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| HEALTH & FITNESS |
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It’s good to exercise at workplace
How HIV positive suffer psychologically Booze as bad for health as smoking No anti-depressants during pregnancy,
please
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It’s good to exercise at workplace The most common excuse one comes across for not exercising regularly is the paucity of time, which is not always true. In metropolitan cities where one has to cover long distances to reach one’s destination, this might be justified but in a city like Chandigarh this is not a problem. If industrialist Anil Ambani can take time out to exercise from his busy schedule, why can others not do so? Most of the neck and back problems occur due to the wrong posture while sitting in office for long hours. Working on computers for long hours too puts undue pressure on the neck and back muscles. Using the spinal cord like a spring is the most important cause for back pain. People working in factories and offices in Japan do stretching exercises during their lunch break which helps in relaxing muscles and preventing neck and back pain. Blood circulation is important to increase the energy level, which helps in improving the concentration and efficiency. It is, therefore, necessary to do five minutes’ exercise during office hours. One can climb the stairs or take a brisk walk in or outside the office during lunch break. Efficient an employee are an asset to any organization. Hence having physically fit employees is a more economical viable option as it increases the efficiency of an employee manifold. People sitting at the desk most of the day feel stiff and tired. By doing stretching exercises for 5 to 10 minutes, one can relax the muscles, reduce physical tension and feel fresh. The following stretching exercises help relieve muscle tension and stress. Neck exercises a. Shoulder shrug: Lift shoulders upward towards the ears. Hold for a count of five and relax. Repeat eight times. b. Chintuck: Sitting upright, place hands under the chin and move your chin in and return back. Repeat eight times. c. Neck stretch: While sitting, bend your left arm and place it behind your waist. With right hand reach the top of your head and cover your left ear. Gently pull your head and tilt your right ear towards the right shoulder. Do it five times. Repeat it on the other side. Stretching of forearms Straighten your arms with the palm pointing forward. With the other hand pull your palm towards the body. Feel the stretch at the front of the forearm. Now with the palm towards the body, pull the wrist and feel the stretch at the back of the forearm. Hold for 10 seconds. Repeat three times. Upper back Most people, while sitting at the desk, hunch forwards leading to the building of tension in the upper back muscles. In order to relieve this tension, grasp your hands behind the back and lift them as high as possible without bending the elbows. Mid-back stretch
Lower back a. Place your hands on the lower back and slowly push the hip forward and look up at the roof. Feel the stretch at the lower back. Return to the neutral position. Repeat this six times.
Leg exercises a. Wall sitting: Stand up against a wall. Bend the knees and gently sit back on to the wall. Feel the stretch at the front of the thigh. b. Sitting on the chair, keep one foot on the floor, raise the other leg several inches off the ground. From this position raise your leg 10-15 times. Repeat it with the other leg. Strength training can be done in the office with the help of resistance bands or with push-ups against the wall. If a person had a tough day and wants to relax, he should take frequent stretch-brakes and breath deeply to overcome the stress. Globally, people with overpacked work schedules, where more and more time is spent in offices, are provided with gym facilities at work places. The Chandigarh Deputy Commissioner has indeed set an example by starting a gymnasium for the employees. Taking precaution is better than spending huge funds on medical treatment. — The writer is a former doctor/physiotherapist, Indian cricket team.
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Medical care: the humanitarian aspect Medicine has not always been a path to privilege. A clinician is engaged in the service of the sick and accepts the burdensome demands that are continually made upon with the thoughtful management of all problems of a sick person and understanding human nature. The care of the patient thus does not end with the correct diagnosis and prescribing treatment. Those he cannot make well, he comforts them and is capable of infusing into his patients optimism and courage. Management thus is concerned not only with the sick person, but also the entire family. Thoughtful management can make the effects of an incurable illness less devastating for both the patient and the family. Managing a patient’s problems is also reflected in the welfare of the family members. A clinician spends a great amount of time communicating with the patients and the family members. The doctors have been trained to deal with individuals, take personal responsibility and to do their best for each patient in the prevailing environment. Unhappiness in the medical community is an international problem. Certain universal aspects of modern medicine may underline much professional unhappiness. A doctor with the pressure of work and without adequate help from the support systems can no longer give all his patients the love, sympathy and individual attention. Because of the ever-increasing workload, the time spent may not be sufficient for a patient to develop a relationship with and