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| HEALTH TRIBUNE | Wednesday, January 15, 2003, Chandigarh, India |
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High blood pressure as the silent killer Safe way to tackle abnormal uterine bleeding AYURVEDA AND YOU
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High blood pressure as the silent killer Silent waters, it is said, are deep and dangerous. A volcano is also quiet till it erupts with devastating results. High blood pressure is somewhat akin to such a situation and if left undetected and untreated it results in brain attack (stroke), heart attack, heart enlargement, heart failure and kidney failure. Unlike volcano, which cannot be predicted, high blood pressure can be detected in the “silent” phase and if treated adequately, the hypertension volcano can be tamed and prevented from eruption.
What is high blood
pressure (hypertension)?
It is now universally agreed that in the adults if repeated blood pressure readings stay at or above 140/90 mm Hg, the person is diagnosed to be having high blood pressure or, in medical terms, what is called hypertension. In India about 10 per cent of adult urban and about 3 to 5 per cent of the rural population suffers from high blood pressure. As there is a rapid transition from the rural to urban areas and more and more adults are changing from the traditional agricultural society to the industrial set-ups and the habits of fast foods, rich in calories, sugar, salt, fats and alcohol, combined with a lack of physical exercise, the prevalence of hypertension in India is fast rising. We thus have several million people to be taken care of from this malady of silent killer, but not necessarily with medicines, as lifestyle modifications go a long way in the prevention and treatment of high blood pressure. There are marked fluctuations in blood pressure records over 24 hours and, therefore, several readings are taken before labelling a person to be suffering from high blood pressure.
The symptoms
High blood pressure is generally a silent disease, specially when it has developed over a long time. Many times it is picked up during a routine check-up or during examinations by medical boards for jobs or insurance policies. In fact, the disease of high blood pressure is not really so silent. The person having vague symptoms like headache, heaviness in the head, impairment in vision, disturbed sleep or lack of it, loss of concentration in work, heavy breathing during work or climbing stairs, must get his/her blood pressure reading taken. If a person has one or more of these symptoms and one blood pressure reading is normal, the doctor must take more frequent readings to ascertain that at least three readings at three different times remain below 140/90 mm Hg before declaring the person as having normal blood pressure. The reverse is more important, i.e. if the first blood pressure reading taken in the doctor’s office or in the hospital is high, one must get it rechecked preferably in homely surroundings and a friendly atmosphere. If these readings are normal, this is not a case of high blood pressure but what is called as “White Coat” effect or “White Coat” hypertension denoting thereby that the person’s blood pressure went high in unfamiliar surroundings, especially the doctor’s office. Children are often afraid of the doctor’s name but it appears that some adults also become very apprehensive when they face the doctor and that makes their blood pressure rise. Fear, anxiety, anger, apprehension, tense and hostile surroundings often tend to raise blood pressure. One should not ignore symptoms like headache, heaviness in the head, shortness of breath, impaired vision and lack of sleep, as these may be due to high blood pressure.
The causes
Unlike diseases like typhoid, TB and malaria, where we know the precise cause of the disease and, therefore, specific drug treatment, in the case of high blood pressure no cause is known in most cases. But we do have effective drugs and other means to treat this condition. When high blood pressure is found in children and young adults, there is generally a causative factor like some abnormality in the major blood vessels of the body or those of the kidneys or some tumours in or around the kidneys. In such situations blood pressure can be permanently cured by ballooning methods or by surgery. In adults, however, such cases are rare and by and large there is no detectable cause or causes of high blood pressure (primary hypertension). Certain risk factors, however, when present make the person more prone to get high blood pressure. Some of these risk factors are: (1) overweight; (2) sedentary way of living and lack of physical exercise; (3) excessive alcohol consumption of more than two ounces of whisky in a day or equivalent of that in other spirits; (4) excess salt intake; and (5) repeated exposures to stressful situations at work or at home. Cigarette smoking, a major risk factor for heart attack, adds fuel to fire when combined with high blood pressure as it leads to death and disability from heart attacks and stroke.
The complications
Treatment of a disease which generally has no symptoms is often very annoying to the patient to continue taking pills when he/she has no trouble. The treating physician, however, has to explain to the patient that if the blood pressure is allowed to stay high it will result in brain damage (stroke), heart failure, heart attacks, kidney failure and sudden death. A great deal of patience and perseverance is required on the part of both the physician and the patient in the treatment of high blood pressure as it is a long-term affair and some drugs have undesirable side-effects too. The writer is Chief Cardiologist and Medical Adviser, Batra Hospital and Medical Research Centre, New Delhi.
