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Osteoarthritis: exercise is the best medicine
Of the right to refuse
life-prolonging treatment High blood pressure: relax and laugh Simple remedies
Injuries are deadlier for obese
people
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Osteoarthritis: exercise is the best medicine Osteoarthritis
is accepted as an inevitable part of aging. But a stitch in time can prevent a large number of surgeries undertaken later in life. Osteoarthritis can affect any joint, but it occurs most often in the knees, hips, spine, small joints of the fingers and the base of the thumb and the big toe. In normal joints, a firm, rubbery material called cartilage covers the end of each bone. Cartilage provides a smooth, gliding surface for joint motion and acts as a cushion between the bones. In osteoarthritis, the cartilage between the joints breaks down. This allows bones under the cartilage to rub together causing pain, swelling and loss of motion of the joint. Bone spur may grow at edges of the joint and bits of bone or cartilage may float loosely in the joint space. Patients of osteoarthritis have the following problems:
The causes of osteoarthritis include aging, heredity, obesity, and injuries to the joint, repeated overuse, muscle weakness, etc. An overweight person is more prone to the osteoarthritis of the knees due to an increase in the load. Treatment focuses on relieving pain through medication, manipulation, stretching, taping, preventing the joints from further damage, and helping to stay active. While osteoarthritis can’t be cured, the progression of the disease can be slowed, and sometimes arrested. Apart from treatment, the patients’s education and social support are effective in reducing pain, discomfort and, above all, the side-effect of medicines. Hyaluronic acid exists naturally in the joint fluid and acts as a lubricant and shock absorber. Hyaluronic acid injections directly into the joint in a series of three to five shots can be given once a week. It’s not a permanent solution, but pain relief can last months. It’s especially helpful for those who can’t take high doses of medicines or whose pain hasn’t been managed by the usual pain relievers. In women, especially after menopause, the decrease of estrogen hormone can increase the risk of developing osteoarthritis. Therefore, oral estrogens for hormone replacement therapy are essential. The progression of osteoarthritis may be slow among the people who take higher doses of Vitamin D, C, E or betacarotene. Acupuncture is effective as it reduces pain. Exercise: Exercises build strong bones and slow the progression of osteoporosis. It also tones your muscles and helps to keep the joint, tendons and ligaments more flexible. A programme that combines strength-building and flexibility exercises is a key component of the treatment. Walking:
Walking can result in better functioning, and more you walk, the farther the you will be able to walk. Brisk walking helps in improving the flow of blood to the heart and also in strengthening the leg muscles. Knee joint: Strengthening the thigh muscles (quadriceps) can relieve symptoms of knee osteoporosis.
Neck:
In nutshell, maintaining a healthy weight and regular exercise can slow the progression of osteoarthritis. Otherwise surgery is the
alternative. The writer is a former doctor and physiotherapist, Indian cricket team.
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Of the right to refuse
life-prolonging treatment In
medical parlance, a life-prolonging treatment refers to all treatments which have the potential to postpone the death of patients suffering from incurable and terminal illnesses. Advancements in technology have made it possible to sustain the lives of such patients for several days, weeks or some times years. The subject has raised a whole lot of new questions and dilemmas in not only the medical and legal circles but also among the general public all over the world. The media has often extensively covered and discussed such examples. Legal and medical literature is replete with opinions and judgements on such questions and cases involving legal interventions. Most such examples have emanated from the West, although there have been a few instances in India. With a rapid expansion of the techno-medical scenario promising almost moon to every individual, the demands of people to live long have also increased. But the costs are tremendous and there are wider gaps in the availability of resources, expertise and manpower, infrastructure, awareness and knowledge in providing life-prolonging treatment. This has posed a huge burden on the shoulders of medical practitioners, health professionals and policy makers. Even more basic than all other considerations is the core issue of medical judgement and its legal sanctity to provide life-prolonging treatment. It is a curious turn of events that medical practitioners tend to look to law for each of their action. No citizen, more so a medical doctor, can afford to ignore law. But medical judgements cannot always be surrogated to legal justifications, especially since the law is silent or ambiguous on most of the issues related to the prolongation of life. The legal considerations as well as the medical opinions guiding the judgements and actions of doctors are yet in an evolving phase in this country on the issue under discussion. It is, therefore, worthwhile to look into the examples available elsewhere. Most of the Western medical associations have come up with more clear guidelines to help doctors to decide their course of action. The British Medical Association has given quite comprehensive recommendations on several issues with respect to decision-making on “withholding” or “withdrawing” life-prolonging treatment. Needless to say that the guidelines can only act as an aid in the process of decision-making rather than form a protocol of action. One of the most controversial subjects is related to the decision of patients to refuse a life-prolonging treatment. The law generally gives the right to an individual to decide and choose an option. One is, however, faced with two different scenarios — in case of a dying patient who may have the capacity to make and communicate a decision vis-a-vis a patient who does not have this capacity (for example, because of altered or impaired consciousness). In other words, a patient may be either competent or may have lost the competence to decide. Our discussion here refers to only the adults since babies, children and several other groups may not legally possess this competence at all. Legally speaking, an adult has the full competence to make decisions unless there are doubts on grounds of mental incapability or misconception of reality. Another important issue which has emerged in terminal care is the concept of “advanced directives”. Several sick patients like to leave written (or even verbal) directives expressing their desires regarding resuscitation and terminal care. The real dilemma is for the doctor looking after a patient who has left a DNR (do not resuscitate) or a “refusal to get treatment” order. The competence of such an advance directive is always challengeable. On the other hand, providing treatment against the expressed wishes of a patient may also land the doctor in trouble. The Medical Associations would, therefore, recommend that wherever genuine doubts exist about the validity of an advance refusal, the doctor should act in favour of giving at least emergency treatment and buy more time to decide in consultation with the family and the colleagues. However, no final protocol can be made for the doctors to act. They need to follow the existing cultural and medical practices of the land. Nonetheless, more individuals are likely to assert their rights in refusing life-prolonging treatments. The core philosophy in terminal care remains — Exit with
Dignity. The writer is Professor and Head, Department of Pulmonary Medicine, PGI, Chandigarh.
