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by Carol Aloysius

Osteoporosis :Close to the bone

Leslie Hellig was incredulous. At 32, she imagined the pains in her wrists were - God forbid - the first signs of arthritis, and sought a routine X-ray. Instead, she was given the news that she had the skeleton of a very fragile 65-year-old. "I was breastfeeding my daughter, had just found out I was pregnant for the second time, and was on an incredible high," she says. Hellig, now 36, listened dumbfounded as her doctor told her to stop lifting her baby, to stop breastfeeding her, and to get in and out of her car with great caution. Because she was pregnant, Hellig could not be prescribed bone-building drugs. Breastfeeding was considered too big a drain on her bone-protective oestrogen supplies.

Few crises of old age are as widely feared as a broken hip, but it's not in the top of the mind when you're so young. It was only when Hellig flicked through her family photo albums that the signs lit up in her mind: a severely osteoporotic aunt and a frail mother.

Not for nothing is osteoporosis called the silent thief: it creeps through the skeleton over decades, slowly stealing away bone mass without any obvious symptoms. The breaking of bones is merely the end game, the point at which a skeleton has become so honeycombed with pits and holes that a wrist, rib, hip or spine can be cracked with a sudden movement or cough. While it's most common in post-menopausal women, osteoporosis doesn't discriminate against men or those under 40, says Dr. Terry Diamond, an endocrinologist at Sydney's St. George Hospital. "The classic dowager's hump - caused by collapsing spinal vertebrae - is only the most obvious giveaway."

If recent reports from the US are any gauge, bone thinning is now the most grossly under-diagnosed condition in the Western world. All women (and men) who have suffered a spontaneous fracture, all women over 65, and everybody with a family history of osteoporosis should have a DEXA scan, the gold-plated test for bone mineral density, advises Diamond. "Unless they have been knocked over by a bus, anyone over 40 with a fracture must be considered osteoporotic - until proven otherwise."

Why is osteoporosis rapidly turning into the epidemic of the 21st century? Blame it on an ageing population and free-falling activity levels over several generations. As weight-bearing chores have become less a part of daily life, so osteoporosis has soared. "Bones get thicker when they're stressed," says Deborah Kerr, senior lecturer in public health at Curtin University. "They're thinning because we don't do the hard physical labour of the past."

To appreciate the extent that weight-bearing exercise has declined, take the example of an average woman on laundry day 100 years ago. After soaking and rubbing clothes in a boiler, she hauled them onto a washerboard, scrubbed them clean, wrung them out, then lugged them to the clothesline in a murderously heavy basket. It was a task requiring real strength, because of the weight of wet sheets, tablecloths and heavy men's clothing, all of which could total more than 100 kg or more for a family of six.

Examples such as this help explain why osteoporosis is rare in the developing world, even though calcium intakes are dramatically lower than in the West. By the age of 65, the average Western woman has lost between a third and a-half of her skeletal mass, and about a third of her muscle mass. In the ten critical years after menopause, she loses bone at a rate two to four times faster than when she was 30, which puts her at special risk if she goes through early menopause.

Greater idleness is one thing, genetics another. If your grandmother or grandfather had a hip fracture, it's quite likely you will, too. Calcium plays a crucial role in heading off osteoporosis, but it's not just a matter of popping calcium tablets. Western diets are dense with Calcium leeching foods, most notably caffeine and sodium and no woman over 50 should be drinking more than 2 cups a day, or eating processed food more than 3 times a week. Teenagers should avoid 'soft drinks' and 'energy drinks' and drink milk instead to avoid osteoporosis when they are older. Courtesy: American College of Pharmacology.

Air travel hazardous for asthmatic patients

Do you suffer from regular attacks of asthma? If you do, and you also travel frequently by plane, then make sure you take the right precautions. Dr. R. A. Thejasiri Wijesinghe, a senior chest physician comments on the risks of flying for asthmatic patients and the precautions they should take.

For normal people who are healthy, air travel is an enjoyable experience. But for asthmatic patients air travel is not suitable or advisable. Generally for mild asthmatics and those with controlled asthma there should be no problem. But any patient whose asthmatic condition is sufficiently severe should be careful. They must always take medical advice before flying. Patients who develop acute severe asthmatic attacks are unfit for air travel. When they are exposed to adverse and injurious conditions they easily develop severe attacks and have to be admitted to hospital for intensive care.

