Take care, foggy season is here again
Dr S.K. Jindal

The beginning of the foggy season is a danger signal for almost everyone but more so for the elderly, small children and the patients with different medical and respiratory diseases. Persistent dry cough is one of the most bothersome symptoms.

Infections of the throat and the lungs as well as the worsening of asthma are frequent. Patients with asthma, chronic obstructive lung disease, for example, chronic bronchitis and emphysema, are the worst sufferers. Smokers, in particular those who suffer from the myth that smoking keeps them warmed up, tend to smoke more and end up with severer problems. Factually speaking, both tobacco-smoke and cold dry air are complementary to each other what is not done by cold air is achieved by smoke.

The two major mechanisms responsible for the bad respiratory health during the season pertain to the fall in the ambient temperature and the inhalation of dry air. The water content of cold air is very low. This is one of the most important factors responsible for respiratory symptoms of a hacking cough and a feeling of choking or constriction in the chest. Dryness of the respiratory tract lining sets a vicious cycle of biochemical and neurological reactions in motion which requires more intense and prolonged management for control.

The cough is not only annoying but also frequently violent and explosive and causes aches and pains in the chest. It often starts with a feeling of irritation or smoke in the mid-chest region and progresses into a severe bout which can also result in vomiting of stomach contents, involuntary leakage of urine and occasionally fractures of ribs. It may be interesting to know that the flow rate or speed of air during such a bout of cough may exceed the air speed of a strong storm. It is, therefore, apt to call this bout as a mini-storm in the respiratory tract.

More serious effects may sometimes happen during a violent episode of cough. Rupture of small blood vessels or capillaries in the eyes and rarely in the brain, transient episodes of fainting or syncope, cardiac arrhythmias, especially in a patient with heart disease and leakage of air from the lungs into the surrounding structures are known to occur.

Wheezing and breathlessness get precipitated in patients with asthma and chronic airways obstruction. These patients, therefore, require more frequent emergency visits, hospitalisation and increased medication. The ill effects are also responsible for absence from schools and places of work, resulting in a significant loss of man-days. All these problems also translate in terms of huge economic losses.

The key to avoid these losses and suffering from illnesses lies in prevention. It is ideal for the highly prone groups to avoid an exposure to fog. This may not be possible all the times. In such situations, the exposure must be minimised and steps undertaken to keep oneself warm and maintain hydration. Adequate clothing and intake of fluids helpful in preserving heat and body fluids.

The importance of hydration in foggy winters must not be under estimated. We all are aware of dehydration and sun-strokes during the summer months. The loss of body water is an equal risk in winters in the exposed populations. Dryness of the skin during this season is common knowledge. The same does happen with the internal organs, especially the respiratory tract.

The only saving grace is the fact that the loss of water during the summers occurs through both the skin surface and breathing. On the other hand there is hardly any loss by evaporation through the skin surface when the external temperature of air is low during the winters. The body is, therefore, able to conserve water. It is mainly through breathing that water is lost. Even smaller quantities of fluids are able to maintain hydration during the winters.

Tobacco smoking must be avoided at all costs and the myth of its providing heat should be dispelled. Smoke contains thousands of irritants and chemicals which aggravate cough and respiratory tract construction. Moreover, smoke is purely a dry aerosol and therefore promotes dryness of the breathing tubes.

Management of symptoms of cough is a contentious issue and requires a lot of patience. Patients with respiratory diseases often need to increase their routine maintenance medicines. Generally speaking, asthmatics should double their dosages of inhaled drugs. This can be done at the very onset of symptoms or worsening of problems. Symptomatic treatments with cough suppressants may temporarily help but cannot be relied upon for long. Infection, if any, needs treatment with an appropriate antibiotic. Addition of other drugs is best left to the wisdom of the physician. Self-medication may result in more problems than their solutions.

Lastly, it must be emphasised that each such episode of worsening may not only result in immediate complications but also has got the potential of leaving some sequalae behind even after treatment. This is especially true in patients with pre-existing respiratory diseases where there is a greater danger of a prolonged or 
permanent damage.

The writer is Professor and Head, Department of Pulmonary Medicine, PGI, Chandigarh.

EYESIGHT
Extreme refractive error: hope lies in management
Dr Mahipal S. Sachdev

Wearing glasses is still a taboo while extreme refractive errors are a handicap to the person concerned. The life of such persons is dependent on their visual aids — glasses or contact lenses. They are usually low on self-esteem and shy away socially.

