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| HEALTH & FITNESS |
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Asthma — a manifestation of respiratory allergy
What to do when there is knee pain?
Mental retardation: a major cause for concern
Chocolates can stop diarrhoea in its tracks
Key to inflammatory diseases unravelled
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Asthma — a manifestation of respiratory allergy
It is somewhat difficult to clearly appreciate the concept of allergy which essentially means an abnormal response of an individual to an extraneous (or sometimes intrinsic) exposure. The response is different or entirely opposite than the normally expected behaviour. In lay terminology, if a benign joke told to a person evokes anger or snider instead of laughter, the response is said to be abnormal (or allergic in medical parlance). Similarly, if a drug (like penicillin or aspirin) causes skin rashes or breathlessness (or asthma), and does not show normal effects, the response is abnormal and the individual is said to be allergic to that drug.
So wide and variable is the spectrum of allergy that it defies all boundaries of anticipation, understanding and assessment. It is for this unpredictability that allergies pose a major challenge for doctors and patients alike. There are several organs and systems in the body which are affected the allergic problems. Allergic disorders of the skin, eyes, nose, lungs and intestines are rather common. There is a growing concern that modern lifestyle promotes the occurrence of allergy. The artificiality of our foods and the environment exposes us to agents which induce biochemical reactions to which the body had been hitherto unfamiliar. The greater the distance from the nature, the greater the chances of allergy. One important manifestation of allergic problems which is responsible for a huge healthcare burden is bronchial asthma. It is not only a troublesome illness, but can also prove to be quite disabling, debilitating and sometimes fatal. Asthma is a common illness of both children and adults. Although it can start at any age, more commonly, it begins in the childhood. About one-third of the asthmatic children may grow out of asthma with the growing age and never develop the symptoms later in life. The other two-thirds of the asthmatic children may either persist with the symptoms or even get worse with age. There is no definite pattern for an individual patient and, therefore, the treatment policy is to consider all asthma as a chronic disease and manage the problem accordingly. Incidentally, the change of season is usually accompanied by an increased incidence of symptomatic asthmatics reporting to doctors for medical advice. It is interesting to note that the actual prevalence of asthmatic individuals does not change with the season. But those asthmatic individuals who have been asymptomatic or stable earlier may get symptomatic and destabilised during these periods. This can be attributed to several reasons which include the change in the environmental temperature and humidity of the air and the increased presence of allergens such as the pollens of grasses, plants and trees. Dusts and smokes of different kinds, as well as the growth of the mites and other insects in the hot and humid surroundings add to the load of triggers which can precipitate and aggravate asthma. In simple terms, one might say that asthma represents an allergic condition which lies dormant unless it gets provoked by a trigger which includes the allergens, infections, dusts, drugs, chemicals and smoking. An attack in an allergic individual may also be caused by physical and/or psychological stresses and hormonal imbalances. Asthma results in spasmodic narrowing of the air tubes, obstructing the flow of air into and out of the lungs. Initially, it is the exhalation of air which gets prolonged and difficult. The patient will complain of heaviness or a block in the chest, presence of wheezing or whistling sounds, cough and breathlessness. In more severe forms of asthma, even the inhalation of air gets obstructed which presents with a choking sensation and a feeling of impending death. This type of severe asthma will require immediate hospitalisation and management. There are many misconceptions about asthma which hamper its effective management. It is neither a curse of God nor an evil disease. It is not infectious and cannot be transmitted to people in the company of a patient. It is not an incurable illness but is definitely chronic in nature requiring long-term maintenance treatment. There are frequent remissions which need careful handling. It does run in families but no definite pattern of inheritance is clearly known. There are no magic cures and attempts to seek such remedies only breed frustration and desperation. Asthma treatment is best given in the form of maintenance inhalers. Inhalational drugs act locally in the lungs and are, therefore, safer and more effective than oral tablets or syrups. It is wrong to believe that inhalers are addictive in nature since the drugs used with inhalers are generally the same as the oral drugs. The inhalers are costlier than the oral drugs, but are better cost-effective in the lung run. Finally, although asthma is an allergic disease, anti-allergic drugs are of little help except in the presence of allergic rhinitis — the runny nose and sneezing. Similarly, desensitisation therapy has got a limited role as of today. Asthma like any other allergy is an inherent or an intrinsic problem. It is best to accept its presence with a positive mind. Fortunately, we have good and effective treatment although none of the available drugs is able to completely cure or eradicate asthma. But one can certainly win over asthma. So did Mark Spitz, who won a record number of Olympic gold medals in spite of his asthma. The writer is Professor and Head, Department of Pulmonary Medicine, PGI, Chandigarh.