Flying in a modern passenger aircraft involves exposure to slightly lowered pressures and therefore lowered concentration of oxygen. (O2). Any patient whose asthma is sufficiently severe to cause a reduction in the amount of oxygen (O2) in the blood should definitely seek medical advice before flying.

Following are some important rules to observe when flying, if you have asthma:

(1) It is a well-known fact that all asthmatics should never smoke. As exposure to smoke leads to severe attack , all asthmatics should ask to be seated in non-smoking section of the aircraft.

(2) Asthmatics should avoid winter season when they arrange air travel. If they are compelled to fly during winter they must carry winter clothing and other necessary items to protect themselves from severe cold, snowing, snow storms etc.

(3) Patients should carry sufficient anti asthmatic drugs and inhalers for use during their stay in the country they visit. It is always advisable to take extra drugs as return flight may be delayed due to unavoidable circumstances. Do not forget to take your diagnosis cards, prescriptions and a letter from your family physician regarding your illness.

(4) If you develop an attack while travelling on the aircraft take your normal anti asthmatic drugs. It is always easy and convenient to use an inhaler as it gives rapid and immediate relief. (5) When patients develop an acute severe attack when they are abroad, they should consult a doctor immediately and seek his advice. Patients should take all the necessary documents when they go for consultation.

These help the foreign doctor to assess your new episode and give you rapid relief. Dr. R. A. Thejasiri Wijesinghe, Chest Physician.

Are you Homophobic?

by Dr. R. A. R. Perera , Visiting Psychologist, Police Hospital, Colombo

The term homophobia often is used to denote the irrational and persistent hatred of homosexuals. Many heterosexuals characterize homosexuals as being sick and dangerous. Because many people's reactions to homosexuals have been so extreme, psychologists suspect that these reactions are phobic - that is, that they are based on a fear beyond the realm of rational.

Deviating from a community's sexual norms often has resulted in punishment for those persons who so deviate and who are discovered. Homosexuals, especially males, have been subjected to ridicule, exclusion and physical abuse over the years. When someone is identified as a homosexual, people often avoid being near him or her.

When a group is told that a male group member is homosexual, that individual often becomes one of the least popular members of the group - even if he had been one of the most popular group members before being labelled. Further a man who is being labelled as homosexual is evaluated as being less honest, unfair, unhealthy, unstable and with a low intellectual ability.

Psychologists have offered a variety of explanations for homophobia. Sex role training that places a strong emphasis on being either male or female is one possible causal factor. Boys learn at an early age, that displaying feminine characteristics exposes them to ridicule. Some western countries are less rigid in the rules of sex-appropriate behaviour and they are less homophobic. Some psychologists believe that homophobia may have its origins in individual's doubts about their own sexual preferences. By directing hostility toward homosexuals, an individual may convince him that he is not homosexual.

A heterosexual who finds that he may have characteristics similar to those of a homosexual become particularly negative in their evaluations of homosexuals. People tend to dislike those people who are different and this dislike can form a basis for prejudice. At times even the slightest indication that another person is different may be enough to produce prejudice and discrimination.

Why do people have such discriminatory reactions? One reason is that a dissimilar person can be a threat to one's self-esteem. The difference in beliefs calls an individual's own belief in to question.

Prejudice persists and is expressed if sustaining mechanisms are present to support and maintain it from one situation to the next. Without sustaining mechanisms an individual's attitudes and actions may change as circumstances change.

The persistence of prejudice depends largely on the social support that the prejudices receive. If expressing prejudices elicits acts of friendship, then prejudiced attitudes are hard to give up. These individuals possess highly traditional views about family, women and religion. Majority of them believes that families should have a dominant father, a submissive wife, and obedient children, and they often are fundamentalist in their religious beliefs.

In Sri Lanka the attitude towards homosexuality is generally negative. But the magnitude of this 'problem' is seen in school hostels, training camps, prisons, armed forces, etc. Even with rigid rules and regulations the prevalence is substantial. Some times in schools in a homosexual relationship, the dominant partner is regarded as a hero among other school children, and they would like to be associated with the dominant partner specially if he is a popular personality. This might lead to a situation where homosexuality becomes an accepted behaviour among some of the students.

