|
|
|
|
| HEALTH & FITNESS |
|
|
|
Chronic diseases: Take it as part of life A sugar patient giving a blood sample for a test Dental health and heart disease
A doctor examining the eyes of a patient Health Notes
|
|
Chronic diseases: Take it as part of life Diagnosis of a chronic disease is the first and almost an inevitable shock which one receives during one’s adult life. There is a stage of doubt and denial in the beginning. Sooner, however, the reality needs to be faced as a part of life. An early recognition and acceptance is always good for the long-term management and prevention of later complications. Chronic diseases, often referred to as non-communicable diseases (NCDs), together pose a major health-care crisis in the 21st century. A bane of modern life-style and longevity of life, the crisis has attracted a global call for action for different governments and international agencies, including the UN General Assembly, thus bringing the NCD agenda to the highest level of attention. Considered in the past as ‘life-style diseases’ or ‘a punishment of the rich’, they are even more common and burdensome among the poor, and in developing countries. Chronic diseases include a host of different diseases of which four major groups (cancer, diabetes, chronic cardiovascular problems and chronic respiratory diseases) account for priority action at the international level. India has included chronic mental disorders and chronic renal disease also in its ambit for its control programmes. It is now estimated that one or the other chronic disease (or diseases) is/are likely to afflict almost every individual beyond the age of 60. What the governments do for their control at the national and international levels is a subject of policy and planning. What individuals can do to safeguard the health and cope with the burden is an issue of interest and understanding for all of us. Living with NCDs is a fact of life. How to happily live and cope with a disease depends upon an individual’s personal perceptions and understanding of the disease as much as on the medical facilities available for its treatment. The natural history of chronic diseases is variable from slow (for most of the illnesses) to rapid progressive for others. Fortunately, most of them are compatible with a normal life-span and style with modifications here and there. For example, diabetes, hypertension, ischaemic heart disease, asthma and mental disorders can be effectively managed with regulated dietary alterations, regular medication, avoidance of precipitating factors/triggers, and rehabilitative measures. On the other hand, diseases such as cancer, chronic obstructive lung disease, chronic heart problem, brain, kidney or liver failures are bound to progress sooner and later culminating into a premature fatal end. With appropriate management, the progress of most of these disorders can be delayed and life-span prolonged. More importantly, the quality of life can be significantly improved. It is also an accepted fact that chronic progressive diseases reach an end-stage in their natural history when curative treatments have little to offer. Only about 5 per cent of us are going to be fortunate to die a sudden death; the rest are destined to be bed-ridden from a chronic end-stage disease for variable periods before the final exit. This is the stage for palliative-care — symptomatic management of troublesome complaints (intractable pain, breathlessness, sleeplessness, severe anorexia, vomiting, gastrointestinal upsets, etc). Unfortunately, several of the symptom-relief medicines are also likely to be detrimental to other organs, functions and survival. As a classical example, the powerful opioid drugs used for getting relief from most of the complaints, as given above, may result in fatal respiratory depression. This ‘rule of double-effect’ is acceptable in specific situations, of course, with a multitude of medical, procedural and legal implications. Preventive steps are most important for the individuals to undertake. Four important risk factors which are common to most of the NCDs (i.e. tobacco smoking, obesity, lack of physical activity and alcohol intake) have been identified the world over. Unfortunately, the prevalence of these factors is quite high — physical inactivity is almost universal in India. Obesity is partly contributed by physical inactivity and partly by the intake of unhealthy diet. High intake of sugar, fat and salt is responsible for several of the ill health effects. Incidentally, the risk factors have a significant social, economic and cultural background. The behavioural changes required for their control and avoidance are difficult and slow. Nonetheless, it is important to minimise their occurrence for a meaningfully healthy life. The bottom line of living and coping with chronic diseases is to accept its occurrence and win it over with the available armament. It is worth remembering what was said almost four centuries ago at the dawn of modern medicine — “Acute disease is an act of God; of chronic diseases, the patient himself is the author” The writer is Professor and Head, WHO Collaborating Centre for Research and Capacity Building in Chronic Respiratory Diseases, PGI, Chandigarh Email:
skjindal@indiachest.org |
|
Dental health and heart disease
Heart ailments have a high rate of occurrence. The heart regulates blood circulation in the body. Any disturbance in its normal functioning can lead to disastrous consequences. All the organs of the body function as a single unit. If any part of the body malfunctions, it effects the whole system. Dental patients usually are perplexed as to why before any dental treatment their dentist makes a detailed history of their medical problems. More so, of their cardiac status. The most common question asked to a dentist is: Is there any connection between the heart and teeth? What difference is it going to make on the dental treatment plan? In a cardiac patient, a dental treatment plan is much more conservative and extra precautions are taken compared to a case of a systemically normal, healthy patient.
