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| HEALTH & FITNESS |
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Why palliative surgery for advanced illness? Take to swimming this summer More fat than proteins in chicken! Garlic can save you from hypertension Stress helps fight flu
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Why palliative surgery for advanced illness? The term palliative care was coined by a Canadian surgeon in 1975. Palliative medicine achieved a speciality status in the UK in 1987. When we speak about palliation we have two main goals: How do we let our patients live longer, and how do we let them live better? The definition of palliation is “to palliate, affording relief, not cure, to reduce the severity of symptoms”. Palliative surgery thus is an invasive procedure used when the major goal of treatment is relief or the prevention of symptoms to improve the quality of life for patients with non-curable illness. The World Health Organisation defines palliative care as the active and total care of patients whose disease is not responsive to curative treatment. The American Academy of Hospice and Palliative Medicine has defined palliative care as providing care focused on alleviating suffering and promoting the quality of life. The time they have left living with their advanced disease can be less painful and more enjoyable. The points which need to considered when we talk in terms of palliation are: are we talking about the control of symptoms or are we talking about a non- curative operation? A clear delineation of these is important and it will influence the way we approach the patient. Patient selection is the key. The goals should be tailored to each patient. When considering the palliation of symptoms, complexity and risks of treatment must be evaluated. When deciding the type of modality it is important to consider the life expectancy of the patient. Consideration for palliative intervention include safety, efficacy, patient comfort, resolution of symptoms, postoperative complications, and temporisation for alternative interventions. Assessing the symptoms is very important. We can alleviate some symptoms —- pain, an obstruction (that blocks a necessary body function —- the food-pipe, stomach intestine, bile ducts, etc), infection, ulceration and bleeding. Fatigue, depression and anorexia cannot be altered with a surgical procedure. Symptoms need to be assessed carefully. The patients must have a realistic and mature attitude towards what is an inevitable life process. Surgical resection need to be looked at carefully and critically. It is best to have a compassionate surgeon who can create some empathy with the patient and the family, and decide the palliative operation to prevent bleeding, obstruction or infection. Surgical procedures for palliation include resections, functional repairs, drainage and reconstruction. Palliative surgery is an important component of comprehensive multidisciplinary cancer care. These palliative procedures may need to be performed on an emergency basis —- palliative procedures for the obstruction of the small or large intestine, stomach, food-pipe or the urinary system; bleeding (stomach, intestine, kidney), fluid accumulation (abdomen, chest or pericardial cavity), compression (spinal cord), pain control, or prevention of local complications (ulceration). Treatment by stents and bypass surgery of obstructed bile ducts give equal palliation of jaundice and itching. Treatment by laser, stent or cryotherapy of obstruction or bleeding of the lower part of the intestine are the treatment modalities that can give effective palliation. Barriers to a comprehensive palliative surgical care are: cognitive (limited formal education or training in palliative care and its definition), psychological (giving up, taking away hope, lack of control), social (financial -burdensome or futile interventions, morbidity and mortality culture), and other problems (feeding in advanced illness, chronic pain management, communication). The risk is justified if patients can be made comfortable. The influencing factors for decision-making for palliative surgery include the patient, the family, and the doctor —- known as “the palliative triangle”. The intent of palliative care is to select the best treatment that maximises the quality of life while minimising the risks and harm. The central theme is a clear understanding between the patient, the surgeons and the family of both expectation and the ability to fulfil those expectations. Palliation of complications demands the highest level of surgical judgment. Conclusions about specific procedures should be based on the potential benefits that can be achieved. Providing optimal palliative care for the patient with advanced cancer is a complex and challenging process. The best palliative care involves treatment planning in accordance with the patient’s wishes, allowing symptoms to be maximally treated, life-span to be optimised, and hospital stay to be minimised. Excellence in palliation is a rewarding endeavour, given the potential positive impact this can have on the patients suffering from advanced cancer. The need for this type of treatment is greater today. The writer is Professor and Head, Department of General Surgery,
PGI, Chandigarh.