These high refractive errors, if not detected in time, cause a lazy eye and have less vision which is a handicap for the person. Still there are people with good vision with glasses or contact lenses. These people can enjoy independent life if their refractive error is corrected. That can be achieved with LASIK / EpiLASIK in a number of cases.

Few cases with particularly high refractive errors are not fit to undergo LASIK or Customised LASIK or EpiLASIK because of one or the other reason. They have the option of surgical correction of their refractive error with Intra-ocular contact lens (ICLs) or clear lens extraction ( CLE).

Intraocular contact lenses (ICLs), also known as implantable contact lenses or Phakic intraocular lenses, are a promising new technique with the potential to correct a much wider range of refractive errors than currently possible with lasers. An ICL is the placement of an artificial lens in front of or directly behind the iris, without removing the eye’s natural lens.

This method of implantation has several distinct advantages over the CLE. First, because the natural lens is not removed, the eye retains its ability to accommodate (change focus). In addition, while the ICL is a permanent solution, it can be replaced if necessary with a different power to adjust for changes in the patient’s refractive error.

The Collamer ICL™ is an extra lens, similar to a contact lens. The difference is that the ICL is placed inside your eye, rather than on the surface of your eye. The lens is soft and tiny, much like your natural lens, but does not replace it. The ICL is specially shaped to correct near-sightedness. The Toric ICL™ also corrects near-sightedness with astigmatism. The lens works by changing the way light is focused on the retina.

The ICL and Toric ICL™ are capable of correcting a wide range of myopia, hyperopia and astigmatism without the removal or destruction of the corneal tissue. The ICL is a small, foldable, injectable lens that is inserted through a tiny, 3 mm incision that does not require sutures. The ICL provides predictable refractive outcome and excellent quality of vision due to its placement inside the eye, as well as its optical performance. The lens is made of a superior lens material called Collamer®, which provides unparallelled biocompatibility.

Many people with extreme near-sightedness or far-sightedness are not good candidates for laser vision correction because of their high refractive error. For these people, the clear lens exchange (CLE) may be a wonderful alternative. During the procedure, the surgeon removes the natural, crystalline lens in the eye and replaces it with an artificial intraocular lens (IOL). The technique used for CLE has been performed for decades on cataract patients with excellent results.

Patients considering CLE need to be aware that the operation will reduce but not eliminate their need for glasses. Because the eye’s natural lens is removed and replaced with an artificial lens of fixed-focal length, the eye will lose its natural ability to accommodate — automatically change focus between near and distant points. Patients who undergo CLE may still require reading glasses for close work.

However, for people with extremely high levels of refractive error — particularly those over 50 years who have already lost most of their natural ability to focus at close range — CLE can be an excellent option. In addition, monovision can be used with CLE to allow excellent reading and distance vision without glasses. Once accommodating intraocular lenses are safe, this procedure will offer patients who are ineligible for LASIK a wonderful opportunity to see clearly at near and far without any corrective lenses.

The writer is Chairman and Medical Director, Centre for Sight, New Delhi. E-mail: msachdev@bol.net.in. 

Go veggie to lose weight!

Washington: If you have made a strong New Year resolution to shed those extra pounds then say no to non-vegetarian goodies and simply start munching veggies to get that enviable figure, according to a study by the Physicians’ Committee for Responsible Medicine (PCRM).

PCRM’s weight-loss study, published in September in The American Journal of Medicine, showed that a low-fat, plant-based diet is more effective at helping women lose weight and improve insulin sensitivity than an omnivorous diet.

“The study participants following the vegetarian diet enjoyed unlimited servings of fruits, vegetables, whole grains and other healthful foods that enabled them to lose weight without feeling hungry,” says Dr. Neal Barnard, the study’s lead author.

“Anyone who wants to make healthy changes in the New Year will do well to try a plant-based diet,” he added.

Other scientific studies support the obesity-fighting power of plant-based diets. In a recent study of more than 55,000 Swedish women, Tufts University researcher P. Kirstin Newby and her colleagues found that 40 per cent of meat-eaters were overweight or obese while only 25 to 29 per cent of vegetarians and vegans were. Worldwide, vegetarian populations experience lower rates of heart disease, diabetes and high blood pressure.

The simplicity of a vegetarian diet appeals to people busy with work and family, and many familiar recipes are easy to adapt. At least four studies published in peer-reviewed journals show that patients give the low-fat vegetarian diet a high rating in terms of acceptability, and that the transition only takes about three weeks or less. — ANI