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| HEALTH TRIBUNE | Wednesday, August 14, 2002, Chandigarh, India |
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Menopause:
a serious but surmountable challenge Rabies
phobia: vaccine and vaccination AYURVEDA & YOU INFO CAPSULE
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Menopause: a serious but surmountable challenge MENOPAUSE is not an ailment; it is a stage of life through which every woman has to pass. In simple language it means age-related stoppage of monthly menstrual bleeding, permanently. The mean age has remained 48-50 years despite an increase in longevity. Now the post-menopausal phase covers about one-third of a woman's life. In this region most of the women experience menopause around 45 years of age, and undernourishment may be a cause for the early development. Women who reach the menopause stage prematurely or suddenly due to the surgical removal of ovaries suffer more distressing symptoms as outlined below. The cause of menopause and the associated symptoms is believed to be hormonal changes, having occurred at this age/stage. This stage requires care and attention by the husband and other family members of the woman, besides her gynaecologists, to keep her in good mental and physical health. Supervision of a gynaecologists will save her from a number of health problems and risks. This will also give a peep into the health status of her husband, which may otherwise be neglected. No doubt, this is the age at which a comprehensive look into the health of wealth and husband is required. Neglect can mean an unhappy and uncomfortable living, besides the risk of several serious ailments. It is important to remember that all women need regular check-ups by a gynaecologist, as they approach their middle age (40 to 58). At this age most women start suffering from one or more unwelcome symptoms — hot flushes, mood swings, irritability, lack of concentration, lack of decision-making power, lack of sleep, night sweats, loss of sex desire, pains in bones and muscles, chest pain with or without breathlessness, lack of control on urination, headaches, distention of abdomen, putting on weight, protrusion of tummy and hips, etc. Also menstrual periods become irregular. Other symptoms may be bouts of rapid heart-beat or actual cardiovascular disease, sudden tears in the eyes, loss of libido, crashing fatigue, anxiety, feeling ill at ease, feeling of dread, apprehension, doom, disorientation, mental confusion, disturbing memory lapses, itchy-crawly skin, sore joints, muscles and tendons, increased tension in muscles, rough and inelastic skin, gastrointestinal distress, indigestion, flatulence, gas pain, nausea, depression, hair loss or thinning of hair on head, pubic, or whole body; increase in facial hair, dizziness, light-headedness, episodes of loss of balance, changes in body odour, electric shock sensation under the skin and in the head, increased bleeding in gums, burning tongue, burning roof of mouth, bad taste in mouth, change in breath odour, changes in fingernails; tinnitus; ringing bells in the ears, etc. More importantly, with the advent of the menopausal age, the incidence of actual heart disease and fractures due to bone weakening also rise manifold. Fortunately, there is nothing inevitable about this incidence, since awareness and preventive measures like HRT can prevent a large percentage of the two great bugbears. Prevention: To prevent unwelcome symptoms and serious health hazards, the middle age women have to institute lifestyle and attitudinal changes, well in time. The best time to make first visit to your gynaecologist is at the onset of perimenopause — a few years before the menses stop, but with the onset of some symptoms like hot flushes or even if you have not suffered symptoms but crossed the age of 40. The gynaecologist will take a detailed history of your symptoms, fears, apprehensions, etc and would also examine your person from every angle. At this stage some investigations to rule out certain ailments like breast/genital cancers would be required. This would also be the best time to discover any ailment — diabetes, hypertension, obesity, bone weakness, heart changes, thyroid function tests, urinary changes, sex-related complaints, eye-related problems, early detection of genital and other concerns etc. While starting with the specific therapy, the gynaecologist will give advice about the essentials of diet, exercises, yoga, joining of a self-help group or a menopause club, etc. Her counselling would cover not only physical aspects but also emotional and social aspects. You are welcome to surf the site gomcochandigarh.com for frequently asked questions and their answers. You are also free to ask any questions at menopausehelpline@gomocochandigarh.com. You are welcome to join menopause helpline club without paying any membership fee. The writer is a senior gynaecologist and SMO in charge, Civil Dispensary, Sector 20, Chandigarh. She is also the author of Better Woman's Health after Menopause.
