately, there is a long lag period, lack of knowledge (and of facilities) in different treatment aspects. All this is further compounded by superstitions and folk beliefs. Factually speaking, any patient who is reported to survive a significant bite without any treatment must have been bitten by a non-poisonous snake. All such "victims" who wake up from stupor following magical-miracles are likely to have lapsed into "stupor" or "unconsciousness" more out of fear or hysteria than due to snake venom. Several first-aid measures can be tried to reduce the problems of envenomation. Immediate panic reaction must be avoided. Running around may only expedite the absorption of venom by increasing the blood flow. If the bite is on a limb, a lightly tight bandage above the site should be tied. One must be careful not to use too tight a bandage so as not to impede the circulation. Small linear longitudinal cuts should be made on all fang points and suction should be applied for as long as possible — almost up to an hour. Cruciate incision should not be made. All the above-mentioned measures may help to some extent in the first few minutes. They lose their value if more than 30 minutes have lapsed. Anti-snake-venom or antivenin is the most effective method of treatment. It must be administered as early as possible. It is mostly the polyvalent antivenin which is available for use. Specific antivenins against particular types of snakes are neither available routinely nor feasible to use in the absence of knowledge about the biting snake. Anaphylactic reactions may occur following intravenous administration. Caution is important with its use. Respiratory support with help of mechanical ventilation is crucial in the case of respiratory paralysis. Death is imminent once the respiratory centre fails. Results are quite gratifying if respiratory assistance is provided in time. The normal respiratory control system restarts functioning once the critical period of 24 to 48 hours is over and the effects of the venom are neutralised. There are several other interesting medical facts associated with the bites of snakes. Instantaneous death following a bite, as is commonly believed, is most unlikely. It always takes a few hours. Rarely a snake may unknowingly inject its venom directly into a blood vessel which may prove to be rapidly fatal. It is also believed that the bite of a snake, that has recently bitten and killed another person, or one that has been recently fed, is less dangerous. Both of these beliefs are not necessarily true. A snake has enough of venom to intoxicate or even kill more than one person. Much depends on the size of the snake. The bigger the snake, the larger is the volume of the venom injected on biting. It is a myth that a person who is repeatedly bitten by snakes gets poisonous for others. It is theoretically possible that a person occupationally or habitually involved with snakes may get desensitised to the venom due to the production of antibodies in his blood through repeated and minor bites resulting in the introduction of minute quantities of venom. He may still be equally prone to the toxic effects of envenomation following a major bite. Finally, it is the fury of the snake which is hurt that enables it to inject the maximum amount of venom. Remember the Gunga Ram of Khushwant Singh’s ‘‘Mark of Vishnu’’. The King Cobra which had inflicted the deadly bite and left a mark on the forehead of the unsuspecting Brahmin was severely injured and furious. Dr Jindal is Professor and Head of the Department of Pulmonary Medicine, PGI, Chandigarh.
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SPECIAL
ARTICLE Dr Rajeev Gupta BEHAVIOURAL scientists believe that cases of depression are showing a steep rise throughout the country. So are those of the persons who commit suicide. These trends are being reported both in urban and rural areas. Many studies have reported a family history of suicide and the early parent loss in suicide victims. Sociologists have always considered suicides as a social behaviour and tried to identify the social forces that cause suicide. The vulnerable groups are migrants, people living alone, patients with chronic medical diseases and those in certain specified professions. Many individuals are unable to cope with the high degree of competition in business and profession. A feeling of alienation is fast developing in society — more prominently in urban areas. The absence of social values further leads to mental confusion, thus adding to the individual’s vulnerability to the state of depression. What made Bathinda farmers commit suicide? Why are students committing suicide after getting fewer marks than they had expected to get? The increasing amount of life’s stress is being blamed by many sociologists for the rise in the number of suicides. Stress is fast building in all sections of society. In our country, the joint family used to be a major stress absorber. With the breaking up of the joint family system, particularly in the cities, individuals are falling apart. They don’t know whom to depend on during periods of crisis. Stress-prone individuals are unable to combat this fast-developing stress. In the absence of any effective support system and a healthy release mechanism, there is no evidence to suggest that our population is going to experience less stress in the future. A suicidal attempt or suicide is one of its protean manifestations. A new disturbing trend is this: suicidal attempts are being made even by school and college students. Among them, high academic demands, problems in social interaction, career choices, and matters of adjustment with the basic values are building pressure. All of us feel that studies are becoming tougher and tougher and most of the college and university degrees have become irrelevant. Admission to professional colleges is getting increasingly