Proper mattress & pillow can help manage back, neck problems
Dr Ravinder Chadha

Posture is defined as the “attitude of the body”. A good posture means bones, muscle and ligament work together in harmony, protecting the body from injury or deformity.

Patients suffering from low back pain are always in a fix about the choice of their bed/mattress. They always consult their physicians regarding the posture they should adopt while lying in the bed. Their inquisitiveness is genuine as the correct posture in the bed reduces their discomfort and helps in the healing process. An individual sleeps during the night for quite a few hours. Therefore, maintaining the right posture during sleep is extremely important. A proper posture allows the muscles, ligaments and other structures in the spine to relax completely.

There are so many advertisements regarding the selection of mattresses/pillows these days. Sleeping on a right mattress/pillow can contribute to proper rest, and a person wakes up refreshed, whereas sleeping on a wrong mattress/pillow can increase back/neck pain and cause sleeplessness.

The choice of the mattress is a matter of personal preference. Mattresses should be selected for the sake of comfort and decreasing the symptom of back pain, but no one should expect that by changing a mattress one’s back problem will be cured.

In general, a firm mattress gives more support to the spine. Our mattress should not be too hard which can cause discomfort at the back and hips. If one feels comfortable on a soft mattress, then one should not be forced to use the firm mattress. As a matter of fact, the best mattress is that on which a person can sleep well and get up refreshed without any pain and distress.

People suffering from a back problem are always in a fix regarding the choice of mattresses, sleep position, etc.

lPatients suffering from arthritis of the back feel comfortable by sleeping on a soft mattress as it produces fewer loads on the spine. Such patients also prefer to sleep in a side position with the knees curled up. This position reduces pressure on the joints.

lPeople suffering from disc diseases feel comfortable by lying on their back on a firm mattress with knees flexed. This position decreases the stress on the spine; alternatively, a small pillow can be placed on the back of the knees to relax the spine.

lPatients suffering from hip pain can sleep on their sides by placing a pillow between their knees which reduces the load on the hips.

It is always better to lie on the mattress before its purchase. If one feels comfortable, only then the mattress should be purchased.

There are many factors which should be seen in a mattress:

Padding on the top is good, but this is a matter of personal liking as some people like thick padding and some thin.

To support the spine, a good mattress should contain enough coils. Very soft mattresses contain only a few coils which leads to an increase in the contours of the body, thereby causing low back pain.

Pillow

Our neck is prone to unintentional movements especially while sleeping. It is ideal to use a feather, plastic filler or home-made pillow. When we sleep our neck should be fully supported by a pillow to avoid sagging lower than the neck. Also, the neck should not be bent too forward by too many pillows. Pillows structurally supporting the natural curve of the neck are ideal.

Support of the neck curvature while sleeping on the back can be easily achieved by using a soft pliable pillow under the head and the neck and bringing the two corners up over the shoulders.

Patients should be discouraged from sleeping on stomach with the head turned to one side as this places undue strain on the neck joints and muscles. One solution for stomach sleepers is to use a pillow under the chest to minimise head rotation. Another is to try and break the habit by tying a sheet around the waist with the knot on the stomach.

Side-sleepers should concentrate on having sufficient pillow support between the head and the neck, and not between the shoulder and the bed that support the spine in a neutral position.

Foam or rubber pillows should be avoided because their springiness aggravates muscular spasm. There are no hard and fast rules, but sleeping on a wrong mattress or pillow can increase back and neck pain and can cause sleeplessness.

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

Hepatitis C: Search for cost-effective cure
Dr Harish Verma

Viral hepatitis is caused by five different viruses known by alphabets — A, B, C, D and E. Of these, hepatitis A and hepatitis E are food-borne and are cured by the body’s immunity. While hepatitis B, C and D are blood-borne and often go unnoticed for up to 20 years in the body, the hepatitis C virus (HCV) can cause fibrosis, or scarring of the liver, and worse, chronic cirrhosis. There is no vaccine for it.

A blood-to-blood disease, scientists are currently not too sure if HCV is also passed on through sexual contact. What they do know is that it is passed on through infected syringes or even infected blood touching an open wound on Tattooing with unsterilised and reused equipment is a definite route of transmission for hepatitis B and C as well as HIV. There is also a rising concern about beauty treatments where abrasive material removes dead cells.

HCV thrives for days even on work surfaces where dead skin cells may have fallen. If the spa or salon does not use stringent sterilisation techniques, clients may be exposed to the virus. Nail cutters, which are commonly shared in family, can also be a source of transmission of hepatitis.

Hepatitis C can occur in two phases:

Acute: Acute hepatitis C refers to the first six months after infection with HCV. Most people suffer no symptoms upon infection, but for those who do, the main symptoms are generally mild and non-specific, and rarely lead to a specific diagnosis of hepatitis C. Symptoms of acute hepatitis C infection include decreased appetite, fatigue, abdominal pain, jaundice, itching, and flu-like symptoms. Persistent infections are common and most patients develop chronic hepatitis C — infection lasting more than six months.

