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| HEALTH TRIBUNE |
Allergy:
cure lies in prevention Frozen
shoulder — start early treatment Being
pessimist has its positive side
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Allergy:
cure lies in prevention Seasonal respiratory allergies are common from March to May and also from September to December. This is because of the changes in aerobiology which varies in different geographic regions, based upon climatic and many other factors. In Chandigarh and the surrounding areas, wheat harvest-related allergy cases are found during April-May. People suffer from symptoms of allergic rhinitis and bronchial asthma, requiring hospitalisation in some cases. It affects children as well as adults, people from cities and villages and from all occupations. It is not confined to only those who are involved in agriculture and wheat harvest-related operations. This is because of the allergen found in wheat threshing dust which travels far and wide, based upon wind velocity and direction. This allergen affects the entire respiratory passage through breathing. People suffer from persistent runny nose, and itching in the nose, ears, throat and eyes. There is continuous headache, pain in the throat, red eyes, fatigue and lack of interest in life. These are symptoms of allergic rhinitis. There is continuous cough, difficulty in breathing, breathlessness and wheezing. This is bronchial asthma. These attacks can be severe, needing emergency hospitalisation for days together. The mortality rate is high during the attacks because the treatment is specialised, which is not available so easily. Time is always precious in managing the problem. March-May is the most crucial period for many. The affected children perform poorly in their exams and at times have to lose a year or miss an important entrance test. For the farmer, if this period is spent in sickness it is the loss of an entire year’s earnings. His Baisakhi can’t bring him joy. Pollens were considered a cause for this allergy. We studied the problem in detail and found that the causative allergen is in wheat threshing dust and its associated fungi. We have also purified and isolated the major allergenic fraction which can be utilised for treatment. Treatment of such patients is to be done in a systematic way and it starts in February, the pre-season period. Patients often do not realise this and suffer. Of course, even an acute asthma attack can be handled successfully, but the problem is can be prevented if treatment starts now, in February. Pre-seasonal treatment prevents the disease and improves the quality of life. There is no loss of school-time or work-time. Treatment of April-May respiratory allergy cases is very specialised and the cure lies in prevention. The writer is a Chandigarh-based
paediatrician and allergy specialist.
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Frozen
shoulder — start early treatment Adhesive capsulitis or frozen shoulder is a painful condition which results in a severe loss of motion in the shoulder. It may follow an injury to the shoulder, but may also arise gradually with no warning or injury. Patients of frozen shoulder have difficulty in lifting their arm above the head, reaching behind back for taking out purse, scratching the back, combing the hair, closing the bra-hook, etc.
Who is at risk? Women than men.
The other predisposing factors include a period of enforced immobility resulting from trauma, overuse injuries or surgery. The shoulder joint is a ball and socket joint. If the movement of rotation is not done frequently, it can lead to decreased joint mobility. In earlier times, this disease was not common as people used to do rotational movement of the shoulder joint like taking out water from the well, weaving clothes with charkha, cutting of chari, etc. Sportsman playing badminton, tennis or cricket are less prone where the rotation of the shoulder is involved. The cause for the frozen shoulder is unknown, but it probably involves an underlying inflammatory process. The joint capsule surrounds the shoulder joint like a watertight bag. Inside the bag, there is a small amount of joint fluid that lubricates the joint surfaces and the shoulder moves through a large range of motion. In the frozen shoulder, the capsule surrounding the shoulder joint thickens and contracts. This leaves less space for the upper arm bone (humerus) to move around. Usually only one shoulder is affected, although in some cases motion may be limited in both arms. Frozen shoulder develops slowly, and in three stages. Stage one: Pain increases with movement and is often worse at night. There is a progressive loss of motion with increasing pain. This stage lasts approximately 2 to 9 months. The most effective treatment at this time is an active range of motion exercise. Stage two: Pain begins to diminish, and moving the arm is more comfortable. However, the range of motion is now much more limited as much as 50 per cent less than in the other arm. This stage may last up to 12 months. At this time aggressive joint mobilisation and active stretches can bring more optimal results. Stage three: The condition begins to resolve. Most patients experience a gradual restoration of motion over the next 12 months. Continued range of motion exercises and active stretches should be done throughout the day to improve mobility. Treatment Treatment of the frozen shoulder can be frustrating and slow. Most cases will eventually improve, but it may be a process that takes months. Initial treatment is directed at decreasing inflammation and increasing the range of motion of the shoulder with a stretching programme. Anti-inflammatory medications may be prescribed. An injection of cortisone with long-acting anaesthetic may bring the inflammation under better control. Manipulation can help in breaking the adhesions, which lead to a decrease in pain and an increased range of motion. Stretching and strengthening exercise can reduce pain and inflammation and can increase the range of motion. Simple exercise helps to stretch and keep the shoulder mobile. Overhead stretch, cross body reach, towel stretch, etc, are very useful. If progress is slow, manipulation of the shoulder under anaesthesia is done. This procedure allows stretching the shoulder joint capsule and breaking up the scar tissue while you are asleep. In most cases, a manipulation of the shoulder will increase the motion in the shoulder joint faster than allowing nature to take its course. It may be necessary to repeat this procedure several times. In the experience of this writer, injection of steroid with proper manipulation can relieve pain, which motivates the patient to start exercises to improve the range of motion of the shoulder. The treatment should be started as early as possible otherwise a frozen shoulder can cause an increase in pain and stiffness.
The writer is a
former doctor, Indian cricket team.
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Being pessimist has its positive side Washington: A recent study shows that pessimism may come in handy in many real-life situations where optimists may be overly hopeful. The study showed that pessimists tend to fare better as gamblers and know when to cut their losses rather than let it roll. Researchers say that kind of attitude may also pay off in other situations, such as playing the stock market, reports Webmd. In the study, researchers looked at
the effects of a person’s disposition on their gambling behaviour,
where three groups of college students were given a list of questions
to determine whether they were pessimistic or optimistic as well as
assess their attitudes about gambling. — ANI
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