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| HEALTH & FITNESS |
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Innovations in surgical treatment of heart disease
Back pain: why prolonged bed rest?
Sunrays can play havoc with skin
Wine or beer? Both are bad for blood pressure
A happy marriage is the key to woman’s healthy heart!
Illegible prescriptions
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Innovations in surgical treatment of heart disease
Tremendous technological advancement during the last 10 years has revolutionised the surgical treatment of heart disease. It is a tribute to modern technology as well as the innovation of cardiac surgeons that what was once the most serious surgery is being regarded as a routine procedure. The advent of the beating heart technique (pioneered by this writer has revolutionised the concept of bypass surgery. No longer is heart surgery a heart stopping experience. Now the surgeon is able to perform a precise reproducible anastomosis without taking the help of the heart-lung machine which damaged the patients’ blood and organ systems and also drained the country of valuable foreign exchange, as these machines are imported. The risk of elective major open heart surgery in most good centres is now under 1 per cent. Selected patients in their seventh or eighth decades of life can be offered safe surgical options rather than waiting for the disease to incapacitate them and make them totally dependent on others. With the beating heart technique, the patient is weaned off all life-support machines within a few hours of surgery, is mobilised the next day and in uncomplicated cases can go home on the third day. With a midline sternotomy (the usual approach) there is hardly any pain and only a mild soreness for a couple of days. A number of large trials have confirmed the superiority of surgery in terms of safety, longevity and cost. Further refinements in technique, including the advent of robotic heart surgery, will help us to reach the stage where a visit for cardiac surgery may be like visiting the dentist! The most important aspect of the surgery is that the patient is able to get back to a normal healthy lifestyle. In fact, one of my patients — a serving colonel — got his surgery performed so that he could play all the holes in his golf course (incidentally, he won the running trophy two years after his triple bypass!!). After discharge (generally by the third day) the patient is encouraged to be a part of a rehabilitation programme where he is given graded exercises under supervision. With the blood flow to the heart restored, the patient realises that he is now able to perform activities that he could not even think of before. It is like getting glasses for the first time — you can immediately see much better. Subconsciously, patients with untreated heart disease tend to limit their activity. Steps to recovery Even after surgery we have to really aggressively reduce risk factors, and the patients who have had bypass surgery need to go on a sensible diet, statin drugs for aggressive cholesterol lowering and aspirin therapy. The following is part of the mandatory instruction sheet that I give to all my patients after surgery: A bypass surgery greatly increases the life span and markedly improves the quality of life. However, having had a bypass surgery is not an excuse to "go wild". A few common sense tips will go a long way in deriving the maximum benefit from your heart surgery. Total abstinence from smoking Smoking is the greatest enemy of the post-bypass surgery patient. Smoking hastens the progress of disease (atheroschlerosis) in the native arteries (some of which may have been normal and so not bypassed) and also in the new grafts. In fact, one of my teachers — Dr Mark Shanahan of Sydney, Australia — would refuse to operate on any elective patient till he was committed to giving up smoking. Besides its deleterious effects on the arteries, smoking can cause lung cancer and stomach ulcers. Gradual walking, exercise and return to normal
activity, A return to normal life is the aim of the bypass surgery. Go slow initially. Gradually increasing the duration and intensity of the walk/exercise. Choose an activity that you enjoy and can do easily at least three-four times a week. You can practice yoga but avoid the strenuous asanas initially. A simple regime of daily walking improves circulation, muscle tone and strength. Walk at a speed where you can simultaneously talk too. Avoid lifting or pushing heavy objects for about three months. Your doctor and physiotherapist will have tailor-made an activity chart for you to aid in your recovery. Stick to a prudent diet Some dietary restrictions are mandatory even for a healthy adult. Follow the diet chart given to you. Basically avoid saturated fats (ghee, butter), deep fried food, red meat, egg yolk and overly spicy food. Go up on the consumption of whole grains, fresh fruits and vegetables. Keep hypertension and diabetes under control: These are two silent killers and not just of the heart. Both can be easily controlled by a regular check-up with your primary physician, dietary adjustments and simple medications if needed. Change of lifestyle It’s always a life-changing event to have something like a bypass surgery happen to you. A heart attack or disease needing bypass surgery should be taken in a positive way by considering them a gentle reprimand from the Almighty/Nature to stop abusing our body. Simple lifestyle changes can be of more use than expensive medicines. Finally, the question that is often asked is: Is life-span compromised by this procedure? Life-span is related to the level of heart function, and in patients with normal heart function, we expect an excellent survival chance. If they don’t take to the old bad lifestyle habits they could live to be 80 or 90 years. — The writer is Executive Director and Chairman, Cardiac Sciences, Sigma New Life Heart Institute, Ludhiana.