trust in the physician. Patient’s expectations are rising and they are led to expect that the advances in technology will be rapidly implemented. Patients expect enhanced services, including rapid access. This is compounded by unrealistic expectations about the power of medicine and technological advances to solve the problems. The job of doctors thus has become more difficult and emotionally demanding. They are painfully aware that they cannot live up to people’s expectations. They are being asked to do more with less. The performance has come under increasing scrutiny all over the globe. The doctors are not selling healthcare. Health is not reproducible from one individual to the next. Patients who have the same disease may require different approaches to treatment. A doctor provides judgment that is based on knowledge and experience, and therapy that is based on the patient’s symptoms, clinical findings and the results of various investigations. A large part of the practice of medicine is a human interaction between the physician and the patient. There is a discrepancy between what patients demand for a doctor and what the doctor and what the doctor can actually accomplish. The changes in relationship with patients and society are important. There has been a perceived loss of trust, coinciding with a feeling that the media has become much more hostile. The blame game by the media and the public is unhelpful, as is the present tendency, to seek simple solutions to complex problems. Considerable unhappiness is caused by the many non-medical roles doctors now have to play — too many hours, too many patients, and a burnout due to physical and emotional expectation. The profession needs to respond to the challenge of being judged not only on the quality of care provided but also on its humanitarian aspect — encourage a fuller understanding between patients and those who care for them. A physician has to specify the impact of treatment on a patient’s lifestyle and emotional state. This will make patients more comfortable and will have an impact on patient satisfaction. In the absence of this, patients underestimate the side-effects of a particular from of treatment and this leads to dissatisfaction with the care provided. The hospital authorities and the government need to improve the support systems to help the physicians desire to serve their patients and help them get better. The attitude of the medical profession must also change to meet the public’s expectations. Medicine has become more effective but the advances have brought their own risks. Openness and transparency are the key for a relationship between the patient, his or her family and the doctor. The public and the media also have to understand that doctors are struggling everyday to protect the patient against the odds. A doctor even under the pressure of work today needs to give all his patients love, sympathy and individual attention. Effective communication will help in building greater trust and improving results. —
The writer is Professor and Head, Department of General Surgery, PGI, Chandigarh.
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How HIV positive suffer psychologically Chandigarh: Discrimination and HIV\AIDS have come to co-exist in our society. But more than the societal dogmas, it is the effect of the discrimination on the psychology of the HIV positive patients that has become a matter of concern for psychiatrists. A study undertaken on 60 HIV positive patients (30 males and 30 females) by a team of psychiatrists at the Medical College and SSG Hospital, Vadodara, has shown that the more an HIV positive person is discriminated against, the higher is his chance of developing psychiatric morbidity. Statistically, the study has shown that 81.25 per cent of the HIV positive patients who are discriminated against have the higher association of psychiatric morbidity than those not discriminated against, as their psychiatric morbidity co-existence is found to be 53.5 per cent. Although it should not come as a surprise for many that a majority of the positive patients (53.3 per cent) in the study face discrimination after they are told about their HIV positive status, the disturbing fact is that a major chunk of patients, 31 per cent, face discrimination at their homes itself. “I feel death would be better than this. My family members give me food and money for treatment but every word is spoken with hatred. They make me feel I am a disgrace and burden,’’ disclosed a 26-year-old male patient. Workplace discrimination is extremely high for the patients as 37.5 per cent of them revealed to have faced some sort of discrimination and harassment at their workplace. “A 28-year-old patient was fired from his job as soon as the employers came to know that the patient was HIV positive,’’ notes the study. Even private hospitals and nursing homes were accused of subjecting the patients to discrimination as 18.8 per cent of the patients revealed to have not been treated properly by the doctors at private clinics. One patient said that he was “discharged from a private nursing home immediately after the doctor got to know of his status.’’ The team of psychiatrists, including Dr Rameet Kaur, Dr Gurpreet, Dr Rekha and Dr Porus R. Vesuna, also say that patients on their own go into a state of shock, despair and disbelief after they are told about their status. “The most common state of mind is sadness, fear, shock and despair. But the male patients especially have a strong feeling of guilt for transferring the infection to their unsuspecting spouses. Most of them even doubted the authenticity of the diagnostic reports when they were told the truth about the HIV positive status,’’ notes the study.
