Hot winds may harm your eyes
Dr R. Kumar

Sunny (10) has landed in an eye clinic after he returned from Shimla, where he had gone to beat the summer heat along with his parents. He is complaining of burning, irritation, redness and pain in his both eyes. He is rubbing the eyes vigorously to get relief.

“Doctor, Sunny seems to have developed eye flue”, opines the anxious mother. After examination, the doctor says, “ No, it is not eye flue, it is injury to his cornea due to dazzling sunlight. The sun has damaging UV rays that can cause photokeratitis, pingueculae and permanent retinal damage. UV-protective sunglasses could have saved his eye from the damage”.

“Children also need to wear protective eyewear”, silently wonders the father! More so, the sky was overcast with clouds for most of the time!

The blazing hot summer with hot winds is already here. What should we do?

Most people think that they are at risk only when they are outside on a sunny day, but UV light can go right through clouds. So, it doesn’t matter if the sky is overcast.

The following put you at additional risk: sunlamps, tanning beds and parlours, photo-sensitising drugs, snow and living at high altitudes. Dust allergies and pollen grain allergies like vernal conjunctivitis are seen in children and adults during summer. Eye flue or other kinds of infections are also common during summer months.

Beware! Use of eye-drops to treat redness caused by summer heat, especially antibiotics or steroids without medical supervision and prescription, can do more harm than good. Similarly, any redness of the eyes should not be presumed to be “simple eye flue” and left untreated. Avoid outdoor activities as much as possible during the summer season.

Hot winds bring dryness in the eyes

The winds not only bring heat and foreign particles, but also dry the lubricating moisture of the eyes as well. This dryness makes the eyes uncomfortable and vulnerable to injury and infections.

Eyes certainly require special care in summer. Wherever you go, be it a beach, theme park or hill resort, it is important to safeguard them. Washing eyes with cold water does not prevent dryness. On the contrary, it adds to the dryness. Cold water just makes you feel good. Tear supplements and lubricating eye-drops are the only solution for dry eyes. Choose your protective eyeglasses

The use of sunglasses is the best way to protect eyes from ultraviolet rays. They act as a visual aid which has lenses that prevent strong light from entering the eyes. They are made of either glasses or plastic. Plastic lenses are made from acrylic, poly-carbonate or CR-39. Glass lenses have good optical clarity and are scratch-resistant, but are heavier than plastic lenses.

l Look for labels that read 100 per cent protection from both UVA and UVB rays.

l Choose sunglasses that are shatter-proof.

l Choose styles that fit the face closely — like wrap-around sunglasses — that protect you from sunlight at many angles.

Despite the glasses, if your child often complains of burning sensation in the eyes, or rubs his eyes frequently or has consistent redness, tearing and white bumps next to the cornea, visit an eye specialist for an evaluation.

The writer is a Chandigarh-based senior eye-specialist. Email — drrkumar16 @gmail.com 

Cancer pain is manageable
Dr Narinder Singh Chawla

Cancer is a devastating diagnosis that affects people at several different levels. According to World Health Organization (WHO) estimates, globally 10 million new cancer cases are diagnosed each year. By the year 2020, there will be 20 million new cancer cases.

There is no doubt that a person diagnosed with cancer wants to be cured or, at least, achieve a long remission from disease. Setting aside prognosis, most patients and their loved ones also want to be able to live well with cancer — whether that life lasts weeks, months, or years. They want to have comfort, dignity and relief from pain as they face the end of life.

Pain remains one of the most common and burdensome symptoms of cancer. Nearly all kinds of cancer pain can be relieved.

The complexity and variability of pain as a symptom of cancer points to the need for a more selective and individualised therapy by a physician dedicated to the field of pain management only.

Most of the cancer patients need pain relief at all stages of their disease; pain can be a presenting symptom of cancer in one-third of patients, it can occur in one-third of patients receiving anti-cancer treatment. So, pain relief and anticancer treatment should go hand in hand. Many cancer patients present with advanced disease. The only realistic treatment option for such patients is pain management and palliative care.

Causes of cancer pain

Disease itself — Cancer causes pain, probably by the pressure on one of the body’s organs or on the bone or nerves or on blood vessels.

Treatment

Chemotherapy produces numerous side-effects that cause pain-like mucositis, peripheral neuropathy, constipation, diarrhoea, nausea, vomiting and abdominal cramps.

Radiotherapy similarly produces pain due to mucositis, peripheral neuropathy, burning sensations, etc.

Surgical treatments: Apart from producing acute post-operative pain, surgery can cause long-term post-amputation phantom limb pain, stump pain, post-mastectomy pain, etc

Concurrent disorder: Spondylosis, osteoarthritis.

Barriers to pain management

Inadequate knowledge among health care professionals, patients and the public; lack of institutional commitment and regulatory concerns pose significant barriers to effective cancer pain management.

Clearly, more education is needed to assist both patients and physicians in the management of cancer pain. It is important to drive home the message that cancer patients taking opioids and other medications do not become “drug addicts” despite the fears that many people do.

Taking medication for pain when it is needed does not mean that “later on,” there will be “nothing left” to treat the pain. There is a large arsenal of pain medications and interventional techniques available to treat cancer pain and there is ALWAYS more that can be done to treat pain

Also, a common myth among patients and relatives is that opioids treatment is often considered only for advanced or terminal cancer patients.