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Take to swimming this summer Entering a swimming pool leads to a quick recovery from fatigue. This is due to the impact and pressure of cold water, which enhances blood circulation in a muscle. Unlike other aerobic activities like running, cycling, jogging, etc, swimming does not put excessive load on the joints and muscles because as one enters the swimming pool, there is significant reduction of body weight due to the buoyancy of water. Swimming has certain definite advantages:
Floating is facilitated by the ratio of an individual’s weight to the weight of a equal volume of water. The specific gravity of water is one and if a person’s specific gravity is greater than one, he is liable to drown and if it is less than one he can float. The specific gravity of an individual depends on the specific gravity of fat, bone and muscles. Since the specific gravity of fat is less than that of bones and muscles, women and obese people float better than a lean muscular person. Swimming is an ideal exercise when performed with a correct and good technique. Arms’ stroke should be rhythmical and strong. The arms should enter water in a slightly bent position with the fingers closed together. After the arms enter water pull through the body’s midline in order to propel the body forward. In a free style if the thumb of a hand enters water first and crosses the body’s midline it is likely to cause shoulder injury. In order to prevent shoulder injury, the free style arm strokes should be akin to climbing a ladder with fingers entering water first. These should also be accompanied by equal body rotation to avoid injury. Your body must rotate at least at 40-50 degrees equally in both directions. The other most significant factor is the breathing technique used in swimming. The ideal way is to turn the head to one side by bringing the ear close to the shoulder while inhaling. Exhalation should be done under water in the middle till the end phase of the stroke. Generally, an attempt is made to breathe in and out while the head is kept outside water. This leads to less intake of air resulting in early fatigue. Once breathing is mastered, swimming becomes easy and enjoyable. Performing exercises in water not only improves cardiovascular fitness but also plays a major role in rehabilitation after sports injuries as the heart rate during deep water exercises is approximately 15-17 beats per minute which is lower than the rate while exercising on land. The swimming equipment required are a swimming suit, goggles to protect eyes and flotation cuffs for the beginners. People suffering from skin infections, fever, throat or ear infections, should refrain from swimming. EXERCISES Swimming is a sport that requires both muscular strength and endurance. People who are not strong can have shoulder and lower limb injuries. It is, therefore, advisable to undertake the following exercises so as to avoid injuries and improve the technique: Biceps curl: Stand with your feet hip width apart. Hold a dumb-bell in each hand with arms at side. Bend your elbows and slowly lift both weights towards shoulders. Return to the starting position and repeat it for it 10 times. Triceps dips: Sit on a stool. Hold weight in one hand at the side of the buttock and lean forward as far as possible. Extend the arms back from a bent-up elbow position. Return back and repeat it 10 times. Shoulder press: Be in a seated position. Lift weights from your shoulders up above your head, keeping the palms of your hands facing forward 10 times. Squat: Stand with feet and shoulder-width apart, holding a dumb-bell in each hand. Keeping weight over heels, slowly bend the knees and lower hips until the thighs are parallel to the floor. Stay for 20-30 seconds. Repeat it five times. Calf raise: Step up on a stable platform or stairs enough for your heels to hang off the edge. Hold a dumb-bell in one hand and place the other hand against a wall for support. With your back straight, rise on the toes of feet. Hold for a second, then return to the original position. Do 10 to 12 repetitions, then switch legs. Crunch: Lie on your back with knees bent, feet flat on the floor, and hands behind your head. Slowly curl your upper body towards your legs until your shoulder blades are 4 to 6 inches off the floor. Hold for a couple of seconds. Do 15 repetitions. As it is true with most sports in India, swimming remain neglected. Swimming pools, coaches and equipment are scarce. Even in Chandigarh there are only a few good swimming pools. The existing pools are overcrowded leading to the infection of ears, eyes and skin. Most countries give priority to this sport as it improves physical fitness. All schools and colleges are provided with good swimming pools because of this factor. The writer is a former doctor/physiotherapist, Indian Cricket Team.
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More fat than proteins in chicken!
LONDON: Non-vegetarians who include chicken in their diet in place of red meat to make it healthier may soon have to reconsider, with scientists at the Institute of Brain Chemistry and Human Nutrition at London Metropolitan University revealing that chickens bred in farms contain more fat than protein due to their dietary intake. They said that due to high energy food intake and lack of exercise, chickens today accumulate nearly three times more fat in their bodies than they did 35 years ago. Prof Michael Crawford of the university feels that intensive farming methods were responsible for the rising levels of obesity. “Chickens used to roam free and eat herbs and seeds. They are now fed with high energy foods, and even most organic chickens don’t have to walk any distance to eat”, The Telegraph quoted Professor Crawford as saying. “Our physiology is adapted for eating wild food. You just wouldn’t find anything like these chickens in the wild”, he added. While comparing the fat content in the chickens, he found that 100 grams of supermarket chicken today consists of 22.8 grams of fat compared to just 8.6 grams in 1970. and there was also a 30 per cent decline in protein levels, as compared to the earlier period.
— ANI
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Garlic can save you from hypertension
WASHINGTON: Researchers at the University of Alabama, Birmingham, have revealed that daily doses of allicin, the active metabolic in garlic, protects against severe chronic pulmonary hypertension in rats. According to the researchers, the human form of pulmonary hypertension often leads to cardiovascular complications such as right heart hypertrophy and failure and is frequently lethal. Dr David D. Ku, who conducted the study with his colleagues, said the findings confirm an earlier study by the team that garlic protects against a less lethal form of acute pulmonary hypertension in rats. It also goes a step further by pinpointing the effective ingredient in garlic and demonstrating that it achieves its protective effects through vasorelaxation. During the course of study rats were given a single dose of monocrotaline, a well-established mechanism for inducing vasoconstriction of the pulmonary arteries. Within three weeks, half the rats had developed chronic pulmonary hypertension. But the other half, which had received the hypertension-causing drug, didn’t experience any such increase, because their diets also had been supplemented daily for three weeks with small doses of allicin. And it was the allicin, not the garlic itself, that protected the supplemented rats from developing the disease. — ANI
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WASHINGTON: A new study conducted by researchers at Ohio State University suggests that stress may enhance the body’s ability to fight the flu. The researchers found that short bouts of intense social stress improved the ability in the mice to recover from the flu by boosting the production of specialized immune cells that fought the virus. These special immune cells are called T-cells and are part of the immune system’s memory response. T-cells “remember” specific infectious agents and can launch future attacks against these intruders. — ANI
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A noble tradition of surgery is a comprehensive philosophy of care, which can incorporate the bounty of technological advances at our disposal and commitment towards alleviating the suffering for a time. Palliative surgery is an important part of the total range of care offered to patients with advanced illness, and the need for this type of treatment is greatly justified.
Swimming with exercises in the pool integrates all broad aspects of fitness, including speed, stamina, strength and flexibility. It is advisable to shift from other aerobic activities like jogging, running, cycling, etc, to swimming which is more enjoyable during the coming summer months.