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Safe way to tackle abnormal uterine bleeding Menorrhagia is a common problem affecting women in the age group 35-45
years. Technically, menorrhagia is defined as heavy periods lasting longer than seven days, or a blood loss more than 60- 80 ml (4 - 5 tablespoons approximately) or presence of clots or when there is a chance of staining clothes. Heavy periods are not just an embarrassment, they can seriously disturb a woman’s lifestyle, cause anaemia, ill health and low morale. The most common cause of heavy periods before menopause is hormonal imbalance, seen in 40% of patients. Other causes include benign growths (fibroids, polyps ), cancer and pre-cancer conditions of uterus, infections, medical disorders of blood, liver, kidneys, or the use of certain drugs like anticoagulants, steroids, and chemotherapy. Traditionally, the first line of therapy in women with no obvious or detectable cause of abnormal bleeding (dysfunctional uterine bleeding - DUB) is medical. The drugs include estrogens, progestins, Danazol, GnRHanalogues, antiprostaglandins like Mefenamic acid, Ibuprofen, antifibrinolytics like Tranexamic acid and SERMS like Orniloxifene. These remedies have their own side-effects and contraindications. They need to be given repeatedly over long periods of time. Symptoms of heavy bleeding usually return once medication is stopped. They are less effective than surgical measures and can decrease blood flow in only 25-80 % of cases and other than GnRHa, cannot stop the bleeding altogether. Drugs are often prescribed for women who desire future childbearing. Dilatation and Curettage (D & C) is not really considered as a treatment of heavy bleeding because only the top layer of the lining of the uterus is removed. It provides only temporary relief for, at the most, few cycles or no relief at all. D&C is mainly for diagnosis for which too it is not very effective because it can miss fibroids or polyps since it is a blind procedure. Surgical options for the treatment of DUB include hysterectomy (removal of uterus) and two different forms of endometrial ablation (destroying the lining of the uterus from where the bleeding actually occurs). With the advancement in minimally invasive surgical techniques in the eighties, hysteroscopic Trans-Cervical Resection of the Endometrium (TCRE) had been the choice of treatment for patients who wanted to avoid hysterectomy. Under the direct view of the endoscope in the uterus (hysteroscope) the lining of the uterus is destroyed with an electrosurgical loop or roller ball or laser. Although other hysteroscopic operative procedures are highly successful, TCRE is associated with a mortality rate of 0.02 % and serious complications in upto 7% of patients like heart failure due to fluid overload, bleeding, infections or perforations. To overcome the disadvantages and risks of established treatments, less invasive and patient-friendly procedures were developed like the Uterine Balloon Therapy (THERMACHOICE), which has been in use worldwide for several years. Using heat energy up to 87 degrees C for eight minutes, the lining of the uterus is effectively destroyed up to a depth of 3-7 mm which is enough to decrease or stop heavy bleeding without any major risk. The Thermachoice Uterine Balloon Therapy system consists of a 4.5 mm diameter catheter with a latex balloon at one end which houses a heating element. The control unit automatically monitors, displays and controls the preset pressure and temperature inside the balloon and the duration of treatment. For safety, the device automatically deactivates when pressure rises or falls below a particular set limit. Success of any procedure is determined by the results, complication rates, safety and hospitalisation. Uterine Balloon Therapy ablation is as good as TCRE, with heavy periods becoming normal or less in about 90% of the cases, with better results in older patients. Failure to decrease heavy bleeding is seen in 7-10% patients, especially those with very large uterus. It is extremely safe, with minor complications in 3% patients like fever, pain and infection which respond well to simple measures. The Uterine Balloon Therapy has been approved by the FDA (Food and Drugs Administration), is well tolerated under sedation and local anaesthesia without general anaesthesia requires only day care hospitalisation for four or five hours with fast recovery and return to normal activity in two days. This procedure can even be done in those patients with certain medical or surgical disorders in whom hysterectomy may be risky or hazardous. Thus the Uterine Balloon Therapy (Thermachoice) has several advantages over hysterectomy , other surgical ablative procedures as well as medical treatments. It is well worth a try in patients of abnormal uterine bleeding with no obvious cause for the bleeding other than hormonal imbalance and when a patient does not want any future pregnancy. Hysterectomy should be the last resort in these patients. By this approach many unnecessary hysterectomies can be avoided with considerable benefit to the patients. The writer, a former consultant at the PGI, Chandigarh, can be contacted at telephone number 0172-663871 (clinic from 10 a.m. to 4 p.m.).
