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| HEALTH & FITNESS |
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Cancer survivors: tips to lead a better life Breastfeeding ensures better health Knee injuries —
conservative or surgical treatment? Bullying makes kids obese Of “wrong-site” surgery
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Cancer survivors: tips to lead a better life Cancer has been transformed from an acute life-threatening illness to one that results in a long-term disease-free survivorship. This has resulted from screening, early detection tests, and highly effective treatment options. It is this growing segment of the cancer-survivor population that needs attention. Clinicians should be concerned about post-treatment survivors so that they lead an enjoyable life. The responsibility of the cancer surgeon does not end once the treatment is completed. The diagnosis of cancer prompts spontaneous changes in health behaviours among cancer patients and survivors with significant changes in diet and physical activity. A substantial number of cancer survivors spontaneously initiate positive behavioral changes, while many do not, especially those with less education and the elderly. There is a greater need to consider how best to coordinate health-promoting strategies among cancer survivors. Cancer survivors look for ways to prevent a recurrence of their cancer and to enhance the quality and length of their lives. The growth in the absolute number of cancer survivors is forcing cancer surgeons to play a central role in setting the cancer survivorship agenda through clinical practice, research and health policy activities. A coordinated strategy is needed for providing follow-up medical care to the growing number of cancer survivors who represent the success of cancer treatments. The role of the patient has changed dramatically, because adjusting to a chronic illness is very different from adjusting to an acute illness. Good adjustment to a rapidly advancing illness involves accepting the gravity of the situation. The patient must maintain self-esteem and play the occupational, social, sexual and psychological roles flexibly and fully. Coping with cancer means coping with death and issues of confronting mortality; accepting higher than normal levels of dependence while attempting to maintain autonomy; being disabled by the disease and treatment and flexibly trying to overcome limitations; coping with disfigurement and changes in appearance that affect self-esteem and role function; and, finally, living with the disruption of life plans. It has been found that psychological distress was lower among the cancer survivors with healthful behaviour — tobacco abstinence, routine exercise, and consuming an ample amount of fruits and vegetables. Smoking cessation is of paramount importance for primary prevention and is essential also for preventing recurrences among those with tobacco-related carcinomas- lung, head and neck, cervix, urinary bladder, and kidney. Cancer survivors are at greater risk of developing secondary cancer and other diseases. Problems in these survivors may result from cancer and its treatment. Recurrent disease and second cancers account for a large number of cases. A second cancer may result from genetic predisposition or immunodeficiency, risk factors, treatment for the first tumour, a chance event, or the interaction of these factors. Dietary interventions among cancer survivors focus on three areas — energy restriction, fat restriction and plant-based low-fat diet. Anorexia and cachexia may continue among some groups of survivors. For many survivors, avoiding or controlling obesity is a far greater problem. Cancer survivors need to reduce saturated fats in the diet and to in for obesity management to prevent heart diseases, adopt secondary prevention strategies for secondary cancers, prevention methods for early detection and management of late effects of cancer treatments such as heart disease. A low saturated fat diet with sufficient amounts of fruits and vegetables and a moderate level of physical activity is advisable. Exercise is associated with many benefits for the cancer survivor. Exercise interventions have been effective in improving physical functioning, and health-related biomarkers such as blood pressure, heart rate, haemoglobin concentration and circulating hormonal levels. However, it is necessary to pursue exercise in a moderate and stepped-dose approach. The goal of health care professionals is to help this group of patients and their family members with specific sites and stages of disease, so that they can adjust to the disease and develop strategies to improve their quality of life. The goal is to restore the fullest functional, psychological, social, vocational and educational potential.
The writer is Professor and Head, Department of General Surgery, PGI, Chandigarh.
