Improve environment, prevent cancer 
Dr Meenal Kumar

The other day we noticed on a table next to ours in a club a group of women drinking, smoking and dining to their heart’s content. The pretty ladies were taking a serious health risk even if they felt socially liberated. Could one or more of them suffer from cancer?

One of the hopeful messages from cancer research is that most of the cases of cancer are linked to environmental causes, and can be prevented. The environment includes both lifestyle factors such as diet, tobacco and alcohol, and radiation, infectious agents and substances in the air, water, and soil. A review of the recent scientific studies shows compelling evidence linking cancer with specific exposures. Breast cancer may be caused by exposure to DDT before puberty, prostate cancer by pesticides and metal working fluids, Non-Hodgkin's lymphoma by pesticides and solvents, brain cancer by non-ionizing radiation, Leukemia by exposure to 1,3-butadiene, and lung cancer by exposure to air pollution, and so on.

We know with considerable certainty that tobacco is a major contributor to cancer. We also know a lot about the cancer risks associated with exposure to ionizing radiation. This includes radiation from many sources --- cosmic rays, radon, X-rays, atomic bombs and above-ground nuclear bomb tests. However, the quantum of contribution from all the other causes of cancer such as diet, occupational exposures, or air and water pollution, is less certain. The estimate that diet may contribute 30-35 per cent is probably right. So, tobacco and diet are major contributors.

There are a number of occupational exposures where the scientists have been successful in decreasing harmful exposures to toxic substances -- arsenic, asbestos and benzidine, and there is some evidence that rates are decreasing for some cancers that are related to these exposures. We now know that HIV and HPV are significant risk factors for certain cancers, and the bacterium H. pylori is an important risk factor in stomach cancer.

Another area from where strong information has emerged are the health effects of physical activity and obesity -- two environmental conditions also tied to diet. For example, physical inactivity is now pretty clearly related to cancers of the colon, breast and prostate, and associations with additional cancer sites are likely to be made in the future. It's very clear that colorectal and breast cancers are linked to physical activity, and prostate, lung, ovarian and endometrial cancers are probably linked too.

The way human beings and animals are being fed and made to inhale chemicals in our environment, we can assume that every Indian has some level of these chemicals in his or her body. That shows that they are at risk to suffer health risks, including cancers. The problem with most of the 80,000 chemicals used in the production of consumer goods is that no one knows the threshold for humans. A recent acrimonious debate between the environmentalists and the cold drinks lobb on the presence of toxic substances is a case in point.

Phthalates (industrial chemicals) are found in shower curtains, garden hoses, table clothes, vinyl flooring, swimming pools, plastic clothing, children's toys, automobile upholstery, carpets, capsules, soap, shampoo, hair spray, nail polish, deodorants and fragrances. They are associated with lower sperm counts, the feminization of male genitalia in male foetuses, childhood asthma, reduced lung capacity. Avoid plastics and eat fresh food grown without pesticides — organic foods.

Similarly, BPA chemicals are found in some water bottles, baby bottles, food storage and heating containers, the lining of metal food cans, dental sealants and toys. BPA has been known to simulate estrogen and is associated with cancer and diabetes.To reduce exposure, use glass, stainless steel or polyethylene bottles instead of polycarbonate bottles; avoid heating food in polycarbonate containers; cut back on canned foods.

Polybrominated diphenyl ether is another class of chemicals found in furniture foam, textiles, kitchen appliances, electronics like TVs and computer monitors, and in the fat of some food animals. These are associated with birth defects, cancer; neonatal exposure affects learning and memory. To avoid the problem, wash your hands frequently; dust with a damp cloth; choose vegetarian food and cooking methods that need no fat. This shows how we can prevent dreadful diseases like cancer by improving our environment.

The writer is a Chandigarh-based senior gynaecologist.

Inflammatory bowel disease: correct diet and rest can help
Dr Harmeet S. Saluja

Inflammatory bowel disease is the name of a group of disorders that cause the intestines to become inflamed (red and swollen). The inflammation lasts a long time and usually comes back over and over again. If you have inflammatory bowel disease, you may have abdominal cramps and pain, diarrhoea, weight loss and bleeding from your intestines.

The exact causes are unknown. The disease may be caused by a germ or by an immune system problem. You don’t have to worry about your family members catching the disease from you, because it isn’t contagious. However, inflammatory bowel disease does seem to be hereditary (runs in your family).

Based on your symptoms, your doctor may suspect that you have Crohn’s disease or ulceartive colitis. Your bowel movements may be tested for germs and the presence of blood. Your doctor will probably look inside your intestines with a sigmoidoscope or a colonoscope. In these procedures, the doctor uses a narrow flexible tube to look directly inside your intestines. Special x-rays may be helpful in diagnosing this illness.

The best thing you can do is take good care of yourself. It’s important to eat a healthy diet. Depending on your symptoms, your doctor may ask you to cut down on the amount of fibre or diary products in your diet. In addition to eating well, you need to get enough rest. It’s also important that you learn to manage the stress in your life. When you become overly upset by things that happen at home or at work, your intestinal problems can get worse.