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AYURVEDA AND YOU Dr R. Vatsyayan After spending a full day at his factory, Sushil Jain, a workaholic businessman, returns to his home late in the evening. A little later as he settles down to take his usual late night dinner, his mobile rings. After a few minutes’ talk, when he is in midway through his meal, Jain’s landline phone starts buzzing. The caller continues the conversation for a couple of minutes covering a wide range of topics which include business and politics. By the time he returns to his meal the scenario is changed. It is his wife who is fretting and fuming, whereas the food has turned cold and the appetite vanished. We have really come a long way from the days when food was valued as god and eating the meal was considered a duty equal to any sacred ceremony. Jain’s case is a classic example of what pulls and pressures of modern day have done to our lifestyle. Today, executives, businessmen, service class people and even schoolchildren have plenty of time to do all other chores. But they find it difficult to get 15 minutes of respite for taking proper food, the life force of all living beings. Thousands of years ago ayurvedic texts, while giving broad guidelines to lead healthy and purposeful life, dealt with the topic of food and nutrition at great length. Here are some valuable food habit tips from these ancient texts, and it seems there could no better time than the present one to recall and follow these rules. What to eat
The first thing is to choose food that is fresh, usually cooked, warm, unctuous and easy to digest. It should be seasonal and not excessively spiced. Avoid eating the food which instinctively repels the mind, is stale, too heavy, over-fried, processed or refined. The meals should include a balanced combination of carbohydrates, proteins, fats and minerals. Ayurveda specifies food according to the individual constitution of a person and directs him to study and adopt what is suitable for him.
When to eat
One should take food only when the previous meal is digested. It leads to proper appetite, purified eructation and proper manifestation of urges of flatus, urine and stool. To achieve this, it is best to establish a regular eating routine, and the habitual use of restaurants and late night dinners should always be shunned. Take special care to keep your dinner lighter and there should be a gap of two hours before going to bed.
How to eat
Immediately before eating, one should wash one’s hands. Chewing a thin strip of ginger marinated with lime juice and rock salt awakens the taste buds. Sit in an easy posture and concentrate on your meal only. No TV, telephone, newspaper or conversation should distract your attention. Observe silence while you eat. Chew each morsel slowly and attentively many times. Feed all senses by eating food which is attractive to the eye, tasty, aromatic and pleasing in the texture. Avoid anger, excitement or any other type of emotional outburst while taking the meals. Moderation in diet is the golden rule as it leads to a happy and perfect digestion. Never succumb to the temptation to over-eat and also avoid taking things of a single taste too often. Acharya Charak has given a very simple rule: divide the stomach capacity into three parts. One part of it should be filled up with solid food, the second part with liquids and the third part should be left empty for body humours to function properly.
Signs of proper digestion
Ayurvedic scholars believe that food taken in the morning should, get digested in the evening and evening meals should show the same results by next morning. It is said that if you take food in proper quantity, there should be no pressure on the stomach and in the sides of the chest and no excessive heaviness in the abdomen. Besides feeling relief from hunger and thirst, one should also be feeling comfort in breathing, standing, sitting and walking. The writer is a senior ayurvedic consultant based at Ludhiana. Phones: 2423500, 2431500. Email-sanjivni@satyam.net.in
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INFO
CAPSULE Washington: A new drug called tamoxifen will now be able to help breast cancer patients to conceive by IVF, claims US fertility experts. In the study, published in the journal of Human Reproduction, researchers from New York’s Cornell University report the first IVF pregnancy to result from the use of tamoxifen as an ovarian stimulant.
ANI
Getting drunk on water
Sydney: Psychologists at Victoria University in New Zealand have revealed that the feeling of being intoxicated or drunk is partly in the mind. They found that a person’s memory gets worse even if they believe they are drinking alcohol when they are actually having water. ANI
Gene variation linked
to beer bellies
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ANI
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