Unwanted pregnancy: Use of contraceptives
Dr Meenal Kumar

When Rimple, 23, a newly married woman, missed her periods, she decided to try out the ‘I-Pill, an emergency contraceptive (EC)’, widely advertised on television. After repeated use of the pill failed to restore her periods she consulted a doctor who found she was six weeks pregnant.

She had to undergo an MTP as the overdose of EC pills she took could have harmed her foetus. Typically, users of the ‘emergency contraceptive’ (EC) confuse it with the abortion pill that is to be taken after a woman misses her periods. EC pill cannot be a substitute for regular oral or injectible contraceptives and should only be used in “emergency” —- after accidental unprotected sex. Long-term use or overuse can be harmful and cause irregular menstrual cycles and side-effects like nausea and vomiting.

No less than 78 per cent of the pregnancies in India are unplanned and at least 25 per cent are unwanted despite the availability of contraceptives. Married or unmarried, if you don’t want a child, contraceptives can come to your rescue. The large majority of women need to rely on modern methods, including female sterilization, the IUD, and the pill. Oral contraceptives are the most commonly prescribed form of birth control; advantages include reversibility as well as a good tolerance and safety profile. Long-term contraceptives like sub-dermal depot compounds or hormone-releasing pessaries in the uterus have been used on a regular basis and seem a convenient alternative for birth control for longer periods. Copper IUDs will be widely used in the future since copper IUDs are effective in preventing a pregnancy for as long as five days after unprotected coitus. Hormonal tablets are less effective and should be taken as soon as possible after coitus.  

Side-effects of contraceptives

The time period of when to start taking a pill is important as every woman’s menstrual cycle is different. Also, some women may be allergic to certain kinds of drugs. Issues such as weight gain, weight loss, acne increase or decrease, and nausea are common with many types of contraception. Irregular bleeding or spotting may occur while you are taking birth control pills. Hormonal changes like acne, nausea, depression and dizziness may also occur. Deep vein thrombosis (DVT)  or  blood clot is diagnosed through a host of symptoms that includes pain in the chest, swelling and pain in muscles and legs, and pulmonary or heart-related complications. Alarm bells start ringing; if you experience sharp chest pain, heaviness in the chest, sudden severe headache, sudden partial or complete vision loss, contact your doctor immediately.

Middle-aged women

Intrauterine devices (IUD) are an excellent method of contraception in older women as they are long-lasting and effective. Specific contraindications include abnormal menstrual bleeding and the presence of fibroids distorting the uterine cavity. Condoms and spermicidal creams can also be considered as an alternative. Spermicidal creams help lubricate the dry vagina in older women; whereas condoms provide the advantage of protecting against STDs and HIV infection. Estrogen-progesterone combined low-dose pills have been found to be safe for middle aged and pre-menopausal, non-smoking women, who do not have other risk factors such as smoking, obesity, hypertension, diabetes and familial history of cardiovascular diseases.

Adolescents’ contraception

In general, sexually active unmarried adolescents are not seeking to become pregnant, and married adolescents do not wish to become pregnant early or, if they have already had a child, wish to delay a second pregnancy. Unplanned pregnancies among adolescents happen despite the best of contraceptive intentions, and the effectiveness of adolescent contraception remains below desired levels. However, low dose contraceptive pills and barrier methods like condoms are recommended for this group. In case of accidental encounter, EC pills taken soon after contact but not later than 72 hours of the episode can help in most cases.

The writer is a Chandigarh-based senior gynaecologist.

Clogged arteries — take care, scientifically
Dr Kulmeet Soin

My recent tryst with clogged heart arteries and associated problems makes it imperative that, being a doctor, I separate best-selling myths and little-known facts associated with this disease.

That an individual shall be involved in a disease precipitated by the clogging of his heart arteries is dominantly determined by his genes and his personality. These million buck -yielding diet and exercise programmes (for their initiators, remember Atkin’s) finally say only two things: you move and you eat less, like your much less automobile-dependant and television-loving ancestors did.

Remember that Winston Churchill died on the pot at 91 years of age. Stress, obesity, smoking, drinking and intolerant desposition be damned.

Remember, this too, that not so long ago nuts (like almonds) and peanut butter were only mentioned to be condemned as a component of our diets. Now they hold the place of pride in all diet charts, and lo and behold, dark chocolate and alcohol are God’s own benediction for hearts on a desperate hunt for panaceas to run more.

Atherosclerosis (the official name of the artery clogging phenomenon) is the predominant culprit in leading individuals to death and disability.

The term is derived from Greek, where thickening of the arterial wall (sclerosis, ’hardening’) and accumulation of lipid (athere, ‘gruel’) categorise the basic disease.

Now, to predict which of us is in the run to get this disease, leading us to contribute to damaging world statistics of death due to cardiac disease is a difficult proposition as the facts exhibit.

