How to prevent the spread of swine flu
Dr A.K. Janmeja

Swine flu, a highly contagious infection, has spread all over the world. It has taken many lives in India. Its symptoms are not different for common human flu, which we notice with the change of season.

As usual, the common symptoms include mild-to-moderate fever, runny nose, sore throat, cough, body aches, fatigue, chills, etc. There may be loose stools and vomiting also. Sometimes there may occur a severe illness in the form of pneumonia, respiratory failure, dehydration, etc, and, if not taken care of urgently, it may prove fatal.

Therefore, there is a need for utmost care for its prevention and treatment. Like any seasonal flu, it may worsen the pre-existing medical conditions — asthma, diabetes, chronic lung infections, etc.

How does swine flu spread?

Swine flu spreads the same way as common cold or flu. When a patient suffering from any type of flu coughs or sneezes a mist of droplets is generated. This mist contains millions of virus-loaded droplets. Inhalation of these droplets by a healthy person causes infection. 

This also happens when the mist gets settled over tabletops, computer keyboard, door-handle knobs, toys, telephone, etc. When any person touches these articles and subsequently his/her mouth, nose, eyes, etc, the virus can result in a disease. 

The flu patients are capable of passing on the infection to others one day before and seven days after the symptoms are seen or till the illness is cured. Therefore, respiratory hygiene/ cough etiquette are the effective ways to prevent the spread of flu infection.

The following measures are recommended for all individuals with signs and symptoms of a respiratory infection:

Treatment

Oseltamivir (Tamiflu) is the drug available both for treatment and prevention of swine flu. By taking the drug a patient can recover faster, any symptoms ameliorate soon. The drug arrests the progression of the disease and also averts complications effectively.

But an indiscriminate use of the drug can lead to the emergence of resistance and, therefore, as a precautionary measure, the government has not permitted its sale in the open market. However, it is freely available to all needy patients free of cost in hospitals.

The Government of India recently issued guidelines for the whole country to make the optimum use of limited resources and to streamline the treatment/ diagnosis/prevention. As per these guidelines, at first, all individuals seeking consultations for flu-like symptoms will be screened at health care facilities, both government-run and those in the private sector.

l Cover the nose and mouth with handkerchief/tissue paper when coughing or sneezing.
l Use tissues to contain respiratory secretions and dispose them of in the waste receptacle after use.
l Maintain hand hygiene (such as hand-washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic hand-wash) after having contact with respiratory secretions and contaminated objects/ materials.

The writer is Professor and Head, Department of Pulmonary Medicine, Government Medical College & Hospital, Sector 32, Chandigarh

Learning to live with knee arthritis
Dr Ravinder Chadha

Individuals suffering from knee arthritis are usually unsure about the physical activity that would be ideal for them to keep fit. They have to keep in mind the precaution to be taken so that pain is alleviated and knee surgery avoided.

As such, individuals often experience pain on prolonged sitting, climbing up or down the stairs and early morning stiffness. They are thus advised rest and avoidance of aerobic activities like cycling and jogging. This results in weight gain, the root cause for numerous complications such as hypertension and diabetes.

An increase of one kg of body weight adds four to five kg of load on the knee. Being sedentary doesn’t slow down the progression of arthritis but considerably reduces the muscle and bone strength. The recommendation is to remain active as far as pain and discomfort allow.

Symptoms

l Pain and swelling.
l Early morning stiffness.
l Pain in the inner side of the knee results in bow-legged deformity.
l Decreased range of motion, crepitus and muscle weakness.

Treatment

The main aim of treatment is to reduce pain and swelling and increase the range of motion. Initially, the treatment entails lifestyle modifications, exercise, supportive devices, etc.

Lifestyle modifications include the following:

Losing weight can reduce stress/pain and increase the range of motion. It can be difficult to lose weight when not active because of knee pain. Choosing the activities that minimise the impact and twisting on the knee. Walking on a treadmill or jogging usually aggravates knee pain. Mild-to-moderate patients can effectively bike/swim to reduce the impact on the knee joint.

In severe cases, the best aerobic option is walking.

Supportive devices: Knee braces help stabilise the knee, facilitating day-to-day activities effectively.