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What to do when there is knee pain?
The human body has more than 150 joints, and the joint most commonly afflicted by injury/disease is the knee joint. One of every five accidental injuries is also of the knee.
Children and adolescent complain of pain during squatting, jumping, and climbing stairs due to the weakness of quadriceps muscle. Adults have pain due to the overuse of legs. There is knee pain on prolonged sitting, the presence of swelling over and around the joints and cracking sounds on movement. The elderly suffer knee pain due to osteoarthritis usually around the age of 60 years. Pain is experienced during weight bearing that is generally relieved on rest. The usual symptoms are morning stiffness, swelling, a decreased range of motion, crepitus, etc. Total knee replacement is becoming popular as most of the patients neglect the early signs of arthritis and try to treat it with medication only. The course of events during a cartilage injury when turning suddenly while walking, jogging and playing are hearing of a soft cracking sound in the knee, occurrence of instantaneous swelling or all this may happen after a few hours. The individual suffers from agonising pain accompanied by swelling and discoloration of the knee. There is also a restriction/ loss of motion. The guidelines of treatment should be RICE. R — Rest to the body part concerned. I
— Ice application every two hours till 24-48 hours to reduce swelling. C — Compression with crepe bandage. E — Elevating the affected part for 20-30 minutes. For successful knee injury recovery not only appropriate treatment is mandatory but also regaining the coordination of the joint along with the strengthening of the muscles and ligaments supporting the joint is equally important. Problems arise when an individual tries to revert to normal activity immediately after pain relief. Too soon, too quick reversion to normal activity carries the risk of recurrence of pain. A proper rehabilitation programme is of critical importance and should be adhered to. The aims are strengthening the muscles involved; regaining power; and regaining the coordination of movements. The rehabilitation programme must start at low intensity, increasing gradually to a high-intensity level and should be concluded when the patient is able to run and jump without discomfort. Treatment Anti-inflammatory medicines are effective but may cause gastric acidity. Analgesic ointment increases the temperature by generating heat in the area, making the patient comfortable but has no curative effect. Knee braces are useful but only in the cases of an unstable joint. These may cause more harm than relief in most cases. Shoes should be able to absorb the shock of the body so as not to place load on the ankle and knee joints. Walking or jogging with wrong shoes completely negates the benefits of the activity. Any individual who runs/jogs two to three times a week must ideally change shoes after a span of six months. Certain hindrances to proper and early knee treatment are: Obesity:
One kg of extra weight increases the stress load on the knees by five or six times. One pound weight exerts an extra 25- 30 pounds of weight on the knees. It is, therefore, of paramount importance to reduce weight for effective knee treatment. Wrong surface: Walking or jogging on a hard surface like concrete/road leads to knee/ankle problems. Ideally, one should run on grass or a soft surface. Wrong activities: Jumping activities (playing badminton, tennis) should be avoided. A modification in aerobic activity like shifting to cycling/swimming is ideal. These activities take loads off the knees. The only precaution while sitting on the saddle of a cycle is to keep the height at a level where the straight leg foot reaches the paddle. Keeping the muscles and ligament holding the knee strong can protect the knees. Weak muscles and ligaments place load on the joints, causing pain especially while climbing up and down. The following basic exercises are advisable for knee pain patients: *
Sit with your back against the wall, bend one leg and raise the straight leg a few inches off the ground. Hold it for a count of five, lower it slowly and relax for a count of five. Repeat 10 times and do three sets. *
Sit on the floor with the affected leg in front. Place a rolled towel/pillow under the knee. Push the knee downward by tightening the muscles of the front of the leg. Hold the contraction for a count of 10 and then relax. Repeat 20 times. *
Lie on the stomach with your chin on the floor. Put a weight or stretch band on the ankle and lift the lower leg 6 to 12 inches off the floor and then lower it slowly. Repeat eight times. These exercises can be followed by those like squats, step-up and the strengthening exercise with
theraband. The writer is a former doctor/physiotherapist, Indian cricket team.