Myocardial infarction (the dreaded heart attack) is the most common diagnosis in hospitalised patients. The death rate (mortality rate) with acute myocardial infarction is 30 per cent, with more than half the people dying before they reach the hospital (this happens in the industrialized First World countries, but the statistics are more gruesome back home). With the recent state of the art treatment modalities available to industrialised countries, inhabitants and to the rich everywhere, one in 25 of these still die within the first year of the episode. The availability of this treatment is not even in the realm of dreaming-about-it scenario of 94 per cent of our population.

The enigma of unpredictable nature of atherosclerosis is confounding.

It develops in time and space, and occurs over decades. The growth of this gruel is discontinuous rather than being scientifically linear —- it has periods when it lies low (silent) and suddenly it gallops. The reasons for its silence and galloping are yet unexplained. Where and which heart artery it chooses to place itself (this gruel) and where it gallops is not understood contemporarily.

The heterogeneity of this disease, its macabre uncertainties, causes, natural history and clinical manifestations are difficult to explain at this juncture of understanding.

Now this is the icing on the cake of uncertainty of this dreaded disease process. Atheromas are deemed to be obstructing disease processes causing blood flow limitation or arterial occlusion leading to death (sometimes too suddenly, in the prime of life). However, in its full glory atherosclerosis can also cause ectasia and development of aneurysmal disease with an increase in lumen caliber. Hey, presto! Then you have all the gruel in the artery but more blood is actually flowing through your dilated artery.

This confounds all analysis. Myths and myriad magic cardiac remedial bullets flow all around the concerned, worried global community.

The writer is a Ludhiana-based radio-diagnosis expert.

Diabetes: Some useful suggestions
Dr Rajat Gupta

According to the recent estimates by the International Diabetes Federation, approximately 285 million people in the adult age group are suffering from diabetes. India leads the pack with 51 million diabetics, aptly called “The diabetes capital of the world”! In addition, about 8-15 per cent of the adults are in the prediabetic stage. If that is not all, Indians are developing diabetes at a much younger age than anywhere else in world. This affects a person’s most productive years of life adversely and hence the nation’s health and economy as a whole.

Type-2 diabetes occurs in genetically predisposed individuals who are exposed to certain environmental influences. The ongoing diabetes epidemic is the result of today’s lifestyle —- abundance of processed food, sedentary lifestyle, obesity and mental stress. Indeed, epidemiological data suggest that nine of 10 cases of diabetes could be attributed to habits and forms of modifiable behaviour. Poor control of diabetes leads to severe complications in the long term. Diabetes mainly affects a patient’s kidneys, eyes, the nervous system and the heart. In fact, diabetes is the leading cause of end-stage renal disease, non-traumatic lower extremity amputation and adult blindness.

Following a healthy lifestyle can help prevent diabetes: This includes proper diet and regular exercise. About 7 per cent of body weight reduction in prediabetic overweight individuals can reduce the risk of development of diabetes by about 30 – 60 per cent.

How much total calories a day does one require?

A healthy person with moderate physical activity requires 25 - 30 kcal/kg of ideal body weight per day. Out of total calories, 55-60 per cent should come from carbohydrates, 25-30 per cent from fats and 15 per cent from proteins. Five hundred-1,000 fewer calories than estimated to be necessary for weight maintenance usually result in a loss of body weight by 0.5-1kg/week. For weight loss, either low-carbohydrate or low-fat, calorie-restricted diets are effective.

What types of carbohydrates are good?

Carbohydrates should mainly come from whole grains (whole wheat flour and brown rice), legumes, fruits, vegetables and low-fat milk. Refined grains such as white rice, bread and other maida containing foods should be minimised. Also, food should contain a large amount of dietary fibres.

What types of fats are good?

Saturated fat intake such as from diary products, butter and meat should be limited to less than 7 per cent of total calories. Trans-fats should be minimised. Trans-fats are present in abundance in fast foods. Dietary cholesterol intake should be less than 200 mg/day. Monounsaturated fats (olive oil and canola oil) and polyunsaturated fats (Canola oil, mustard oil, sunflower oil, safflower oil and soyabean oil) are preferred.

What type of exercise is preferable?

It should include aerobic exercises (brisk walk, jogging, swimming, etc) of moderate intensity with a minimum duration of 30 minutes per day. Resistance-training exercises are complimentary if there is no contraindication for that. Those with coronary heart disease should consult a cardiologist before initiating any exercise protocol.

With these simple yet effective lifestyle modifications, a person can prevent/delay the onset of diabetes. In addition to diabetes prevention, recent studies indicate that adopting a healthy lifestyle is also beneficial regarding other diseases such as high blood pressure and coronary heart disease. But it is time to do it, not just know it.

The writer is Consultant, Diabetes and Endocrinology, Alchemist Hospital,Panchkula.