competitive and difficult. The education system has failed to address the changing demands of the present time. The significantly changing trends of suicide in our country are: a rise in suicide among those from affluent families, suicide among old people and an increasing number of suicide attempts by women. Commenting on suicide in old people, Dr Venkoba Rao, a former Editor of the Indian Journal of Psychiatry and an expert on depression, says: “Old people have a lack of social integration in their families. The old ones are like lonely islands”. Many Indian studies are confirming the reported higher prevalence of the depressive illness in our old population. The older generation is facing a high degree of neglect in many families. Suicide among young married women is almost culture-specific. Dowry demands, the problem of adjustment, mental and physical torture by the in-laws and forcing many women to a state of despair and severe depression are to be taken note of seriously. (To be continued)
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PUBLIC AWARENESS Dr J.D. Wig What is chemotherapy? Chemotherapy is the medication used to help keep cancer from returning. It can be given before surgery, after surgery, with radiotherapy, or as a sole mode of treatment. It helps the body to fight cancer. It may be a single-agent therapy or a combination therapy. How does it work? Chemotherapy is designed to kill cancer cells. It travels through the body via the bloodstream, stopping the life-cycle of the cancer cells. As a result the cancer cells die. For which tumours is it used ? It is often used for tumours that are large or aggressive. It is also used for cancers that have spread to other parts of the body. What are the modes of administration? The medication may be taken in pill form or through an intravenous line or both. It may be instilled in body cavities — the abdomen or the pleural space. The duration of the treatment varies. Between treatment cycles the body has a chance to recover. Can chemotherapy cause side-effects? While helping the body fight cancer, it can cause side-effects. These include fatigue, nausea and vomiting, mouth sores, hair loss and an increased risk of infection. Special medication may help control them. Some drugs may have adverse effects on the heart, lungs, the gastrointestinal tract and blood cells. Are there any changes in physical appearance? The changes in physical appearance include alopecia (loss of hair) and pallor. There is gradual resolution once the therapy is completed. What about fever and infection during treatment? Unrealistic fears of fever and infection during chemotherapy may lead to unnecessary disruptions in the family routine. The incidence is relatively low. The source of febrile episodes is generally the patient’s bacteria and not something that one catches from others. Would I be sick all the time? There is a relatively limited time period over which nausea and vomiting usually occur. There have a rhythm in the time of the onset and the duration, and this becomes increasingly predictable with each treatment cycle. Newer antiemetic regimens have provided improved control. What about the threat to parenting roles of women with young families? The quality of life during the therapy may be significantly influenced by the ongoing parenting responsibilities. The ultimate goal of increasing the chance of being cured, and the expected resolution of most toxicities, should be discussed with the entire family. Young children may have much difficulty in adjusting to the changes in the mealtime and activity schedules. Educating parents about how their children may respond to the side-effects brought on by treatment may help them anticipate the emotional and behavioural changes that cananise. Mothers should be encouraged to discuss the anticipated physical changes (like the loss of hair) with children. Fatigue is a universal sequelae of chemotherapy, and a mother may find it increasingly difficult to provide the same level of care during the therapy. An aggressive management of the toxic effects of chemotherapeutic drugs help minimise their impact. Patients and their family members are reassured that these are temporary symptoms. Reassurances help the patient and the family to prepare for the ‘‘bad days’’. The treating doctors have an important role to play and much of the anxiety can be relieved if these are addressed early in the course of the therapy and adjustment is facilitated. Dr J.D. Wig, FRCS, is a tireless clinician, public educator, medical writer, students’ guide, versatile surgeon and Tribune readers’ indulgent adviser. His address: Department of Surgery, PGI, Chandigarh. (Next week: Radiotherapy)
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HEALTH BULLETIN Dr R. Vatsyayan, Ayurvedacharya GILOY
is a well-known name in Ayurvedic medicine. It has references in the Ramayana and the Durga Saptashati. Almost all ancient acharyas of Ayurveda have studied and analysed its remarkable healing properties and called it amrita (nectar). Giloy is famous for its usefulness to man by its conduct of strengthening the immune system and keeping the functioning of various body organs in a balanced state. Due to these unique properties, it continues to get an exalted status and trust and respect from physicians and patients. Known by many names in Sanskrit such as gaduchi and kundalini and scientifically called Tinospora cordifolia, its climber is a common sight in the countryside of tropical India. Growing spirally and clinging on to big trees, and sometimes even to electricity poles, it throws aerial roots, gradually covering the host. The stem and leaves of giloy are of medicinal importance. Its chemical composition consists of various alkaloids, glucocides, fatty acids and volatile oils. Ayurvedic texts describe it as bitter and astringent in taste and