‘Black eye’ can be a serious problem
Dr R. Kumar

Simran and Rahul reported to an eye specialist, holding each other’s hands that they were unable to open their eyes. They had marked swelling and blackness around their eyes.

They revealed that they had a bout of drinking in their hostel the previous evening, followed by arguments and wordy duel. It led to punches and blows on each other’s face! “We cannot see properly, doctor, can it be serious?”

“If you had restrained yourself, you could save yourself,” the doctor counselled.

A black eye is caused when blood and other fluids collect in the space around the eye. Swelling and dark discoloration around the eyes result in a “black eye”. Most “black eyes” are relatively minor injuries, but some may signify a more serious injury. Despite its being the case of a “black eye,” the eye itself is not usually injured. The skin around the eye is very loose, with mostly fat underneath it and fluid getting accumulated easily in this area. The skin around the eye is one of the first places to swell when the facial area is injured.

As a black eye heals, the swelling around the eye decreases, and the bruise gradually fades away. The bruising will usually lead to a very dark purple. As it fades, it may change to light purple, then greenish, then yellow before disappearing. It can take 2-3 weeks to subside.

Signs of a more serious injury are double vision, loss of sight, or inability to move the eye, loss of consciousness, blood or clear fluid coming out of the nose or the ears, blood on the surface of the eye itself, or persistent headache. Rush to a doctor if there are changes in vision, severe pain or swelling, signs of infection (for example, fever, warmth, redness, pus-like drainage), or behavioural changes, nausea, vomiting or dizziness.

Any of the following symptoms should be brought to the attention of the doctor:

Hyphema is an accumulation of blood in the front of the eye following injury and can cause damage to the interior tissues of the eye. The amount of blood may be too small to see with the naked eye, or the entire front of the eye may fill with blood.

Glaucoma may also result from blunt trauma to the eye, and can occur immediately or years later. The force of the trauma can cause bleeding inside the eye which leads to an increase in eye pressure, and damages the optic nerve. Delayed onset of glaucoma (angle recession glaucoma) can occur as scar tissue from the injury builds in the eye.

Orbital floor fracture (blowout fracture) may also occur as a result of the forceful blunt trauma to the eye. The force of the blow pushes the eyeball further into the eye socket, fracturing the very thin walls of the bone that make up the eye socket. This can lead to pinching of the optic nerve and the muscles that move the eye. Loss of vision or double vision can result and must be treated as an emergency case.

Retinal detachment can result in permanent vision loss. Trauma to the eye can lift or pull the retina from its normal position, lining the back of the eyeball.

Symptoms include partial or total loss of vision or flashing lights or spots in the field of vision and must be treated immediately.

In brief, most black eyes are relatively minor injuries, but they may signify a more serious injury that may threaten vision or life. An eye specialist must be consulted at the earliest. First aid for a “black eye” case includes rest. Ice should be applied early after the injury to prevent swelling and pain. Wear appropriate protective gear for any athletic or work-related activity. Avoid drinking and road rage, keep your cool and avoid disagreements.

The writer is a Chandigarh-based eye specialist.

Always keep watch on your feet
Dr Ravinder Chadha

Feet are the most important part of our body, yet these remain neglected unfortunately. We mostly concentrate on the workout of the upper body to look muscular. The next priority is lower limb strengthening. The most neglected part remains the feet which should have top priority, being a weight-bearing part. Walking exerts pressure around one and half time the body weight whereas running increases this pressure around three to four times the body weight.

In clinical practice, parents usually complain of their child getting tired quickly after playing for a short time. On examination, most of these children are found either having knock knees/flat feet or both. Children with flat feet/knock knees tend to move the leg/foot outwards while running, thereby putting an extra load on the muscles which causes fatigue/pain in the legs.

The shape of the foot is the most important aspect which should be watched in the early stages of life. Flat feet/high arched feet can cause heel pain (plantar fascitis), tendoachilles, low back pain, corns, blisters, etc

Foot pain affects both men and women but women suffer more due to their light bone structure and wearing narrow-toe, high heel shoes. Feet are designed to provide balance and strength during walking/running even over uneven surfaces. When high heels are worn there is alteration in bio-mechanics of the lower limbs obstructing normal functioning. Wearing high heels round the clock has its drawbacks. Wearing high heels in one’s 20s and 30s is alright, but it leads to problems in age groups beyond 50 years. The common cause is the loss of fat in the sole of the foot, osteoporosis of bones, etc. Long/pencil heels can make one prone to losing the balance.

Problems with the feet can be the first indication of conditions such as arthritis, diabetes and circulatory disorders. Swollen ankles can indicate congestive heart disease. Feet that are numb can be due to diabetes. Cold feet may be due to a circulatory disease, and clubbed toe-nails may indicate chronic respiratory disease.