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High blood pressure: relax and laugh NEW DELHI:
With four in every 10 Indians suffering from high blood pressure, health experts are now advocating alternate therapies like relaxation techniques, dietary control and humour therapy to treat it rather than medicines alone. Around 5.3 lakh Indians die of hypertension-related coronary disease every year and the figure is likely to double each year, medical experts say. It has been found in a study from northern India that incidence of hypertension increased from 3.98 per cent in 1963 to 26.78 in 2000 among men while the cases rose from 6.647 per cent to 27.65 per cent among women. Sedentary
lifestyle and faulty dietary patterns are the major causes which lead to a steady increase in the number of hypertensed patients, numbering around 45 million, especially in urban areas where around 25-30 per cent cases are found as compared to 10-15 per cent among rural subjects. “Physical exercise, yoga, relaxation techniques and nutritional diet help in lowering blood pressure levels and controlling mental and psychological stress. So, these therapies are initially recommended to hypertensed patients,” says Dr Srikant K Reddy, cardiologist, AIIMS. Hypertension cannot be detected at the initial stages and symptoms are visible only when the body organs like kidney, eyes, heart and arteries get affected, he says. Therefore, regular physical and relaxation exercises help in preventing the onset of hypertension or high blood pressure, Dr Reddy adds. As a first step to control hypertension, doctors recommend patients to change faulty dietary patterns which include reduction of sodium chloride salt, intake of colorie-restricted diet, more
potassium-contained fruits and vegetables, says Dr Mukesh Batra, a Mumbai-based cardiologist.
— PTI
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Simple remedies Big houses. Fast cars to get away from homes. Today, we worry about what we eat. Not about what is eating us. We worry about what we wear. Not about what is wearing us out. The style of life breeds stress and strain. These bring disease and despair. Resultantly, the modern man is afflicted with problems. Dr. B.L. Manocha, in his book “Health, Disease and Hope”, suggests simple solutions for a multitude of maladies. At the outset, he asks, “Man and food. Who eats whom?” The opening chapter gives the way to health and happiness. Regular exercise, proper food, healthy habits and freedom from stress are the secrets of good health. This is the first lesson. All need to learn it. In fact, the chapter can be a part of the curriculum in our schools. And the 42 chapters that follow cover almost all matters of concern. From “Acne” to “Warts”. Be it allergy, anaemia, angina pectoris and arthritis or obesity and osteoporosis, the book details the cause as well as the cure. Still more, the remedies are not confined to the homoeopathic system alone. The author has drawn upon his long experience and suggested solutions from different systems. To illustrate: for Anaemia, he gives Iron from the allopathic, “Amla” from the ayurvedic and ferrum metallicum from the Homoeopathic systems of medicine. Such instances abound. Acupressure is useful for the beautification of the face and figure. Prayer can cure the ‘patient.’ The author quotes Dr. Herbert Benson of the Harvard Medical School to say, “Repeating prayer, words and sounds, and passively disregarding other thoughts, many people are able to trigger a set of physiological changes. Mind works like a drug, relieving AIDS symptoms, lowering high blood pressure and curing infertility.”
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Injuries are deadlier for obese
people
CHICAGO: Obese people who suffer critical injuries are much
more likely to die than thinner victims because their overall health
tends to be worse and surgery is riskier, a study said. Obesity —
which has reached epidemic proportions in the United States — can
reduce lung capacity and cause heart problems that can worsen the
outcome of an injury. In a 2002 study of 242 Los Angeles trauma
patients, 63 of whom were obese, researchers concluded that rates of
multiple organ failure and death were significantly higher among the
heavier patients. “Obesity, as an independent risk factor, carries
a nearly six-fold increase in mortality rate,’’ said study author
Angela Neville of Los Angeles County and the University of Southern
California Medical Center, Los Angeles. — Reuters
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Eggs can prevent you from going blind
Sydney: A compound in eggs may help in keeping macular degeneration, one of the leading causes of blindness in the world, at bay, according to nutritionists. Leutine, a plant chemical found in green leafy vegetables and egg yolks, helps protect the eye against damage from ultraviolet and other light, “Leutine is the only compound the body concentrates in the macular region of the eye, and it does that because leutine absorbs blue wavelength and ultraviolet light and so protects that region of the eye from the damage,” US biochemist and nutrition researcher Donald McNamara said, before speaking at a conference in Sydney.
— ANI
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