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Hot flashes: a bane of women Hot flashes are a common symptom of menopause. They are uncomfortable, embarrassing, and highly disruptive to a woman’s life at work. A sharp decline in estrogen levels, as seen during the menopausal zone - sometimes caused by medications or surgical removal of the ovaries - is responsible for this distressing symptom in women. However, because estrogen is known to stimulate the growth of breast cancer cells, replacing the declining hormone is not a simple option for women with this symptom. Hormone replacement therapy (HRT), a combination of estrogen and progesterone, has recently fallen out of favour as a long-term solution for the prevention of heart disease and osteoporosis in women, but it still can be used for short-term menopausal symptom relief in women who are cancer-free. Even so, women and their physicians have tended to proceed with caution, weighing both the risks and the benefits. In the following discussion, let us share what is new, what is working, what is hot and what is not. The recommendations given below are equally relevant for women whose hot flashes are a consequence of menopause and those whose symptoms stem from cancer therapy. Are hot flashes natural? They are a common symptom for many women as they reach menopause, which makes them seem “natural.” As estrogen levels drop, a woman’s blood vessels may expand rapidly, causing her skin temperature to rise. They’re especially prevalent, by the way, in breast cancer survivors. Doctors actually create hot flashes in these women when they treat them with tamoxifen, a type of hormonal cancer therapy. Chemotherapy puts pre-menopausal women into an abrupt menopause, which causes hot flash troubles that aren’t “natural” at all. How serious are hot flashes? They’re not dangerous, but they can be extremely disruptive. A woman can get a flushing episode at a business meeting. She may start sweating right in the middle of a personal interaction and may have to remove her coat or sweater. Night sweats are a bigger problem. Women wake up wet. Their bedclothes are wet. Sometimes they have to get up and towel off, and then they can’t get back to sleep. If this happens two or three times, they become very tired and can’t respond well to daytime challenges, because they are sleep-deprived. Those women who have a history of breast cancer or are at high risk for developing the disease are not good candidates for estrogen replacement. Are there any other hormonal treatments these women can use to ease their hot flashes? We’ve had good results with megestrol acetate (Megace), a hormone that stimulates appetite at high doses, but at very low doses it decreases hot flashes by 85 per cent. In fact, megestrol acetate seems to work as well as estrogen. However, it’s still a hormone, and there are lingering concerns about giving any hormone to breast cancer patients. What non-hormonal treatments researchers are looking at? They have looked at clonidine (Catapres), a blood pressure medication that decreases hot flashes by about one hot flash per person per day, which isn’t much, but it’s more than a placebo. But clonidine has its own set of side-effects, such as drowsiness, dry mouth, sleep problems and light-headedness, plus it’s not especially effective. The researchers have also looked at vitamin E, which, like clonidine, decreases hot flashes by about one hot flash per person per day. The nice thing about vitamin E is that it’s cheap. It’s readily available. It’s nontoxic. But it’s not good enough. Some doctors have started prescribing antidepressants for hot-flash relief. What is the research telling us about these medications as a weapon against hot flashes? They have studied the effects of three different doses of the antidepressant venlafaxine (Effexor). The lowest dose was 37.5 mg a day, the next highest was 75 mg and the highest was 150 mg a day. The placebo reduced hot flashes by about 27 per cent over a four-week period. The 37.5 mg dose of venlafaxine decreased them by about 40 per cent. And the two higher doses reduced them equally by about 60 per cent. They also looked at fluoxetine (Prozac), another antidepressant, and found that it significantly decreased hot flashes too - not quite as much as venlafaxine. —
The writer, a senior gynaecologist, is the author of “Better Health After Menopause”
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Booze as bad for health as smoking LONDON: A new study conducted by researchers at the Centre for Social Research
on Alcohol and Drugs at Stockholm University suggests that alcohol causes almost as many deaths and disabilities globally as smoking or high blood pressure. According to the BBC, the study published in the Lancet points out that alcohol is a factor in about 60 different diseases. The researchers led by Professor Robin Room found that 4 per cent of the global burden of disease is attributable to alcohol, compared to 4.1 per cent to tobacco and 4.4 percent to high blood pressure. “The evidence we have is that if you increase the drinking hours then you get more trouble with alcohol.” He said the potential effects on health were not taken into account when changes to licencing laws were considered. The report looks at diseases including cancers of the mouth, liver and breast, heart disease and stroke, and cirrhosis in which alcohol can play a role. It also highlights the role of alcohol in car accidents, drownings, falls and poisonings. Alcohol is also linked to a proportion of self-inflicted injuries and murders. Using data on the alcohol cost and UK alcohol-related mortality information, they estimated that increasing the price of alcohol by 10 per cent would produce a 7 per cent drop in deaths from cirrhosis of the liver in men and an 8.3 per cent drop in deaths in women.
— ANI
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No anti-depressants during pregnancy, please Washington:
A study published in the latest issue of The Lancet has revealed that babies exposed to anti-depressants called Selective Serotonin Reuptake Inhibitors (SSRIs) in the womb may be born with a withdrawal syndrome. The researchers said that doctors should avoid or cautiously manage the prescribing of anti-depressants to pregnant women with psychiatric disorders. SSRIs were introduced in 1988 and are becoming the gold standard treatment for depression and a wide spectrum of other mood and behavioural disorders. The presence of a withdrawal reaction to SSRIs is now widely recognised and several cases of neo-natal withdrawal syndrome associated with the drugs characterised by convulsions, irritability, abnormal crying and tremor have been reported. Emilio Sanz of the University of La Laguna, Spain along with his colleagues screened the WHO database of adverse drug reactions for cases of neo-natal convulsions and neo-natal withdrawal syndrome associated with the use of SSRIs. The database contains information from 72 countries and holds over 3 million records dating from 1968.
— ANI
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