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Rabies phobia: vaccine and vaccination THERE are two types of anti-rabies vaccines available for dogs: (1) nerve tissue vaccine (NTV) and (2) tissue culture vaccine (TCV). The latter being superior than the former in action and safety. Immunisation can be pre-and post-exposure. The first dose of pre-exposure or preventive immunisation against rabies should be started between two-three months of dog’s age and repeated after one month as booster, and thereafter every year. The post-exposure vaccination/treatment as three-six injections as per a dog’s previous vaccination status and should be given in consultation with the canine vet. Not every laboratory is equipped for the diagnosis of rabies. Confirmatory diagnosis is made from the fresh/frozen brain tissues of the animal within a few hours of death by a well-equipped lab. The Central Research Institute (CRI) at Kasauli (HP) is one of those wellreputed centres for the purpose. It is strongly recommended that the dog/animal in question must be confirmed for rabies by the laboratory. Elimination of the predominant animal species (stray dogs in India) along with wild life reservoirs is the recommendation by WHO (World Health Organisation and has given excellent results when the Rabies Control Programme has been implemented seriously at regional and national levels by the respective governments in many countries. A comprehensive guideline for the control of rabies in dogs prepared by the WHO. The treatment could be preventive or curative. The decision should be based on the following facts: (i) If the cause of the bite was provocative? (e.g. disturbed while the dog is eating or accidentally stepping on the tail). (ii) If the suspected dog has been exposed to the bite or saliva or to the nervous tissue of a rabid animal in the past 30-50 days prior to the date of bite. (iii) If there has been or could have been a direct contact with the potentially rabid animal’s mucous membranes or saliva or break in skin even if there was no actual bite. (iv) If there is a history of wild/stray cat, mongoose, etc, visiting the premises or a dog having chased or killed such an animal in the past 30-50 days. (v) The anti-rabies vaccination status of the dog at the time of exposure. The above questions can be common for both vaccinated and unvaccinated dogs. In the case of unvaccinated dog, it is strongly recommended by the WHO that it should be destroyed immediately and confirmed for rabies. And if the biting dog is a pet and vaccinated it should be checked for (i) its recent exposures to any other animal (ii) the cause of bite (iii) extent of the bite/injury and (iv) vaccination status — if the vaccination was given more than six months from the date of bite. If the vaccination status is doubtful — the dog should not be given any post-bite treatment. Instead it should be chained and observed for symptoms. Once suspected, it should be sacrificed and confirmed for rabies. In the meantime, the preventive treatment should be initiated for the victim. If confirmed positive by the diagnostic lab, a complete course of treatment is recommended by a qualified doctor. When a person or a dog is exposed to a dog’s bite, the circumstances should be evaluated, carefully. The evaluation should include the following: (i) The type of dog involved — pet or stray? (ii) The type of wound, a scratch or a bite, deep or a superficial wound? (iii) The vaccination status of the biting dog? (iv) If properly vaccinated, the cause of bite — provocative or no? (v) The history of dog — any contact with other animal suspected for rabies? If the biting dog/cat responsible for the exposure is stray it should be destroyed and immediately submitted for rabies diagnosis and preventive treatment initiated for the victims. It is an irony that no serious attempt has been made to initiate a rabies eradication programme in the country. Instead, people have been scared by different agencies to further add to their already existing myths and misconceptions. When a case is presented with an injury by dog, nobody — the doctor or patient — wants to discuss the cause of the bite. Unfortunately, the myth — that every dog’s bite or contact causes rabies, still exists. In the process, many a times an expensive treatment is initiated and the dog in question is sacrificed. The public in general needs to realise that preventive vaccination of pets as well as semi-pets against rabies is one of the most practical measures besides strict control of stray dogs. It can play a significant role in preventing this dreaded disease, at least to the tolerable levels, if not complete eradication. (Concluded) The author is General Secretary, Small Animal Clinicians Association, Chandigarh.