Common foot problems

Pain under the heel early in the morning while getting out of one’s bed or after a prolonged rest can be due to plantar fascitis.

Achilles tendonitis — There is pain on the back of the heel in the morning or post-exercise. Achilles tendon connects the calf muscles to the heel bone. Pain under the heel and Achilles tendonitis are the conditions caused due to obesity, lack of flexibility of calf muscles, wearing worn-out shoes, flat/high arch feet and a sudden increase in training intensity.

Bunions (hallux-valgus) — There is displacement of the great toe towards the other toes. The incidence is more common in females due to wearing high heels and narrow-toe shoes.

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. 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 wearing tight shoes.

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

Treatment

• Wearing a heel pad takes off some of the strain.
• Weight reduction.
• Using sports shoes (with more cushion/flexible and raised heel).
• Most of the foot problems can be prevented by wearing comfortable shoes that fit well. Our shoes should have a firm heel with a minimum amount of slipping. They should be broad from the front and flexible in the toe box, and should not collapse in the arch.

Exercises

Towel curls — Placing a small towel on the floor and curling it repeatedly using toes.

Big toe pulls — Placing a thick rubber band around both big toes and pulling the big toes away from each other holding for 5 seconds, repeating 10 times.

Object pick-up — Place a handkerchief/sock on the floor. Picking up and releasing it back to the floor helps in increasing the joint mobility and muscle tone.

Calf stretch — Standing with both extended hands on the wall, placing one leg in front of the other, bend the front leg without raising the heel of the back leg. Stretch will be felt at the back of the calf muscle. Staying for a count of 15, change it to a alternate leg, repeating two to three times a day.

Self stretch — While sitting, place a foot on the opposite knee, put all five toes into extension. Hold for a count of 10. Repeat it five times a day.

The writer is a former doctor/physiotherapist, Indian cricket team. chadha_r2003@yahoo.co.in

Chew tulsi leaves to reduce stress level
Dr R. Vatsyayan

A small perennial shrub, deeply embedded in the cultural beliefs of India and held sacred by the devout, tulsi (holy basil) is acknowledged as a herb of great medicinal value. Scientifically called ocimum sanctum, it is found throughout the Indian subcontinent, ascending up to the lower range of the Himalayas, but is more commonly grown in gardens, courtyards and earthen pots in all Indian homes.

Tulsi is described as pungent and bitter in taste and light, dry and hot in effect. According to ayurvedic beliefs, it counters vitiated kapha and vata in the body. With a bitter post-digestive effect, all parts of the tulsi plant are of medicinal use. There are many varieties of tulsi of which some are cultivated while others grow wild. More or less, all of these have identical properties.

Over the centuries, tulsi has been amply studied by leading lights of ayurveda and it has been found to possess numerous curative properties. It acts as a very good antipyretic, stimulating, bactericidal, digestive, diuretic and an anti-oxidant herb. Tulsi is used in a number of ailments, which include simple cough and cold, bronchitis, fever with catarrh, hepatopathy, gastrointestinal upsets, leaucoderma and worm infestations.

Modern research has additionally proved tulsi to be carrying anti-rheumatic, anti-stress, anti-cancer, anti-diabetic, anti-viral and immuno-stimulant effect. The chemical composition of tulsi consists of an aromatic oil besides certain other compounds. As a household remedy, tulsi is relied upon by millions of people. The leaves of tulsi are boiled with tea and used during the rainy season as a preventive against malaria and dengue fever. In the case of acute fever, a decoction of fresh tulsi leaves boiled with pounded cardamom brings down the body’s temperature.

Tulsi leaves can also be boiled with a slice of fresh ginger and one teaspoonful of fennel (saunf) and this brew can be given mixed with a little of honey to manage mild respiratory problems and cough and cold.

Tulsi is regarded as an adaptogen or anti-stress herb. Simply chewing about 10 leaves of tulsi twice a day can reduce stress levels, raise immunity and help keep the digestive system in order. In paediatric infections also, the use of tulsi along with routine antibiotics hastens recovery. Unani physicians and naturopaths use the juice of tulsi leaves for local application in a number of skin ailments, including ringworm infections and white patches.

There are a number of classic ayurvedic preparations which are obtained by stirring in the juice of fresh tulsi leaves. The famous Tribhuvankeerti Rasa and Muktapanchamrita Rasa are first grade medicines to treat acute and chronic fevers. If used singularly, 20 to 40 of its leaves can be taken in two or three divided doses in a day. The dose of the juice of fresh tulsi leaves is 10 to 20 ml.

Caution — An overdose of tulsi can produce excessive sweating and symptoms of restlessness.

The writer is a Ludhiana-based senior ayurvedic consultant. E mail- yourhealth@rediffmail.com