Members of men or women's groups that concentrate on problems of intimacy, communication and friendship have become accepters of homosexuality.

Bottled water draft regulations

TheBottled Natural Mineral Water and Bottled Drinking Water industry has expanded in Sri Lanka in the recent past. The import of bottled water is also on the increase. In view of the money spinning nature of the industry and the potential for production of spurious bottled water was brought to the notice of the FAC. The FAC has therefore decided that this industry and imports should be brought into some control with the view to safeguard the consumers.

The draft Food (registration of Bottled (Packaged) Natural Mineral Water and Bottled (packaged) Drinking Water) Regulations was the result of this decision.

According to these regulations, it will be an offence for any person to manufacture or import bottled water except on registration with the Chief Food Authority. Chief Food Authority would register such premises or importation only if the conditions stipulated in the regulations are fulfilled. The conditions include General Requirements, Hygienic Requirements, Physical, Chemical and Microbiological Requirements, Packaging and Labelling Requirements. The bottled water should also comply with Chemical and Microbiological requirements prescribed separately for Natural Mineral Water and Drinking Water.

Officials of the Food Control Administration Unit assisted by the Field Officers will carry out extensive inspection and evaluate the suitability of the premises prior to being registered, and further carry out periodical inspection of the facilities to determine termination of registration due to failures or continuance.

From our readers...

Helping the hearing and speech disabled to communicate

Q: I am interested in the article that appeared in the Sunday Observer of 4th Aug. under the headline mentioned above. Please help me by giving the address or the place where the two women Savitri and Lasni de Alwis could be contacted. - P.A.D. Nanayakkara

A: Thank you for your letter. Due to the large number of requests of the speech therapists we featured in our Health Page sometime ago, we give you Miss Lasni de Alwis's address. She can be contacted at: No. 6, Mallikarama Road, Ratmalana. Her telephone number is 724903.

- Editor

Causes and prevention of suicide

Q: Having read the above article which was published in page 27 of Sunday Observer, I am writing this letter to make a request. There is a 20 year old boy who is a relation of mine having most of the symptoms mentioned in the above article. However, he has not spoken of suicide, to my knowledge. To assist this boy to get over his situation, I wish to know whether he could be taken for counselling to the writer. If so, please inform me how I could set about to do it. Concerned

A: Dear Concerned,

I am sorry we are not in a position to give you the address of the writer of the article in suicide which appeared on this page on August 04. However it would be advisable to take the young man to a psychiatrist or an organisation like Sumithrayo which helps in counselling people with suicidal tendencies, as soon as possible. The address of Sumithrayo is No. 608, Horton Place, Colombo 7. The telephone No. is 692909.

- Editor

Kaunch - the miracle herb that cures most ills... Q: I came across this interesting article which appeared in the India Perspective of August 2001. I strongly feel the publication of this article in your page will be of benefit to your readers. M. Azhar Dawood Kaunch (Mucuna prurita) is a herbaceous twining climber. Its leaves are trifoliate and its purple flowers appear in axillary, pedulous racemes. The pods are slightly curved in the shape of the letter 'S' longitudinally ribbed and turgid, each being three to four inches long and containing four to six brown to blackish kidney shaped seeds.

The plants grow in damp places, ravines and scrub jungle throughout the plains and tropical areas of India.

Kaunch is notorious for the bristly hair that cover its fresh and dry pods and which cause intense itching on coming into contact with skin - to the extent of causing blisters and even dermatitis.

Its root, seeds and legumes are much valued in the Indian systems of medicine. The root is tonic, stimulant, diuretic, purgative and emmenagogue. It is used for diseases of the nervous system, kidney troubles and dropsy. An ointment prepared from the roots is applied in elephantiasis. A strong infusion of the root sweetened with honey is given in cholera morbus. The root is also useful in curing fever related delirium. It is powdered and made into a paste for application in dropsy.