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Breastfeeding ensures better health
International Women’s Day has become a major occasion for focusing attention on the legal and social rights of women. However, the women’s rights groups involved invariably forget an important right (and duty) of all women — breastfeeding their own infants. It is estimated that if every infant is exclusively breastfed up to six months of age, 3500 lives can be saved everyday. What a simple solution it is to prevent such a gigantic and tragic problem! The World Health Organisation (WHO) has focused on three salient points: initiation of breastfeeding at birth without any delay; exclusive breastfeeding till six months; and while adding rich semi-solids at six months onwards, continuing breastfeeding till two years or more. According to some studies less than 10 per cent mothers continue breastfeeding till two years. An adequate supply of human breast milk is known to satisfy virtually all the nutritional needs of an infant at least for the first six months of life. It is easily digestible and facilitates skin-to-skin contact and physical warmth between mother and child, which further strengthens the emotional bond between them. Breast milk, especially colostrum, in the long term, prevents atherosclerosis, hypertension, and obesity. It also prevents allergy to non-specific proteins and develops immunity. Breastfeeding has a vital child-spacing effect, which is important in developing countries where the awareness, acceptability and availability of modem family planning methods are low. In a country like India where a large majority of the population has a low income and poor education, the need for breastfeeding becomes even more marked and, in fact, it represents the only way of preventing infections while giving a fair chance of survival and good health to an infant. Benefits to the baby Breast milk contains antibodies against infections and strengthens the immune system; reduces the chances of skin allergies, eczema, asthma, etc; reduces the risk of diarrhoea, coughs, ear infections, diabetes, etc; reduces the chances of obesity; ensures that the baby’s jaw development is healthier; and is likely to protect against serious ailments in later life. Benefits to mother (a) There is reduction in the risk of breast cancer, ovarian cancer, osteoporosis. (b) Breastfeeding reduces unnecessary weight and helps in returning to the pre-pregnancy shape early. (c) It reduces the cost of nutrition, since breast milk is free whereas formula milk is expensive. (d) Breast milk is readymade, easier to offer at night or anytime. (e) It delays next pregnancy. (f) It gives satisfaction and a feeling of achievement to the mother. In a study, it was found that the duration of full breast-feeding was less than three months in Delhi, Goa, Himachal Pradesh, Punjab and West Bengal. In Chandigarh, where the population of educated and working women is high, the situation is no better, since the recommendations of the WHO regarding breastfeeding are not followed. Mothers, please, come forward. You need not struggle to exercise this first right of motherhood.
The writer is a Chandigarh-based senior gynaecologist. |
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Knee injuries — conservative or surgical treatment? The most commonly affected joint in the human body is the knee joint. The causes could be varied as injury, disease or the aging process. Acute injuries of the knee joint cause considerable disability and time off (from sports, day-to-day activities). These injuries are common to sports where twisting movements and sudden changes of direction are undertaken (as in football, basketball, hockey, etc.) The course of events is the hearing of a soft-cracking sound in the knee, followed by instantaneous swelling, discoloration of the knee accompanied by agonizing pain. This is followed by restrictions/loss of motion. In case appropriate conservative treatment is not given, one has to live with discomfort, especially while climbing up and down, feeling of giving away, locking, etc. The extent of the injury can be assessed depending on the signs and symptoms. After the establishment of diagnosis, the decision regarding conservative or surgical management has to depend on a number of factors: age of the patient, degree of instability, associated injuries, whether performing pivoting sports, or cost of treatment. Surgery should be advised where athletes wish to participate in high-speed sports where constant change of direction and pivoting are required. These injuries do require a long-term post surgery management as the knee with a repaired ACL tend to remain unstable for prolonged periods, risking further damage to the “restored” ACL.
Surgical reconstruction of the knee does not strengthen it; in fact, it merely puts the ACL (or a substitute for the ACL) back into position within the knee. If the entire knee area is not strengthened, the individual remains at high risk, especially if the new ACL structure is weaker than the old one. Exercises: Quadriceps: Wall slide (with towel) Hamstrings: Lying on back, knees towards chest, then one leg is extended. Wall squat: Knees should remain over ankle and lower leg does not go beyond perpendicular line to the floor. If increases more than 90 degree, patellofemoral stress increases resulting in pain. Lunge: Involved leg in front, bend and shift weight to the front leg. The knee should be in line with great toe. Keep the lower leg perpendicular to the floor, and the knee should not move forward ahead of the foot. STEP-EXERCISES STEP-UP: Start when weight bearing on the involved leg is comfortable. Step height around 4” (10 cm) and increase to 8” (20 cm) — Involved leg first with back straight.
STEP-DOWN: Stand up on a step. Lower uninvolved leg to the floor. Heel touches first. Then lift the body backward to starting position. The toe remains off the ground.