Unloader brace shifts the load from the affected portion of the knee, opening up the inner side of the joint. A support brace helps support the entire knee load.

Heel wedge in the shoe tilts the heel, taking pressure off the inner side of the knee.

Sports shoes can absorb the impact of the shock.

Stair climbing and descending: The ability to go up and down the stairs requires strength and flexibility. At first, use a handrail for support and go only one step at a time. Always go up the stairs with the good knee and come down the stairs with the bad knee.

Glucosamine sulfate/ diaceren builds joint cartilage.

Visco-supplementation, a concentrate of hyaluronic acid, lubricates the joint making the movement easy and smooth. There is less fluid in the knee with osteoarthritis when compared to a healthy knee. Three to five weekly shots are needed to alleviate pain and discomfort with an increase in knee bending.

Exercises

The range of motion and stretching exercises help improve the motion of the knee and protect from shock and stress.

Exercises with a stretch-band are very safe and improve muscle strength. Individuals with knee arthritis having strong leg muscles suffer less. Such exercises protect the knee joint from further damage.

Those suffering from knee arthritis must undertake some aerobic activity like walking, cycling and swimming.

The writer runs his pain management clinic in Chandigarh. E-mail-chadha_r2003@ yahoo.co.in 

EYESIGHT
Looking beyond Lasik
Dr Mahipal Sachdev

Working in Dubai, 26-year-old Ujjwal was a very troubled individual. With a high power of -18 DS alongwith -2.0 cylindrical in the right eye and -16 DS with -3.5 cylindrical in the left eye, he was virtually helpless without his glasses.

His glasses were thick and cumbersome and he felt trapped behind them. On a friend’s recommendation, he approached one of the senior ophthalmologists in India who after extensive tests advised him to go in for an Implantable Contact Lens (ICL).

An ICL is an ultra-fine lens made of collamer, a bio-compatible material with high water content and anti-reflective properties. It transmits light just like the natural lens and has the added advantage of blocking out the harmful ultraviolet rays, thereby protecting the eye from further damage. For people like Ujjwal, it’s the most suitable answer to their problem.

Most significantly, thin corneas are not a hindrance at all. The lens is placed inside the eye between the iris and the natural lens and is invisible to both the patient and the observer. The cornea is not ablated, so complications related to thin corneas are totally eliminated.

On the day of surgery, Ujjwal walked into the hospital feeling slightly anxious and worried, wondering how long it would take for him to recover. But after putting a few drops to numb his eye, the doctor told him to relax and within a mere 15 minutes, the procedure was over.

For patients with high powers and thin corneas, there is hope beyond Lasik. Apart from ICLs, other options include Sub-Bowman’s Keratomileusis (SBK) using the Intralase femtosecond laser.

Another treatment modality is surface PRK using Mitomycin C or Epilasik, in which a thin sheet of corneal epithelium is removed to allow laser ablation, thereby saving more corneal tissue.

Clear lens extraction with multifocal or Toric IOL implantation may be considered in selected patients. For people with keratoconus with progressive thinning and steepening of the cornea, Collagen Cross Linkage (C3R) and INTACS can help stabilise the disease process and improve the vision respectively.

So, now with the advent of complete refractive solutions ranging from Intralase, the blade free lasik, to customised lasik, SBK, Epilasik, ICLs, INTACS, 3R, Multifocal and Toric IOLs, there is something to suit almost everyone’s needs.

Options for patients with thin corneas and/or high power:

l SBK or SUB-BOWMAN’S KERATOMILEUSIS in which a 90 micron flap is made using the IntraLase femtosecond laser.

l Epilasik or surface PRK in which a thin sheet of corneal epithelium is removed to allow laser ablation, thereby saving corneal tissue; the epithetlium grows back in two-three days.

l ICL or implantable contact lenses made of collagen co-polymer which are placed between the iris and natural lens.

l Clear lens extraction with multifocal or Toric IOL implantation collagen cross linkage (C3R): To stabilise and strengthen the cornea in the people with keratoconus with progressive thinning and steepening of the cornea.

l INTACS or intra-stromal ring implants to change the shape of the cornea and improve vision.

The writer is Chairman and Medical Director, Centre for Sight, New Delhi. Email: drmahipal@gmail.com