Chronic: Chronic hepatitis C is defined as an infection with the hepatitis C virus persisting for more than six months. Clinically it is often asymptomatic, and is mostly discovered accidentally (e.g. usual check-up).

Once chronic hepatitis C has progressed to reach the stage of cirrhosis, signs and symptoms may appear that are generally caused by either decreased liver function or increased pressure in the liver circulation, a condition known as portal hypertension.

Possible signs and symptoms of liver cirrhosis include ascites (accumulation of fluid in the abdomen), bruising and bleeding tendency, varices (enlarged veins, especially in the stomach and esophagus), jaundice and a syndrome of cognitive impairment known as hepatic encephalopathy.

Treatment

The current treatment option includes a combination of pegylated interferon-alpha-2a or pegylated interferon-alpha-2b, and the antiviral drug ribavirin for a period of 24 or 48 weeks, depending on the genotype of hepatitis C virus. Treatment is generally recommended for patients with proven hepatitis C virus infection and persistently abnormal liver function tests.

A large number of patients will experience side-effects ranging from a flu-like syndrome (experienced for a few days after the weekly injection of interferon) to severe adverse events, including anaemia, cardiovascular events and psychiatric problems such as suicide or suicidal ideation. The latter are exacerbated by the general physiological stress experienced by the patient. Moreover, there are a large number of patients who don’t respond to the antiviral therapy leading to the need for a cost-effective alternative therapy.

But the current therapy couldn’t get much popularity in India, China, Bangladesh and Bhutan as it is very expensive and the treatment may be physically demanding, particularly for those with a prior history of drug or alcohol abuse. It can qualify for temporary disability in some cases.

Herbal treatment

Some herbs have been found to be effective for the treatment of Hepatitis C. These can be classified as hepatoprotective (these protect liver cells against the harmful effects of HCV and normalise liver enzymes), immunomodulator (increase the body’s immunity and boost our fight against virus) and antiviral (which stops virus from multiplication). In one clinical study it was found that if these three types of herbs are given in one go they are very effective to decrease the viral load as well as in the normalisation of liver enzymes. These herbs need further clinical data and research. These can prove to be a ray of hope for a cost-effective interferon-free treatment.

The writer is a Delhi-based senior ayurveda specialist. Email:drharishverma
@gmail.com

Lysosomal storage disorders
Rare, but it can happen to your child as well
Dr I.C. Verma

A disease is considered rare if it affects a small percentage of population. The precise definition varies in different countries, from one in 1500 in the US, one in 2000 in Europe and one in 2500 in Japan. However, there are almost 4,00,000 people having rare disorders in India.

The lysosomal storage disorders (LSD) is one such group of rare diseases. Although individually rare, collectively lysosomal disorders affect one in 10,000 infants at birth. In India, their frequency is expected to be higher due to consanguineous marriages in many communities. Using even lower figures, it is estimated that about 2600 infants affected with LSDs are born every year in India.

In LSDs, there is a defect in the special chemicals called enzymes that are required to break down certain waste products in the body. As these enzymes are found in a compartment of the cell called lysosomes, hence the name given to these disorders as LSDs. As a result of the deficiency of the enzyme, various "waste products" inappropriately accumulate in the cell. Over time, the amount of material building up in each lysosome causes it to swell and occupy more space in the cell, leading to interference with normal cellular function. Thus, the liver, spleen, and bone get enlarged and the skin becomes coarse. This results in a wide variety of clinical symptoms.

LSDs affect mostly children. Due to a lack of awareness the diagnosis is often made late. Almost 30 per cent of the affected children die at a young age. The lack of awareness is such that many times the affected child dies before a definite diagnosis is made.

Due to recent advances many LSDs are now treatable with enzyme replacement therapies. This means that the enzyme which was deficient is now manufactured and given as an injection to the affected child, reversing the clinical symptoms. The first ERT (enzyme replacement therapy) to be developed was for Gaucher disease, the most common of the LSDs. The other common lysosomal disorders for which enzyme treatment is available are the Hurler syndrome (MPS type 1), the Hunter syndrome (MPS type 2), MPs type 6, Pompie's disease and Fabry disease. Enzyme therapy for many other disorders is also being developed. For example, for MPS 3 and 4, it is already under clinical trial.

There is one caveat, however. The available treatment with the enzyme is beyond the affording powers of many parents in India. People living with lysosomal storage diseases often display unusual courage, tenacity and grace in dealing with extraordinary challenges thrown up by their disease.

However, these children need the support of society and the government so that the life-saving treatment with the enzyme can be provided to them. Family members of LSD patients around the country are trying to reach out to the government and other institutions for their support so that their children get the required treatment and can lead a normal life.

In India major support has to come from the government, which should set up facilities for screening, early and accurate diagnosis, appropriate enzyme therapy, and rehabilitation to making the patients' lives more comfortable. Centres should also be created for diagnosing these disorders during pregnancy so as to limit the number of the affected infants being born with the disease. The immediate and pressing need, however, is that the government should work out a scheme to provide free treatment for such patients, as the number of cases with such disorders is manageable.

The writer is the Director, Centre of Medical Genetics, Sir Ganga Ram Hospital, New Delhi