Bridging (bum lift) with knee bent and afterwards with extending the legs. MINI-HOPS: 3x10 each leg and increase to 3x50. Hop on one leg on the spot while landing with bending of the knee. AEROBIC
Start with cycling, walking and jogging. Gradually increase the distance, speed, etc.
The writer is a former doctor/physiotherapist, Indian cricket team.
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WASHINGTON: If you thought that getting your kids onto the playfield will help them shed the pounds, and also get rid of all the bullying they go through, well then you have to keep in mind that the same taunting is what’s keeping them off the playfield in the first place. The study, conducted by a team of researchers from the University of Florida, found that about one out of every five children is chronically bullied. Dr Eric Storch, who led the study, said that the as rates of peer victimization among overweight kids went up, rates of physical activity went down. “We found that as rates of peer victimization among overweight kids went up, rates of physical activity went down. When you speak to overweight kids, one of the things you often hear is just this. Kids are targeting them. Kids are picking on them. You’re going to end up avoiding those types of situations. The problem clinically is if kids are avoiding PE class or playing sports because of fears of negative peer relationships, their health status is affected,” he said.
The researchers said that not only was a supportive family system essential to lessen the blows bullies inflict, but that schools also need to create a zero-tolerance culture for bullying and perhaps provide gym teachers with training on how to recognize bullying and intervene.
— ANI
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NEW YORK: It’s a patient’s worst nightmare — to wake up from surgery to find that the surgeon has operated on the wrong organ or limb. It happens, but thankfully not often, according to a new report. The study also indicates that surgical ‘’site-verification’’ procedures designed to prevent so-called ‘’wrong-site’’ surgery are not always effective. Wrong-site surgery includes procedures performed on the wrong side of the body, the wrong body part, the wrong lesion or growth, such as moles on the skin, the wrong vertebra of the spine, or even the wrong patient. ‘’We learned that fortunately this kind of mistake is very rare and only occurs one time in 113,000 operations,’’ Dr Mary R Kwaan from Brigham and Women’s Hospital in Boston told Reuters Health. Patients are always asked to sign a consent form, which describes the planned procedure, at some point after the decision is made for surgery. ‘’They need to be able to understand the description of the procedure, including what exact part of the body is involved,’’ Kwaan said. Still, ‘’No protocol will prevent all cases,’’ she and her associates write. ‘’Therefore, it will ultimately remain the surgeon’s responsibility to ensure the correct site of operation in every case.’’ — Reuters
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Health Notes WASHINGTON: Go ahead and have that second cup of coffee — or third, or fourth. A study published shows heavy, long-term coffee drinking does not raise the risk of heart disease for most people. The study, which followed 128,000 men and women for as long as 20 years, showed that drinking filtered coffee — not espresso or French-style brews — did not raise the risk of heart disease. Heavy coffee drinkers did tend to smoke and drink alcohol more often and those two factors clearly do raise heart risk, the researchers report in the journal Circulation. ‘’We believe this study clearly shows there is no association between filtered coffee consumption and coronary heart disease,’’ said Esther Lopez-Garcia, an instructor in the School of Medicine at the Universidad Autonoma de Madrid in Spain, who worked on the study. — Reuters Domestic violence bad for toddlers LONDON: A new study has found that children exposed to domestic violence, under the age of five, suffer similar emotional problems as kids who are physically abused, and that it can alter their developing brain. The study was conducted by a team of researchers at the Institute for Public Policy Research (IPPR). According to Scotsman newspaper, the study found that children who witness violence in the home are at a significantly increased risk of developing emotional, behavioural, speech or language problems. The study also found that domestic violence can have other negative effects on children, and that they are not only more likely to develop aggressive and anti-social behaviour, but are also at an increased risk of suffer from lower self-esteem.— ANI Alcoholism runs in the family WASHINGTON: A new study has found that individuals with a family history of alcoholism have a greater risk of developing alcoholism themselves than people with no such history, and that male members who have behavioral disinhibition are at the highest risk. Behavioral disinhibition reflects a general disposition characterized by an apparent insensitivity to punishment, an increased sensitivity to immediate rewards, a tendency to prefer immediate smaller rewards as opposed to larger long-term rewards, and a failure to consider and inhibit behavior when aversive consequences are likely. — ANI |