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Back pain: why prolonged bed rest? In my clinical practice I come across countless number of patients who complain of experiencing pain after prolonged periods of sitting, driving or rest after childbirth (in females). Common occurrence in such individuals is the past history of low back pain due to disc-prolapse or muscle or ligament strain, and the fact of their having been advised bed rest for many days. Prolonged bed-rest causes disc degeneration and muscle weakness, reducing the shock absorption capacity of spine, resulting in the tendency to LIVE WITH PAIN. Low back pain afflicts more than 60 per cent of the population at least once in their lifetime. Advising bed rest to patients is an ancient practice, which is difficult to eradicate. It is a matter of changing mindsets. Innumerable studies now stress the need to remain active and carry out usual activities barring a few cases. Even then a vast majority of medical practitioners hesitate to change their views as regards this continuing practice. Patients with back pain due to varied causes are being advised bed rest for a period of two or three weeks. Doctors too believe that bed rest is a natural healer and routine physical activity, and movements are capable of irritating the spine leading to an increase in the intensity of pain. But prolonged rest can, in fact, cause the loss of muscle strength, cardiovascular de-conditioning, loss of bone mass and weakening and atrophy of spinal muscles, which are so important to stabilise the spine. In some cases, lying in the bed for a long period makes the individual depressed and mentally weak. This, in turn, hampers recovery considerably. In individuals suffering from severe back pain with the inability to walk, it is advisable to give rest intermittently but the patient with the ability to walk should continue normal activities. Activities, which aggravate pain like heavy manual work, lifting heavy weights, twisting, sitting for a long duration, driving, etc, should be avoided. During the first week of acute back pain, physical exercises are not advised but in chronic cases individuals should be encouraged to follow an active exercise programme. Trials have proved that there is no difference in pain intensity when bed rest is advised for two-three days instead of seven days. Recommendations:
The patients who are in job should be advised to return to work as quickly as possible. In the case of patients who suffer from severe back pain with associated low limb (leg) pain and numbness as in disc-prolapse cases, a short period of bed rest with medication in the form of analgesics is the recommended line of treatment. The rationale behind bed rest is to decrease the intra-discal pressure and nerve root irritation. Such cases comprise a small percentage of backache patients. Disc-prolapse cases or neurologically affected patients should lie down supine (on their back) with lower half of the body slightly elevated with a pillow under the knees or remain lying on the side-on position with the knees bent. Patients with neurological complaints—pain/numbness in the leg or foot — should be reassured time and again that their symptoms are usually self-limiting and hence should gradually increase their activities as mentioned below.
Bed rest, if advised in all cases of low back pain irrespective of the cause, can, in fact, prove to be a bane and not a boon. So remember when you suffer from low back pain STAY ACTIVE. — The writer is a former doctor/physiotherapist, Indian cricket team.