heavy, unctuous and hot in effect. It pacifies all the three doshas. Vaidyas accustomed to the practice of pharmacology apply a specific method to derive a starch-like substance from the pieces of its stem which is known as satva (extract). This satva has the same properties but is considered to be cold in effect. The medicinal plant has been described as an anti-pyretic and anti-arthritic, a stomachic, a blood purifier, a nutritive agent and a bitter tonic. It is useful in fever, rheumatism, gout, dyspepsia and urinary diseases. It is also an immuno-modulator, an anti-oxidant, a rejuvenator and a restorative tonic. Being an efficacious drug, and because of its abundant and easy availability, giloy is a household name. Some of its common uses are as under: Chronic and intermittent fever: Its watery extract is known as Indian quinine. Taking 10 to 20 ml of it twice a day is an effective home remedy in non-specific febrile conditions. Rheumatoid arthritis: As an immuno-modulator giloy is well-known for its recuperative role in the treatment of RA. Many acharyas have written that taking one gram each of the powder of giloy and sonth twice a day along with the chosen guggul preparation is a simple and effective treatment of amavata. Gout and raised uric acid: There is no better herb than giloy to lower the raised level of the uric acid. Patients of gout can regularly take 20 ml fresh juice of giloy (stem and leaves). A decoction of dry giloy and gorakhmundi is an excellent adjuvant. Kaishore guggul is another medicine for gouty arthritis. Acid dyspepsia: Take half a gram of giloy satva with a piece of amla murabba daily on an empty stomach. It is also a very good medicine for the burning hand and feet syndrome. Diabetics can take it in one gram of dry powder of amla. General weakness: During convalescence, the use of giloy satva expedites the normal functioning of the body. It is a drug of choice in a number of other problems like the malfunctioning of the liver, urinary tract ailments and sexual diseases. It gives excellent results as an anti-oxidant and herbal rasayana. Giloy is used in countless classic Ayurvedic formulations. Nowadays, more and more multinational pharmaceutical companies are in the race for coming up with new-fashioned derivatives of giloy. But none of these segregated extracts should be confused with or compared to the composite use and broad efficacy of the traditional giloy satva. Dr Vatsyayan is a Ludhiana-based ayurvedic consultant. He is based at the Sanjivani Ayurvedic Centre near the Rose Garden. Phones: 423500 and 431500; E
mail-sanjivni@satyam.net.in
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QUESTIONS
& ANSWERS Q Is tuberculosis a major problem in our country ? Why and how has it been brought under control in developed countries ? Q How does TB spread ? A It is caused by a bacteria, mycobacterium tuberculosis in most of the cases. This is an infectious disease and is mostly spread by cough and sputum. Coughing and spitting by tuberculosis patients release these bacterial which float in the air. If a person inhales the bacteria, he may get the disease. Q TB is rampant in our country. How come most of us do not get the infection ? A It is a common disease, particularly in slums. The probability of developing the disease depends upon the balance between the number of bacteria inhaled and the defence mechanism of the person. In some cases the infection may rapidly go on to the disease; in other cases the defence mechanism may be able to kill the bacteria. Tuberculosis may remain dormant and whenever the resistance of the affected person goes down, the disease is caused. Q My wife has been diagnosed to have tuberculosis of the intestine. What are the organs this disease may affect ? A Almost any organ in the body can be affected by TB — the lungs, the lymph, the glands, the intestine, the bones etc. Other parts are the joints, the brain, the kidney, the urinary bladder, the male and female genital organs and the skin. Q How to suspect tuberculosis ? A TB has varied presentations and it is not possible always to suspect the disease. However, it must be thought of when there is cough for more than three weeks, particularly blood tinged, fever of an unknown origin lasting for more than three weeks, the loss of weight and appetite, exhaustion, night sweats, the presence of glands in the neck, unexplained cessation of periods in a young woman and bone pain — particularly; in the spine. Q My chest x-ray has been suspected for tuberculosis but how can it be confirmed ? A The examination of the sputum is the most important test for the diagnosis of lung tuberculosis. In a suspected person the sputum should be examined at least on three days before clearing the patient. Sputum culture, examination of the stomach wash and the biopsy of the involved tissue are the other confirmatory tests. Dr Bose is Professor and Head of the Surgery Department at the PGI, Chandigarh. |
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Laparoscopic surgery Dr G.R. Verma, FRCS, says: The beauty of this surgery is that the body organs are neither exposed to the atmosphere nor touched by hands. His detailed observations will be published next week. Vitiligo is yielding Dr Gurinderjit Singh, a dermatovenereologist and hair transplant surgeon, explains:Vitiligo is a treatable depigmenting disorder caused by the loss of epidermal melanocytes. It affects all races and both sexes. (Full article next Wednesday) |
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HEALTH BULLETIN
A Unfortunately, tuberculosis is a major health problem in our country and it is estimated that about 1.5 crore patients are at present suffering from it. About five lakh patients die of tuberculosis every year. The spread of TB is linked to poverty, illiteracy, habitational congestion and improper, inadequate and incomplete treatment.