Cases of heart attack
In such cases, patients are usually put on anti-coagulant drugs (drugs used to prevent blood from clotting) such as Ecosprin, Disprin, Colsprin, etc. These drugs prevent blood from clotting. This implies that if due to some reason bleeding results, then it is likely to occur for a longer period of time than normal. In some cases, there may even be difficulty in controlling such bleeding. If in such a case a dentist has to perform a surgical procedure such as extraction of a tooth, then under cardiological guidance the patient is instructed to stop the intake of such drugs a week before the procedure. Also the dentist may get bleeding and clotting time checked for such a patient before performing the procedure. Moreover, the dentist advocates plain local anesthaesia that is free of adrenaline as the latter can adversely effect the heart’s functioning. Also, dental procedure may stress the patient and since stress can adversely affect the heart, patients are given anti-anxiety drugs. It is also extremely important that the patient’s blood pressure is normal. A written cardiological clearance before undertaking dental treatment is mandatory.
Valvular disorder
Microbial infection of the heart valve leads to a condition called infective endocarditis. Bacteria causing this infection are similar to those causing dental periodontitis (which is an infection of the supporting structures of the teeth). During various dental procedures such as teeth cleaning (scaling) or extraction, these bacteria can enter the blood stream and reach the heart valves where they may cause infection. Hence in such cases dental procedures are undertaken only after proper antibiotic administration.
Patients having pacemakers
Dental instruments which are electrically operated are usually avoided in such cases as they may hinder in the functioning of pacemakers thereby leading to complications. Therefore, it is important that the patient discloses that he/she has a pacemaker fitted. It is necessary for cardiac patients undergoing dental treatment to avoid shortcuts and follow the proper instructions of both the cardiologists and the dentist to avoid complications. The writer is a Ludhiana-based
dentist |
|
How not to damage your eyes with steroids, antibiotics Shikha (28), a doctor by profession, went to an eye clinic for the assessment of her vision for a medical examination at the time of entry into service. It was found for the first time that her left eye was not functioning. ‘I cannot believe it, I can see everything with both eyes open. Are you sure, doctor? How did it occur, when did it occur, can you cure it with glasses?’ On eliciting past history, she revealed that she was diagnosed as a case of spring catarrh/vernal conjunctivitis in a medical college hospital at the age of 10 and was prescribed steroid and antibiotic drops for two weeks. The treatment helped but symptoms returned after stopping the drops. After that she went to several other doctors who repeated the same treatment. She got the impression that these are the only drops to treat or prevent the condition and that she may have to use the same for a long time. She continued with the treatment till date to contain the ‘nuisance of persistent itching’ at her own and was happy that she could prevent the symptoms with the regular use of drops. The eye-doctor pronounced, “You have lost all your vision in the left eye because you have developed glaucoma-related optic atrophy due to the misuse of steroids. We cannot reverse it now.” Shikha was crestfallen and asked if she could sue the doctor who prescribed her the treatment 18 years ago?
The warning
Antibiotics and steroids are very important drugs to treat many illnesses. While antibiotics terminate bacterial growth, steroids are used in treating allergic conditions. Misused, antibiotic eye-drops can be quite irritating to the eye and may cause prolonged redness. Prolonged use can also cause dry eye symptoms. Similarly, the abuse of steroid drops may cause cataract and/or glaucoma in the eye. When taken orally for a long time, steroids may cause problems like muscle weakness, high blood pressure, weight gain, inhibited growth in children, thinning of bones, skin problems like bruising, acne, liver damage and, worst of all, the immune system failure.