The diagnosis of cancer does not mean that you have to suffer with debilitating pain. Application of the WHO principles of systemic opioid therapy in combination with adjuvant drugs provides adequate analgesia in 70-75 per cent of patients with cancer pain. The success with the use of pharmacotherapy depends upon the proper use of medications in the recommended formats.

However, a significant number of cancer patients such as those with bone involvement or those with plexopathies cannot achieve adequate analgesia or reach an acceptable balance between analgesia and opioid-related side-effects. These patients may benefit from interventional pain management.

Interventional procedures are therapeutic options for managing cancer pain that is uncontrollable by conventional pharmacotherapy. The techniques involved include somatic/ sympathetic nerve blocks, radiofrequency ablation, intraspinal administration of opioids and/or other agents and spinal cord stimulation. Spinal cord stimulation involves controlled application of pulsed electrical energy across neural structures to modulate painful signals, thereby producing analgesia.

These interventions have the following advantages:

l Neurolytic blocks provide longer duration of pain relief

l Long-term indoor ward treatment is avoided

l Frequent visits to the pain centre are not required

l Patients can remain at home pain-free even in areas where medical help is scarce.

Chronic cancer pain can be psychologically devastating because it is a constant reminder of the incurable and progressive nature of the disease. Therefore, all available measures appropriate to the patient should be explored.

The writer is a consultant, Pain Management Centre, Ivy Hospital, Mohali

Fighting obesity: need to spread awareness
Dr K.P. Singh

Obesity, now considered a “killer lifestyle” disease, is an important cause of preventable death worldwide. Over all, about 2.5 million deaths are attributed to overweight/obesity worldwide.

There are approximately 350 million obese people (BMI > 30.0) and over 1 billion overweight people (BMI > 25) in the world. According to the World Health Organisation, 1.2 billion people worldwide are officially classified as overweight. In India, more than 3 per cent (35 million) of the population is in the obese category.

Obesity is no longer a disease of the adults. Now kids and school-going children are also afflicted. Similarly, type II diabetes can be seen in children nowadays.

Overweight and obesity can be demarcated on the basis of BMI (body mass index) and waist circumference.

BMI is calculated as weight (kg) divided by height in square metres (m²). BMI was chosen as a simple measurement of body weight in relation to height because it is in principle easier to measure at the population level than body fat. BMI gives information about the general obesity of a person.

The Health Ministry has reduced the diagnostic cut-offs for BMI and the standard waist circumference to fight the battle against obesity. The new BMI is 23 kg/m2 as opposed to 25 kg/m2 globally. A person with a body mass index of 23 kg/m2 will now be considered overweight and below that as one with normal BMI - unlike the cut-off limit of 25 kg/m2 earlier. Those with BMI of 25 kg/m2 will be clinically termed obese.

Standard waist circumference: From the clinical perspective, central obesity (approximated by waist circumference is known to generate diabetogenic substances and should, therefore, be more informative than general obesity (body mass index). According to guidelines, cut-offs for waist circumstances will now be 90 cm for Indian men (as opposed to 102 cm globally) and 80 cm for Indian women (as opposed to 88 cm at the international level).

Medical disorders due to obesity

Being obese is associated with a higher risk of disease, particularly if body fat is concentrated around the abdomen. The disease outcomes for obesity include: diabetes type II, ischemic heart disease, stroke, hypertension, osteoarthritis and cancers (colon, kidney, endometrial, and postmenopausal breast cancer) being obese can also cause problems such as sleep apnoea and osteoarthritis.

The causes

The causes can be divided into endocrine(hormonal), genetic and lifestyle. The common endocrine causes include hypothyroidism (thyroid or pituitary origin), polycystic ovarian disease (PCOD), Cushing’s syndrome and hypothalamic lesions which are usually genetic. The majority of the cases of obesity are caused due to lifestyle problems. This is simple obesity, caused by wrong eating habits and physical inactivity. Few anti-diabetics, anti-depressants and steroids on prolonged use can also lead to weight gain and obesity.

Obesity and metabolic syndrome

Obesity is considered the link between insulin resistance and metabolic abnormalities which includes diabetes, hypertension and dyslipidemia, all of which are risk factors for coronary artery disease (atherosclerosis).

The metabolic syndrome is described as a clustering of conditions in a person having abdominal obesity (waistline >90cm) , hypertension (BP > 130/85), high fasting blood glucose (>110mg/dl) or the presence of diabetes along with hypertriglyceridemia (serum triglycerides >150mg/dl) and low HDL(<40mg/dl). 3 out of these 5 conditions fulfil the criteria for labelling the person as having metabolic syndrome.

Persons with the metabolic syndrome are nearly three-four times more likely to have general as well as cardiac morbidity and mortality. The basic cause of morbidity and mortality in metabolic syndrome cases is insulin resistance due to central obesity (intrabdominal fat).

Fat cells (adipocytes) act as metabolically active organs and trigger the release of several cytokines (adipocytokines), TNF and Interleukins. These active products of fat cells on the one hand induce insulin resistance and on the other it accelerates the atherosclerosis. Insulin resistance is the central pathogenic factor for causing diabetes, dyslipidemia and atherosclerosis.

Significance of obesity awareness

It can be highlighted by the saying, “Larger the waistline, shorter the lifeline.” The US National Nutrition Survey has clearly shown that 10 kg weight loss in obese individuals leads to four years’ increase in life and improvement in all parameters of diabetes, lipids, angina and hypertension.

The writer is a Senior Consultant, Endocrinology, at Fortis, Mohali, and Founder Member of the Association for the Study of Obesity in India. Email: k.singh@fortishealthcare. com.