You will most likely be treated by a team of doctors. This team may include your family physician, a gastroenterologist (a specialist in stomach and intestinal disorders) and, possibly, a surgeon.

The goal of treatment is to get rid of the inflammation. Many types of medicines can reduce inflammation, including anti-inflammatory drugs such as sulfasalazine, corticosteroids such as prednisone, and immune system suppressors such as azathioprine and mercaptopurine. An antibiotic such as metronidazole may also be helpful for killing germs in the intestines, especially if you have Crohn’s disease.

To help treat your symptoms, your doctor may recommend anti-diarrhoeals, pain relievers or other over-the-counter (OTC) drugs. It is important to talk to your doctor before taking any OTC medicine on your own. Your body may not be able to handle the effects of medicine. If you have severe symptoms such as diarrhoea, fever or vomiting, you may need to go to the hospital to be treated with special fluids and medicines that must be given intravenously (in your veins).

If your ulcerative colitis becomes so severe that it can’t be helped by medicines, it may be necessary to remove part or all of your colon surgically. Crohn’s disease usually isn’t helped with surgery.

Because Crohn’s disease and ulcerative colitis keep coming back and their symptoms cannot be predicted ahead of time, patients with these illnesses can become depressed. If you feel depressed, talk to your family doctor. An antidepressant medicine could help you feel better.

By asking questions, reading information materials and discussing your treatments with your doctor, you’ll be able to understand your illness and manage it better. Patient support groups are helpful, especially if you have severe disease.

The writer is a consultant (Gastroenterology), SPS Apollo Hospitals, Ludhiana.

Foot pain — your shoes may be the cause
Dr Ravinder Chadha

Foot is a very important part of the body yet it is widely neglected. Many people actually bother little about the footwear, may be due to various reasons — ignorance regarding its importance, economic reasons, etc.

The main functions of the foot are to support and absorb the shock of the body weight while walking, running, etc. Females are generally fond of adorning high heels with narrow toes to look tall, which leads to discomfort/deformities in the long run.

Wearing shoes that don’t fit properly is one of the most common reasons to develop foot problems.

lNarrow toe shoes tilt the great toe towards the other toes and a bony lump appears on the toe (hallux valgus).

lTight, constricting shoes interfere with normal growth thereby resulting in deformity.

lIll-fitting shoes lead to corns, etc.

lHigh-heeled shoes can cause tendo-achilles (pain in the back of heel), plantar fascitis, etc.

Common foot problems

Bunions (hallux-valgus): This is a common deformity of the forefoot. There is displacement of the first metatarsal bone away from the midline. The upper part of the great toe moves towards the other toes. The incidence is more common in females due to wearing high heels and narrow toe shoes.

The important part of the treatment is wearing appropriate shoes that conform to the shape of the foot and do not cause pressure points.

Corns and calluses: These are caused by the pressure of the skin on the foot. They may occur when the bone of the foot presses against the shoes. Common sites are on the big toe and the fifth toe. Treatment involves relieving the pressure with the use of pads or by modifying the shoes.

Hammer toes: In this case there is a permanent bend in the middle toe joint. This deformity can occur due to tight shoes. A hard corn may develop over the top prominent area, resulting in pain. Treatment involves a change in shoes to accommodate the deformed toe-shoe inserts or pads may also be helpful.

Plantar Warts: These occur on the sole of the foot and look like calluses. These result from an infection by a specific virus. They are like warts elsewhere, but they grow inwards because of the weight placed on it while prolonged standing. One may experience severe pain when walking. These warts can be treated with skin softening ointments, injecting or freezing the warts with medication or surgery in rare cases.

Flat feet, lock knees/bow leg can cause injuries, gait problems, etc.

Most of the foot problems can be prevented by wearing comfortable shoes that fit well.

The following tips should be kept in mind to get proper fitting shoes:

lIt is advisable to select shoes by the way they fit the foot rather than by the size marked inside the shoe.

lThe size of the feet changes as one grows older. So, always have your feet measured prior to buying shoes.

lThe best time to measure the feet is at the end of the day when their size increases due to swelling.

lMost individuals have one foot larger than the other, so fit the shoe to the larger foot.

lOne should select a shoe that is shaped like one’s foot.

lDuring the fitting process one should make sure that there is enough space (3/8” to ½”) for the longest toe at the end of each shoe when one is standing up.

lOne should make sure that the ball of the foot fits comfortably into the widest part of the shoe. A shoe should only bend in the toe box, and should not collapse in the arch.

lThe heel should fit comfortably in the shoe with the minimum amount of slipping. The shoes should not move up and down on the heel while walking.

To save oneself from suffering agonising pain or discomfort, every individual should check his or her feet regularly. In the case of pain/discomfort, a doctor’s advice is mandatory to prevent chronic debilitating diseases/deformity.

The writer is a former doctor/physiotherapist, Indian cricket team.