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Sunrays can play havoc with skin
Tribune News Service While the best way of protecting your skin is minimal exposure to the rays by wrapping cool cotton on the skin, the option may not always be feasible. Sunscreen lotions, with a good Sun Protection Factor (SPF) and Tan Protection Factor (TPF) are the best alternative to save the skin away from getting damaged. “If the skin is exposed to harmful sunrays for long hours, it can result in acne, allergies, pigmentation, black spots, darkening and early ageing and wrinkling. In extreme cases, the sunrays can cause skin cancer, which is very rare on the Indian skin,” says a dermatologist at General Hospital, Sector 16, Dr Vanita Gupta. Skin specialists recommend that people who move out in the sun should wear cotton full-sleeves, caps and shades, or must use umbrellas, which work as a physical barrier for the rays. “If physical barriers are not possible, the calamine lotion or good sun-screens with a minimum SPF of 15 should be used. For Indian skin, the Tan Protection Factor (TPF) should also be taken into account while buying a sun-screen lotion. This prevents your skin from getting darkened due to over-exposure in the sun,” adds Dr Gupta. Sun burns (severe reddening of the skin), another common problem in summer, too, can be avoided by a regular application of sun-screen thoroughly on the skin, especially 15 minutes before moving out in the sun. Dieticians further recommend that seasonal fruits (the red fruit) should be consumed which act as anti-oxidants and provide a cooling effect not only to the skin but also the entire body system. Doctors say the fruits that have lots of vitamin A like papaya, melon and watermelon and tomato are very good for skin in the summers. “In its synthetic form, Vitamin A is available in capsules which can also be taken,’’ adds the doctor.
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Wine or beer? Both are bad for blood pressure Washington: Red wine might be considered good for overall health, but it raises blood pressure nearly as much as beer does, Australian researchers reported. People at risk of high blood pressure should not switch to red wine in the hope of being able to drink more, they concluded. ‘’A positive relationship between alcohol consumption and blood pressure is well established, but the relative effect of specific alcoholic beverages is controversial,’’ said Renate Zilkens of the University of Western Australia who led the study. Some drinkers may have hoped that red wine’s antioxidant compounds could counteract the effects of alcohol in raising blood pressure. But, writing in the American Heart Association journal Hypertension, Zilkens and colleagues said they found no such effect in 24 healthy, non-smoking men.
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A happy marriage is the key to Washington: A new study conducted by researchers at the University of Pittsburgh and San Diego State University suggests that women in satisfying relationships are less likely to have a dangerous clustre of heart risk factors called the metabolic syndrome than women dissatisfied with their marriage. The team led by Wendy M. Troxel analysed data from more than 400 healthy women who entered the study at ages 42 to 50, with an average age of 47. The women were again analysed after 11.5 years. After controlling for other factors that affect metabolic syndrome, they found that marital dissatisfaction tripled a woman’s odds of having the metabolic syndrome. Widowed women were 5.7 times more likely to have the metabolic syndrome than married women who were satisfied with their relationship. Divorced and single women were twice as likely to have the metabolic syndrome than satisfied married women. “Interestingly, the comparisons between maritally satisfied women and single women were not statistically significant, perhaps because of the diversity of experiences of single women,” Troxel added. — ANI
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Illegible prescriptions
Many physicians have very poor handwriting. However, the consequences of their handwriting should not make us laugh. Who would laugh at the injury or death caused by providing wrong treatment or medicine when the doctor writes a correct prescription but the pharmacist or the nurse cannot read it? Or by the time the pharmacist or the nurse is able to decipher the prescription, the patient’s condition becomes worse. A recent survey conducted by the Institute of Healthy Handwriting concluded that 30 per cent doctors have problems with their handwriting. Poor handwriting can spoil one’s career too like the infamous recent case that received a lot of attention in the US media. A Texas jury blamed a physician’s illegible handwriting for the accidental death of a man who had a heart attack and subsequently died after he was given a wrong medicine. The written prescription was difficult to read. The jury found the pharmacist, the pharmacy and the physician liable for punishment. The doctor had to pay $225 and the pharmacist and the pharmacy $112 each. You must know that the doctor was well known in his profession. Using the computer system may be a solution for avoiding mistakes caused by poor handwriting. However, this is at a stage of development. In any case, doctors will be required to use their handwriting for prescription purposes. — The writer, a handwriting expert, is the pioneer of the Healthy Handwriting Movement in India.
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Go in for a sun-screen with an SPF of 15.