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| HEALTH & FITNESS |
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Back pain is common in menopause
When elderly face the scalpel
Prevent big toe deformity
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Back pain is common in menopause
It is a well-known fact that most women in the menopausal zone are deficient in calcium because of its low intake through their diets, and then there is erosion of their bones, especially the spinal bones, due to hormonal imbalance. The required calcium intake for most postmenopausal women is 1200 mg/day. Besides osteoporosis, back pain most often occurs from strained muscles and ligaments, from improper or heavy lifting, or after a sudden awkward movement. Sometimes a muscle spasm due to stress can cause back pain. In some cases, back pain may be caused by bulging or ruptured disks. Arthritis in the spine can also lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis. Scoliosis, a condition in which your spine curves to the side, also may lead to back pain. In the case of Jaspal, several factors came into play! Prevention
The following factors that increase one’s proneness to back pain need attention: Female gender, smoking, obesity, older age, physically strenuous work, sedentary work, stressful job, anxiety, depression, etc. You may be able to avoid back pain by doing the following: 1. Regular low-impact aerobic activities. Walking and swimming are good choices. 2. Quit smoking. 3. Reduce weight, protruding tummy is no asset. 4. Stand smart and sit smart. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. 5. Give attention to your mid-life health, consult a gynaecologist and start hormone replacement therapy, if advised. What specific exercises can you do to stretch and enhance comfort? Sit in a chair and press your buttocks together. This will strengthen the muscles that help support your back and legs. Hold for five seconds, relax and repeat. Work up to 20 repetitions a day. Lie in a bed and bend each knee to your chest. Gradually increase to l0 repetitions each, then pull both knees to your chest and hold for six seconds. Repeat, increasing to l0 repetitions. Lie on your back and move your feet and legs in the air as if you’re riding a bicycle while counting to five. Relax and repeat, gradually increasing to l0 repetitions a day. To stretch your hips, lie on your stomach in the bed or on a padded floor. Raise your leg, and leg and foot off the bed or floor, keeping your knee straight. Hold for five seconds. Repeat, and work up to 10 repetitions. Repeat with the other leg. When should you seek medical advice? When pain is constant or intense, especially at night or when you lie down Pain spreads down one or both legs, especially if it extends below the knee Causes weakness, numbness or tingling in one or both legs Causes bowel or bladder problems Is associated with pain or pulsation (throbbing) in the abdomen, or fever Follows a fall, blow to your back or other injury Is accompanied by unexplained weight loss Over-the-counter pain relievers may be all that you need if the pain is occasional and not severe. Low doses of certain types of antidepressants have also been shown to relieve chronic back pain. A physio-therapist can apply a variety of treatments such as heat, ice, ultrasound, electrical stimulation and muscle-release techniques to your back muscles to reduce pain. If other measures don’t work, your doctor may inject cortisone — an anti-inflammatory medication — into the space around your spinal cord. Surgery is usually reserved for pain caused by a herniated disk and nerve compression. The writer is a senior gynaecologist based in
Chandigarh.
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When elderly face the scalpel
Adults aged 65 years or above, classified as the elderly patients, constitute the fastest growing segment of the population. Very elderly are defined as those older than 85 years. The care of the elderly involves physicians, surgeons, radiologists and intensive unit care specialists. Elderly patients require specialised care due to problems associated with deteriorating organ function, minimal organ reserve, blunted response to stress and general overall fraility. A coordinated approach to diagnosis and management should serve to optimise a favourable outcome in this vulnerable group of patients.
Older patients are potentially being undertreated out of concern that other coexistent medical comorbidities, typically cardiovascular or neuro-degenerative diseases, may place them at a higher risk. The outcome of these conditions can be influenced by the use of aspirin and other antiplatelet and anticoagulation drugs. A few common conditions that may necessitate admission in these patients are hernias, gallstones, cancer, acute abdomen (intestinal obstruction, perforation, etc), gastrointestinal bleeding (upper and lower) and intestinal ischemia. It has been observed that there may be a delay between the onset of symptoms and the presentation of an elderly patient to the hospital. This delay may result from difficulties in leaving home, fear of hospitalisation, alteration in usual symptoms and diminished perception of them, or diminished ability to express themselves effectively. For example, individuals with dementia may not be able to communicate changes in their health. More patience and diligence is required in evaluating clinical symptoms and signs in the elderly. Many elderly patients are on more than one medication for the treatment of several ailments. Medical conditions can feature in the elderly patients not only as comorbidities, but also as the major cause of complications following surgery. Emergency surgery is one of the most important factors influencing surgical outcomes in the elderly and hence risk assessment is essential to formulate a proper management strategy. It is important to decide what can be done to optimise the patients’
condition for surgery. Recent medical advances have improved surgical outcome in the elderly patients. Better delivery of anaesthesia using better instruments and improved techniques, better patient selection and better preoperative cardiac care have all enabled complex procedures being undertaken for the elderly patients. It is unwise to defer surgery on the basis of age alone as an unnecessary delay may result in the aggravation of the underlying problem. This may ultimately necessitate an urgent procedure which may have an unfavourable outcome. Recovery following surgery in the elderly can be improved considerably by combining the use of newer techniques, newer technology, early mobilisation, adequate pain relief and nutritional support. The patient and his family must become an integral part of the decision to treat, and their wishes and expectations must be respected. Good results depend on careful preoperative evaluation, balancing the risks and benefits of surgery. A 24-hour recovery facility and intensive therapy unit bed should be available at all hospitals for these patients. The writer is a former Head, Department of Surgery,
PGI, Chandigarh.
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Prevent big toe deformity
Foot is made up of bones, muscles and ligaments. In order to perform the functions of mobility, flexibility and support, all these three work together. The foot has to absorb the load, provide support and assist during the movement of the body.
