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| HEALTH TRIBUNE | Wednesday, July 3, 2002, Chandigarh, India |
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The disease of kings and the king of diseases
Childhood asthma
AYURVEDA AND YOU INFO CAPSULE
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New photodynamic therapy to treat age-related eye disease As a person advances in life, the effects of age start showing on the body. The hair dons a coat of silver; one need not pretend being deaf; the smell of good food is irresistible but the teeth are unable to bite and the stomach no longer able to digest. It is difficult to accept these changes, but perhaps most difficult to accept is when watching television becomes like listening to the radio, reading newspaper becomes a futile exercise and the end result of an evening walk is swollen toes as a result of bumping into objects even on a familiar walkway. Whereas cataract, glaucoma, diabetic eye disease, etc. have definite treatment protocols, with good visual outcomes, there is one disease which has since long been a bug-bear for the eye surgeons to treat. This is known as age-related macular degeneration (ARMD). The introduction of a new treatment modality called photodynamic therapy (PDT) promises to bring back the smile on the face of our ageing population. In order to understand the problem, we must have some background. The retina is the internal lining of the back of the eye. It is the sensory layer that generates the image, much like the film in a camera. The macula is the very small central part of the retina that is responsible for all the fine distant and reading work that we do with our eyes. Macular degeneration is an eye disease which involves the macula. The most common cause of macular degeneration is ageing. ARMD is the leading cause of severe, central visual loss in individuals over the age of 50. Up to 2,00,000 new cases of wet AMD are diagnosed in the USA each year. Macular degeneration causes our fine vision to go bad. To start with, objects start appearing distorted and out of shape. If left to progress, this distortion keeps on increasing and ultimately the central portion of our visual field is just a blur. A patient of advanced macular degeneration will have great difficulty in not only reading and doing fine work but may also be unable to recognise his near and dear ones. Macular degeneration almost never causes complete blindness, but instead may cause a loss of all central vision. This central vision loss may make reading and driving difficult or impossible, but usually does not impair the ability to walk or care for oneself. There are two categories of macular degeneration — "dry" and "wet". In "dry" macular degeneration, the main defect is a gradual thinning of the central retina. This problem is usually slowly progressive and at present has no known treatment. The amount of central vision loss is directly related to the location and amount of retinal thinning. The very centre of the macula is called the fovea. If the fovea is involved, vision may be significantly reduced; otherwise vision may remain good for a long time. In "wet" macular degeneration, leakage develops under the retina causing a blister formation that may or may not have associated abnormal blood vessels. Without such vessels, these blisters are generally left untreated. Although vision may be somewhat impaired with blister formation, very useful vision may remain indefinitely. Frequently the blister becomes invaded by blood vessels (a neovascular membrane) and vision will almost certainly deteriorate without treatment. This decrease is due to scar formation in the macula. Wet AMD with a new vessel membrane may sometimes benefit from treatment. In order to treat ARMD, it is imperative to study the condition of the macula. The most accurate test for this is known as angiography. This involves injecting fluorescein dye and indocyanine dye into an arm vein and studying the circulation of these dyes when they pass through the blood vessels of the retina in the back of the eye. Should there be any leaking blood vessels, the dyes will also leak from that site. The abnormalities are captured on a digital scanning laser machine and studied in detail. The goal in the treatment of wet ARMD is to close leaking new blood vessels without damaging the overlying retina, thereby preserving or improving central vision as much as possible. Treatment of ARMD traditionally involved the use of a conventional Green laser (the same as used to treat diabetic retinal disease). Green laser therapy has been proven to a limited extent . However, the green laser, in addition to destroying the abnormal blood vessels, also destroys the overlying retina which we are trying to protect in the first place. This side-effect of the green laser is unacceptable. However, since nothing else was available this was better than doing nothing at all. So, although the patient would benefit from the control of the leaking blood vessels, he would also suffer vision loss due to retinal damage in the area treated by conventional laser. Photodynamic therapy can be equated to a smart bomb. It is a treatment which homes in to destroy the diseases’ blood vessels while at the same time keeping the collateral damage to the minimum. This is achieved with the help of a photosensitive dye called vertiporfin. This dye is first injected into the vein of the patient. This dye had the property to bind itself selectively only to the diseased blood vessels in the macular area. Once the dye is in place, a laser of specific wavelength is used to activate the dye. This leads to the release of nascent oxygen from the dye which disrupts and destroys the walls of the abnormal blood vessels. Unlike the green laser, this is a cold laser and no heat is used in this process. There is no collateral damage to the overlying retinal tissue also. With PDT patients have a unique opportunity to preserve or even restore vision lost to wet ARMD.