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AYURVEDA
& YOU R. Vatsyayan HYSTERECTOMY
is the medical term for surgical removal of the uterus. Most hysterectomies are performed as a last resort to save a woman from a number of problems which most commonly include fibroids of the uterus causing heavy bleeding, pelvic discomfort and pain. Endometriosis, uterine prolapse, pre-cancerous conditions and cancer are other problems in which case hysterectomy is more or less considered a necessity. With reasons varying from patient to patient, many times ovaries and fallopian tubes are also removed along with the uterus. Once uterus is separated from the body, the menstrual cycle comes to an abrupt end. Removal of ovaries adds to a more severe type of hormonal imbalance which invariably makes a woman experience certain short-term and long-term health upheavals. Hysterectomy performed during the reproductive life-span acts as a surgical or enforced menopause. Though normal menopause is in itself an important milestone in a woman’s life, its sudden and unnatural occurrence makes the situation more eventful. Ayurveda divides a woman’s life-span both according to the conditions of her reproductive phases and also in accordance with the predominance of various doshas at different age levels. Cessation of the menstrual cycle whether naturally or surgically makes a woman’s entry into the vata period of life though it also severely alters her total doshic equilibrium which corresponds with the inequity of hormones. Old texts indicate these conditions to be dealt as dhatuksheenata which means a stage of general decline of body tissues and their functioning. Many women adopt nicely to the post-hysterectomy changes. Still a large number of them report a spurt of unsavoury symptoms which can be well understood according to the ayurvedic description of body humours. Nervousness, anxiety, tachycardia and sleeplessness occur due to the vitiated vata dosha and irritability, anger, night sweats and hot flushes are a pitta phenomena whereas the aggravation of kapha results into depression, lethargy, numbness and obesity. Many other symptoms of far-reaching consequences are related to the imbalance of more than one dosha. As matters relating to the safety of HRT (hormonal replacement therapy) and long-term dependence upon a bunch of mood altering medicines are still being discussed, ayurveda in this context supports safe and soothing treatment. Many single herbs like ashwagandha and shatavar or their combinations have a proven effect in the treatment of post-hysterectomy weakness, lethargy, body aches and insomnia. Classic medicines like brahm rasayan, mukta pishti, praval pishti, kamdudha rasa not only replenish the calcium deficiency in a most natural way, but, if given along with combinations of brahmi, jatamansi and shankhpushpi, also cure hot flushes and other psychological problems like irritability, anxiety and depression. Advance ayurvedic measures like panchkarma treatment has also a positive role in the treatment of such cases. Various types of massages, shirodhara and sudation therapies calm the tense nerves and strengthen the declining body tissues. Life-style modifications and the adoption of a regular and controlled regime of exercise along with prescribed yoga postures and brief meditation sessions immensely benefit to overcome the customary or episodic emergence of anxiety and depression. The fast changing socio-economic scenario is designing a greater role for women. Many of them are already performing multiple duties like working outside while caring at home for children, husband and elders in the family. Post-hysterectomy blues in no way should be allowed to affect their capacity to work efficiently. In this context the ayurvedic concept of total health, which emphasises on keeping mind and soul happy along with maintaining the equilibrium in the body tissues, needs to be worked out in a right way. The writer is an ayurvedic consultant based at Ludhiana. |
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INFO CAPSULE LONDON:
One nutrient that has managed to establish itself firmly in mainstream medical practice is iron. Even doctors who view nutritional supplements with some scepticism are generally comfortable about firing off prescriptions for this blood-building mineral. Yet, while iron undoubtedly has the ability to do much good in the body, taking it is not without risk: iron
therapy often gives rise to tummy trouble and might increase the risk of certain conditions such as heart disease. Iron is essential for the manufacture of haemoglobin. Contained within the red blood cells, haemoglobin transports oxygen to the tissues, where it sparks life into the body’s metabolic processes. If haemoglobin levels become low — the medical term for which is anaemia — fatigue, reduced capacity for exercise and low moods are often the result. Anaemia can be caused by many underlying factors, but iron deficiency is the most common.
Guardian New drug for cancer WASHINGTON:
A ‘’magic bullet’’ drug that targets a protein active in a wide range of cancers works against not only breast but also prostate cancer tumours, researchers said. The experimental drug, called 2C4, is not designed to cure cancer, but to stop the growth of tumours and give patients a respite. Doctors hope to eventually be able to turn cancer into a chronic but manageable disease with such drugs.
Reuters Father’s liver for son BEIJING:
A Shanghai hospital has successfully transplanted part of a father’s liver to his son. The condition of father and son is stated to be stable after the 10-hour long operation at Zhongshan Hospital in East China’s Shanghai city. Doctors said compared with the transplant of a dead donors liver, the transplantation of part of a liver from a close relative has many advantages like a good quality liver and less chance of rejection.
PTI Drug may restore hair colour BOSTON:
A drug normally used to treat an adult form of leukemia may be able to restore colour to gray hair, according to a team of puzzled French doctors. Of the 133 people they treated with the drug, sold under the brand name Gleevec by Swiss drugmaker Novartis AG, five men and four women who started out with hair ended up with their old colour back.
Reuters New Alzheimer’s scan STOCKHOLM (SWEDEN):
Brain researchers report that by using high-tech brain scans and computer simulations, they are now able to detect subtle, almost invisible changes in brain function 40 years before those changes cause the memory lapses, confusion and dementia associated with Alzheimer’s
disease. Such early detection may be the key to devising effective treatments to prevent the onset of symptoms. The findings were reported at the Eighth International Conference on Alzheimer’s Disease and Related Disorders.
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