A seemingly simple activity like walking puts immense pressure on the feet, which is approximately two to three times the bodyweight. Most of the problems afflicting the foot are not because of walking but due to ill-fitting shoes. If the shoes are too tight, the foot gets squeezed, thus increasing pressure. Loose shoes make the foot slide and rub against the shoes causing friction. Bunion is a common deformity, also referred to as hallux valgus. The great toe tilts over towards the other toes and a bony lump/swelling appears on the inner side of the great toe. There is a lateral deviation of the great toe over 20 degrees. The average deviation being 15 degrees approximately. The incidence is much higher in women than men. The cause could be the common use of high heels with narrow toed shoes worn by the fairer sex. Radiographic findings also corroborate the fact that wearing heels of 3 inches or more causes the greater toe to move towards the other toes of the foot. This deformity develops slowly and if ignored can lead to dislocation of the joint, causing instability during walking. In advanced cases, the big toe can overlap the second toe. The defect can initially be corrected with the help of orthotics/exercises. Chronic deformity is difficult to treat and surgery is needed in cases of intolerable pain, decreased ability to perform duties, shoes are difficult to fit. Causes
Family history of Bunion: This does not mean that the siblings are bound to suffer. The connection seems to be usually flexible joints (hereditary) that are more prone to suffer. Abnormal foot function — inward motion of the foot particularly in people having short first metatarsal bone (big toe). Frequent use of high heels and narrow toed shoes. Rheumatoid/osteoarthritis patients are more prone to develop bunions. Symptoms
Redness, swelling or pain at the great toe. Discomfort/pain on wearing shoes. Therefore, it is noticed more often in winters. If there is pain at night or at rest, then there may be arthritis of the great toe also. The foot becomes so broad that it is difficult to get wide enough shoes. Pain is predominantly on the upper part of the great toe when the toe rubs under the shoe or under the surface of the second toe due to the pressure of the great toe. Callus formation over the great toe, which may lead to ulceration. Certain cases may present with a cyst or bursa containing fluid. Treatment
The following conservative treatments can limit the formation of bunion and relieve pain. Apply a pad around the bunion to avoid the formation of callus, corn formation. Avoid high heel shoes. Wear shoes with wide and deep toe box with low heel to reduce the weight on the forefoot. If the bunion becomes painful and swollen, elevate the foot and apply ice. Injection of steroid or local anaesthesia is given to reduce the inflammation. Night splint/taping helps in reducing pain. Mobilisation is useful in the early stages. In the beginning of the bunions, the following exercises can help increase the range of motion. Repeat them 10-15 times, twice a day. 1. While sitting, place the foot on the floor, lift the toes as high as possible while holding the ball of the foot on the flat surface for four seconds followed by bending toes downwards. Again hold for four seconds and return to the starting position. 2. While sitting, spread the toes apart as far as possible. Use hands if required to hold the toes apart. Hold for four seconds. 3. Towel curls: Place your foot on a wet towel on the floor. Curl the towel towards the body with the help of toes. For the good health of one’s foot and prevention from agonising pain, do not ignore the great toe pain. Also avoid wearing high heel and narrow-toed shoes to prevent deformity. Be more comfortable than fashionable. The writer is a former
doctor/physiotherapist, Indian cricket team. chadha_r2003 @yahoo.co.in
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Health Notes
London: Researchers at the University of Western Australia have found that men who eat diet rich in antioxidants — vitamin E and beta-carotene — boost their chances of making a baby than those who don’t. In a study of crickets, they found that a combination of these antioxidants proved to be the best weapon against sperm damage. The study suggests that dietary intake of foods like cantaloupe, carrots, apricots, pumpkin and mangos — orange-coloured foods rich in beta-carotene — and almonds, soybean oil and broccoli, which are rich in vitamin E, could help maintain healthy sperm in men. To carry out their hypothesis, scientists used crickets to pit the sperm of several different males in direct competition to fertilise the female’s egg — some were put on antioxidant-rich diets and others went deprived. Quitting daily aspirin raises heart attack risk
London: Those heart patients who discontinue taking the prescribed aspirin are two-thirds more likely to suffer another attack, according to a new research. It found that up to half of long-term users are believed to stop taking aspirin against medical advice. The findings come from a UK database of nearly 40,000 patients who had been prescribed the drug by their doctor. Low-dose aspirin is recommended for all heart disease patients to help prevent blood clots, which can lead to future heart attacks. “This research is yet another reminder of how effective a little daily pill of aspirin can be at preventing someone from having another heart attack. So, it’s very concerning how many people with heart disease are not taking their aspirin,” the BBC quoted Ellen Mason of the British Heart Foundation as saying. Too much coffee reduces the chances of becoming a mother
London: A researcher at the University of Nevada School of Medicine has found that high caffeine consumption is associated with infertility in females. Sean Ward, professor of physiology and cell biology at the university, says caffeine reduces muscle activity in the Fallopian tubes that carry eggs from a woman’s ovaries to her womb. “Our experiments were conducted in mice, but this finding goes a long way towards explaining why drinking caffeinated drinks can reduce a woman’s chance of becoming pregnant,” said Ward. By studying muscular fallopian tubes from mice, Ward and his team discovered that caffeine stops the actions of specialised pacemaker cells in the wall of the tubes. — ANI
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Jaspal Kaur has been a dedicated computer worker for the last several years. Lately, she has started complaining about back pain after day-long work. This has become more accentuated after she celebrated her 45th birthday. After a bout of sneezing her backache became acute. Besides scanty menses, hot flashes, frequent urination, lack of interest in physical intimacy, insomnia, protruding tummy, back pain has been constantly bothering her. Why?