The seeds are astringent, anthelmintic, a nervine tonic and aphrodisiac. They are prescribed in the form of powder in leucorrhoea and spermatorrhoea. A standard compound preparation containing these seeds and other herbs is said to be the best aphrodisiac. This preparation is also useful in leucorrhoea, profuse menstruation and in paralysis. The seeds are said to absorb scorpion poison when applied to the part stung.

The leaves of this plant are applied to ulcers. An infusion of the pod-hair is used in diseases of the liver and gall bladder and applied externally as a local stimulant and mild vesicant.

Swami Prakashananda Ayurveda Research Centre in Mumbai, during a clinical trial observed their usefulness in the treatment of Parkinson's disease as well. The plant is even cultivated in some parts of India for its pods, which are cooked and eaten as vegetable. The leaves can also be used as fodder. Courtesy: India Perspectives

A reader suggests ... The correct procedures of dispensing drugs

Last week we spot lighted some common doctor-made illnesses. The following suggestions sent by Dr. W.Y. Rambukwella show you how these illnesses can be avoided.

Many patients discharged from hospital are given drugs to be continued at home. If such a patient had to consult another doctor, particularly in an emergency, it would be a great help to the second doctor if the NAME and STRENGTH of each drug were written together with the other instructions because doctors cannot identify a drug from the size, shape or colour of a tablet or capsule; it would also be risky to try to do so.

To site an example, my sister-in-law was in the Cardiology Unit recently for four weeks. When she was discharged two kinds of tablets were given in two small polythene bags, Instructions were written on a strip of paper in each bag but the NAMES of the DRUGS were not stated; she became unwell again and it was important to know the names of the drugs she was taking and I had to phone the Cardiology ward to get this information.

If the patient had to get another supply of the drugs from a pharmacy outside the hospital the second pharmacist will not be able to identify the drugs with certainty without the names and any guess work would be unsafe for the patient. Most tablets, capsules and injections come in different strengths; e.g.: Digoxin tablets: 0.25 mg and 0.0625 mg.

Thyroxine tablets: 0.05 mg 0.1 mg

Stating the strength of a drug in the instruction slip is very important to eliminate errors in dosage.

Most patients are educated and at least they should be told the names of the drugs they have been prescribed and, ideally, the reason for giving each drug and its main adverse (side) effects. If a pharmacist dispenses a wrong drug due to the prescribing doctor's hand writing being illegible, any complications to the patient arising there from would be easily and readily explained if the pharmacist has written on the instruction label the name of the drug he/she actually dispensed.

Surgery in homoeopathy

In Sri Lanka, most of the homoeopathic medical practitioners do not know the types of cases in which surgical treatment is required. As a homoeopath and a specialist in Unani medical System, I would like to strictly point out the subject on surgical treatment to save patients. A homoeopathic physician is one who can perceive what is to be cured in every individual case of disease and observe the cardinal principles of homoeopathy. He should have up to date knowledge of medicines to eradicate suppressions produced by drugs of other systems of treatment, and the causes discovered by investigations which help him in the cure of the patient.

Surgical diseases are those in which surgical treatment is essential in order to bring about complete restoration of health to the patient. These conditions may be physiological or pathological.

For example: during pregnancy in women suffering from contracted pelvis, the homoeopath has to send the patient to a surgical ward for the safe delivery of the child. It is a physiological condition. In such a case it is not possible for medicine to bring about safe delivery, specially as it is a mechanical job, so it should be done in the Surgical Unit of the hospital. Unfortunately, we have no homoeopathic govt hospitals in Sri Lanka, but there are Allopathic government hospitals where we want to send the patients.

Furthermore on pathological conditions eg: in case of intestinal obstruction the disease cannot be cured by a homoeopathic remedy but requires a surgical operation. In case of fractures if it is essential to take the help of a surgeon and x-ray specialist too; bring about the correct alignment of the bones in order to help the union of bones. Thus there are certain cases in which surgical help must be taken by a homoeopath.

Some surgical diseases can be cured by homoeopathic remedies eg: Tonsillitis, Appendicitis, Hernia, Haemorrhage, piles, etc.

Dr. Hebnemann has given a special category in the classification of diseases to surgical diseases. There too, the all homoepathic medical practitioners would better follow him to avoid unnecessary problems in the homoeopathic field.

By Dr. Y. M. Mousoom

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