The writer is an Amritsar-based eye specialist. |
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The disease of kings and the king of diseases Gout is one of the oldest disease known to humanity. In the past, gout was often known as "the disease of kings and the king of diseases" because it was associated with wealthy men who overindulged in rich food and drink, and formerly it was a leading cause of disabling arthritis. Today it is known that gout is a complex disorder found exclusively in human species that can affect anyone. It is really amazing to know that long before the crystal deposition phenomenon was ever discovered, the name "gout" was coined by the "ancients", based on an intuition that it is caused by the deposition of some sort of toxin or poison "noxa" into the joints "guta by guta" (Latin for drop by drop). In fact, the only improvement by scientific medicine has been to substitute "crystals" in the place of "drops" in the ancient description of aetiopathogenesis! However, "traditionally" the name "gout" is given to the crystal-induced arthritis related to uric acid deposition in joints and tissues. The rheumatic syndromes produced by "other microcrystals" are called "pseudogout". Signs & symptoms In the complete development of its natural history, gout passes through four stages (1) asymptomatic hyperuricemia — when the uric acid level is high but there is no symptom of gout; (2) acute gouty arthritis; (3) intercritical gout — periods between gouty attacks; and (4) chronic tophaceous gout with no pain-free intercritical periods. The symptoms of gout are almost always acute, occurring suddenly — often at night — and without warning. They include intense joint pain. Gout usually affects the large joint of the big toe but can occur in feet, ankles, knees, hands and wrists. The pain typically lasts five to 10 days and then stops. The discomfort subsides gradually over one to two weeks, leaving the joint apparently normal and pain-free. Inflammation and redness — the affected joint or joints will become swollen, tender and red. Some people develop uric acid stones. The yearly risk for the development of urate stone in people with established gouty arthritis is approximately 1 per cent. As the ancients people suspected, and later science has proved, the central chemical culprit of classical gout is uric acid and its salts. Uric acid is the end product of purine degradation in humans. Gout is caused by excessive blood levels of uric acid, a waste product formed from the breakdown of purines. These are substances found naturally in one’s body as well as in certain foods, including organ meats — such as liver, brains, kidney and sweetbreads — and anchovies, herring, and mackerel. Smaller amounts of purines are found in all meats, fish and poultry. Normally, uric acid dissolves in the blood and passes through kidneys into urine. But sometimes the body produces too much or excretes too little of this acid. In that case, uric acid can build up, forming sharp, needle-like crystals in a joint or surrounding tissue that cause pain, inflammation and swelling. The following conditions or circumstances can increase the chances of developing high levels of uric acid or gout:
Prevention There is no sure way to prevent initial or subsequent attacks of gout. However, if you have gout your doctor may prescribe certain drugs to prevent or lessen the severity of future episodes. These drugs need to be taken daily to slow the production and speed up the elimination of uric acid. Keeping uric acid down in the normal range is the long-term key to preventing gout. Self-care Lifestyle changes can’t cure gout, but they can help treat it. The following measures may help relieve or prevent symptoms:
The writer is a Chandigarh-based cardiologist and rheumatologist. |
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Childhood asthma
London
It has long been known that asthma may be triggered by factors such
as exercise, cold air and allergies. However, the apparent link
between asthma and merriment is a new one. For young asthmatics at
least, laughter might not to be the best medicine. |
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AYURVEDA AND YOU Since ancient times and in almost every ayurvedic treatise exercise (vyayama) has been described as an important part of one’s daily routine. The famous Charaka Samhita says that exercise helps clear the channels of the body so that all the tissues are thoroughly cleansed via sweat and other eliminatory passages and are supplied with nutrients. Exercise strengthens one’s body’s musculature by keeping it firm and in shape. Apart from building stamina and stimulating immune response, exercise also helps on mental and emotional level to reduce tension and anxiety, thus promoting a sense of overall well-being. There are many forms of exercise. The first one of the passive exercise which is done through self-massage or massage by someone else. The second or the active exercise is what we normally think of as exercise (walking, jogging, team sports, etc). The third type is known as energy balancing type exercise such as yoga. There is a lot of confusion regarding how much exercise one should do. The Ayurveda says that generally one should exercise only 50 per cent of one’s capacity. For example, if one can swim 12 laps at most, one should stop after six. To avoid undue strain on the body, it advises to stop exercising before the point of heavy perspiration or heavy breathing. By exercising in this way one can increase one’s capacity and endurance slowly. Though applying some checks and balances, slow and easy stretches of yoga asanas can be done by everybody, it is the different constitutional type of the bodies where distinction is made and exercise is prescribed accordingly. As the vigorous exercise of lifting weights, jogging and fast walking is prescribed for "kapha" people, still they are advised not to overdo it. The "pitta" type should stick to moderate exercise like swimming and cycling whereas "vata" people are advised to adopt a mild form of exercise such as slow walking. There are many points which need to be taken care of while doing exercise. The Ayurveda says that one should exercise daily except the period of illness. The best time is the "kapha" period, from 6 a.m. to 10 a.m. If one starts breathing heavily through the mouth or starts perspiring profusely, it is the time to cut back. Stamina should be gained slowly and if one feels invigorated, not fatigued at the end of the exercise period, one is doing the right amount. The correct amount and intensity of exercise varies with age and other conditions. People who are above 40 or with a history of heart disease and hypertension are advised to be more careful and moderate. Those who are already tired, hungry and thirsty or are suffering from any acute illness should postpone their exercise programme. The exercise routine should also be adjusted according to different seasons. The winter season is known to be more in tune with vigorous exercise. Exhaustion and low stamina are the hallmark of summer. It is most important that one enjoys one’s exercise schedule. The atmosphere of the exercise space whether outdoor or indoor is as the type of exercise itself. The precision of the movements and maintenance of the routine demand both concentration and discipline. The Ayurveda says that good exercise helps to reduce stress in the system and promotes longevity.
The writer is a Ludhiana-based Ayurvedic consultant. |
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INFO
CAPSULE BOSTON:
To doctors’ amazement, experimental new medicines are rescuing people from the brink of blindness so that they can read and drive, and sometimes even regain perfect vision. These lucky few are the first beneficiaries of a new category of drugs that many hope will revolutionise eye care. These drugs are designed to stop the two top causes of adult blindness: the “wet” form of macular degeneration, which affects the elderly, and diabetic retinopathy, the biggest source of blindness in working-age people. Vision loss seems halted for most if they take the drugs soon after their symptoms begin.
AP Surrogate children LONDON: Children born to surrogate mothers tend to have healthier relationships with their parents than those raised by their biological parents, a British study published on Monday says. Families with children born in vitro or by surrogate mothers tend to score higher on four aspects of parenting: affection, emotional relationships, maternal quality, and paternal quality, the study found.
AFP Curable cancer cases OSLO:
One-third of the world’s 10 million cancer cases diagnosed each year can be prevented and another third can be cured through early detection and treatment, according to a World Health Organisation (WHO) report. The report on the National Cancer Control Programmes recommended primary prevention and early detection, saying that no country should rely merely on treatment-oriented approaches.
AFP For strong immune system LONDON:
It might now get easier for doctors to test leukaemia patients in danger of getting a relapse, as a study has suggested that a strong immune system is as important as the right treatment in patients who recover from leukaemia, reported the British Journal of Haematology. Helping patients get clinical aid before they relapse could boost their immune system — possibly by a vaccine and ultimately save their lives, the researchers suggest. Dr Mark lowdell, scientists, Royal Free Hospital, said, "Our findings propose that it is the immune response, rather than the chemotherapy per se, which is responsible for continued remission. The measurement of a patient's immune response to their leukaemia when they have completed their therapy may be used as an indicator or risk of subsequent relapse." The researchers conclude that the immune system plays a vital role in keeping cancer at bay.
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New photodynamic therapy to treat age-related eye disease