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Mental retardation: a major cause for concern
Suresh (name changed) was born with a silver spoon in his mouth, his father being an elite socialite with huge family business. But his fate changed completely after he had a diarrhoea infection.
The child had been dehydrated for a few hours, leading to an extensive electrolyte imbalance. His brain got affected. He was no more a normal boy. Lack of oxygen supply due to severe dehydration left Suresh’s brain partially damaged for life. The paediatrician informed the parents that they would have to be more vigilant about the baby’s growth and development pattern. Suresh and his parents’ world changed in just 24 hours from a happy-go-lucky young couple to that of being guilt stuck in disbelief and reluctant parents to know that their son had reached the level of being categorised as a developmentally delayed/mentally handicapped child. Lack of information on the part of parents, careless and over-strained medical staff, lack of a well-equipped emergency section, etc invariably result in children becoming mentally handicapped. But mental retardation is not a disease, it is a disabling condition of impaired development of the brain. In this condition, the physical, emotional, intellectual capabilities of a person slow down; the development and growth get affected. So the overall skills required for better adjustment are developed at a slow rate, rendering the individual incapacitated in many ways. Limitations in logical thinking, strategic planning and foresight are among the most important deficits. There is no medicine as such to reverse the condition of mental retardation. Only with systematic special training the affected individual can have a better quality of life. Mentally retarded people are not necessarily mentally ill. There is a difference between the two. Mental handicap can occur due to different reasons. The following indicators must be kept in mind: delayed birth cry; the baby not sitting till one year; not walking till one and a half years; not speaking simple words even after two years; not able to dress up by six years age; should be able to read/ study simple stories by age seven or eight years; not able to comprehend social situations by 10 or 11 years age; should be able to systematise his/her own work by age 12 years. The writer is a neuropsychologist at Government Medical College and Hospital, Sector 32, Chandigarh.
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Chocolates can stop diarrhoea in its tracks
Washington: A new study published in The Journal of Nutrition has shown that a chemical found in cocoa beans can limit the development of fluids that cause diarrhoea.
The study by Children’s Hospital and Research Center researchers in Oakland states that cocoa beans contain a large amount of chemicals called flavonoids, which can be used to create natural supplements to ease diarrhoea symptoms. “Our study presents the first evidence that fluid loss by the intestine can be prevented by cocoa flavonoids. Ultimately, this discovery could lead to the development of natural treatments that are inexpensive, easy to access and are unlikely to have side-effects,” said Dr. Horst Fischer, co-author of the study. For more than a year, the scientists tested cocoa extract and flavonoids in cell cultures that mimic the lining of the intestine. All of the cultures reported lower fluid levels.
— ANI
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Key to inflammatory diseases unravelled
Washington: The molecular roots of inflammatory and autoimmune diseases such as asthma, arthritis and multiple sclerosis (MS) have been discovered by a team of researchers led by The University of Texas M.D. Anderson Cancer Center.
They say their findings may point to ways to effectively treat these diseases - if not stop them before they start. In a lead article in the November issue of Nature Immunology (released online on Oct. 2), the scientists report finding a novel type of “T helper” cell they say is the culprit for initiating chronic inflammation and autoimmunity in a variety of body tissues. This newly described T cell — which they call inflammatory TH cells (or THi) — produces interleukin 17 (IL-17), a potent cytokine that researchers have already linked to an immune system gone awry. “We suspected that IL-17 is a player in autoimmune and inflammatory diseases, but we didn’t understand where IL-17 came from before this finding,” says the study’s lead investigator, Chen Dong, an associate professor in the Department of Immunology. “Now we have discovered the source of IL-17 and also have solidly demonstrated that these are the crucial cells that regulate tissue inflammation in autoimmune disease and asthma,” he says. “These findings suggest that shutting down the activity of these THi cells might stop chronic inflammatory diseases from developing in the first place.” He adds that while such drugs are years away from development and clinical trials, agents that block IL-17 could represent an effective treatment, based on these results.
— ANI
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