Steroid abuse
They give the appearance of an instant miracle cure which matches the expectation level of the client. So, many doctors turn to steroids as the first, rather than the last, line of attack for their anti-allergic effects. Chemists also join in the party to give instant cure by selling expensive drops. The ethical doctors who avoid the use of steroids to save the ill-effects may lose the race.
What is allergic conjunctivitis?
Itching is the most typical symptom of eye allergy in these cases and more than 75 per cent of patients report this symptom when seeking treatment. Symptoms are usually worse for patients when the weather is warm and dry, whereas cooler temperatures and rain tend to assuage symptoms. The number of such patients increases with the change of seasons. Besides the physical discomfort, it also limits activities such as going outdoors, reading, sleeping and driving.
What are common allergens?
Most cases of seasonal conjunctivitis are due to pollen and occur in the hay fever season. Grass pollens in early summer and various other pollens and moulds may cause symptoms later in the summer. Perennial conjunctivitis is commonly due to an allergy to house dust mite, a tiny insect-like creature that lives in every home. Other sources of allergens are animal skin and secretions such as saliva, perfumes, cosmetics, skin medicines, air pollution, smoke, antibiotics and other chemicals.
The message
If the symptoms are mild, a cold compress can be used to provide relief. It is a quick and easy solution without using any medication. Mast cell stabilisers can help patients with allergic conjunctivitis when cold compress is no longer effective. They tend to have delayed results, but they have fewer side-effects than the other treatments and last much longer than those of antihistamines. A common mast cell stabiliser that is used for treating allergic conjunctivitis is sodium cromoglycate eye-drops. Doctors may prescribe steroid drops for a short time to handle a problem. The message is: Do not over-treat, do not self-treat and avoid miracle cures. The writer is a Chandigarh-based eye specialist.
|
|
Health Notes Adelaide:
Teens are becoming so addicted to computer games and the Internet that health experts are calling it a disorder. Distressed parents have been flooding psychiatrists with pleas for help for their children hooked on the cyber space. The condition, known as “pathological Internet misuse”, is growing so rapidly among adolescents and young adults that it could soon be formally recognised as a mental health disorder. International mental health experts are considering including video game addiction and Internet addiction in the next edition of globally recognised Diagnostic and Statistical Manual of Mental Disorders to encourage further study. One mother from Sydney said that her 13-year-old son was so addicted to computer games that he had attended school only intermittently over the past two years and violently resisted attempts to remove him from the screen. — ANI Low-cal diet improves heart function in obese diabetics Washington:
A low-calorie diet eliminates insulin dependence and leads to improved heart function in obese patients with type 2 diabetes, a new study has claimed. Diabetes is a chronic illness in which there are high levels of glucose in the blood, and type 2 is the most common form of diabetes, representing 90 to 95 per cent of diagnosed cases among adults. “Lifestyle interventions may have more powerful beneficial cardiac effects than medication in these patients,” Sebastiaan Hammer, the lead author, said. “It is striking to see how a relatively simple intervention of a very low calorie diet effectively cures type 2 diabetes mellitus. Moreover, these effects are long term, illustrating the potential of this method,” he said.
— ANI 4 or more babies could prevent heart disease in women London:
Mothers who have four or more children are one-third less likely to die from stroke, a new study suggested. Research involving 1300 women in California suggested those who had more children were one-third less likely to die from cardiovascular disease. The majority of the effect seemed to result from the prevention of stroke, as mothers of large families were almost 50 per cent less likely to die of a stroke. “In conclusion, women in this study had less CVD mortality risk if they had more than four pregnancies, with the strongest association observed for non-CHD CVD mortality,” The Telegraph quoted the study’s lead author Marni Jacoobs of the University of California as saying.
— ANI
|
Diagnosis of a chronic disease is the first and almost an inevitable shock which one receives during one’s adult life. There is a stage of doubt and denial in the beginning. Sooner, however, the reality needs to be faced as a part of life. An early recognition and acceptance is always good for the long-term management and prevention of later complications.
Chronic diseases, often referred to as non-communicable diseases (NCDs), together pose a major health-care crisis in the 21st century.
