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| Sunday, 23 March 2003 |
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Features |  |
| News Business Features Editorial
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Irritable bowel syndrome: a mind related disease by Dr. R. A. R. Perera The diagnosis of irritable bowel syndrome is based on the exclusion of organic disease in a patient complaining of abdominal pain and a disordered or irregular bowel habit. Patients are often subjected to numerous repetitive investigations, even including surgery in some cases. The results of these time-consuming and expensive tests are invariably normal. Sooner or later the patient's symptoms are ascribed to psychological causes and labelled as functional. Excessive and unco-ordinated segmental contractions of the large bowel have been reported in patients with irritable bowel disorder. An abnormal psychological mechanism can cause this disordered function of the bowel. The tendency to this disorder may be congenital or acquired. In Sri Lanka, despite the widespread occurrence of irritable bowel disorder, and the large number of patients in whom the diagnosis is made, few formal studies of the psychological aspect of this condition have been carried out. There is high incidence of depression, anxiety and marital difficulties in patients complaining of irritable bowel disorders. The obsessional personality with traits such as orderliness, rigidity, conscientiousness and preoccupation with planning and detail, has been emphasised in these patients. There is no doubt that emotional states can profoundly affect bowel function. Irritable bowel disorder is a chronic condition characterised by relapses and remissions. There is an association between relapses of this disease and critical life events. Depression: Changes in appetite and weight are common in depression. Anorexia and retardation of activities, which is associated in depression, can cause constipation. Diarrhoea may occur in agitated patients. Abdominal pain may also be a feature of depression. Anxiety: The biological accompaniments of anxiety often include diarrhoea. Muscle tension associated with anxiety may produce abdominal pain. Morbid preoccupation with bodily function, and especially bowel function, may be a feature of anxiety states. Management: It is essential to establish the diagnosis and to carry out all the investigations necessary for the exclusion of organic disease at the outset. After that, the approach to the patient should be holistic, with the emphasis shifting from the somatic to the psychological. The treatment therefore, does not consist of prescribing either an antidepressant or a high fibre diet, but should be adjusted to suit the circumstances of each individual. The relationship between the doctor and the patient is especially important. Patients with irritable bowel disorder often need repeated opportunities to discuss their symptoms with the doctor. The doctor should accept, and be seen to accept, that the symptoms are real and not imagined by the patient. Irritable bowel disorder is a chronic relapsing condition which extends over many years, sometimes from childhood. Whatever the treatment the condition could last for a long period of time. In Sri Lanka native treatment offered by the 'vedamahaththaya' is a popular way of treating irritable bowel disorder. Some times it is an effective treatment either due to the medications or due to the psychotherapy which is apart of the 'treatment'. ############ Childbirth - Nature's way If a close friend or relation or even your wife who is pregnant goes into labour without prior warning and there is no time to call a doctor or midwife, here's what you should do, says Dr. Y. M. MAUSOOM. Birth is a natural process. A woman having her first baby will feel mild labour pains about 15-16 hours before delivery. If you ever must aid in a birth that occurs without benefit of physician or hospital, chances are great that you can do so successfully keeping in mind certain golden rules. Dilation, expulsion or delivery and expulsion of the placenta are all stages of childbirth we are familiar with. The dilation stage is usually the longest. During this stage, the cervix gradually dilates from small opening to about four inches (Fig. 2,3) in order to allow passage of the baby's head. The labour pains increase frequency usually occurring at 10 minutes intervals, then gradually progressing to 4 minutes, 3 minutes, 2 minutes, 1 minute or a little less. Labour pains are involuntary; the mother should not try to beardown, but rather should relax as much as possible. And to help, you can provide reassurance and make her as comfortable as possible. In the stage of expulsion or delivery, the cervix is completely dilated, (Fig. 4) the baby is ready to slide down. In this time mother may feel as though she needs to have bowel movement because of the pressure of the baby's head on the rectum. Explain the reason for the feeling and reassure her. She must not be allowed to go to the bathroom as she could have the baby in the toilet. Although the bag [fluid and blood-stained mucus] may break out at anytime of the first stage or the beginning of the second stage. This is expected do not be alarmed by it. Painful Delivery is close at hand when strong contractions are coming 1 to 3 minutes a part and a bulge appears at the vaginal entrance. Now the mother should try to bear down with each contraction. She should be lying on her back with knees drawn up. Do not attempt to hurry on interfere with the birth. In a normal delivery, the first sign of the baby usually will be the top of the head, beginning to appears with each contraction. This is called "crowning" and once it occurs the baby will usually deliver within the next two or three contractions. By placing your hand gently on the baby's head [Fig 5], you can help to assure slow emergence with each contraction. Do not attempt to hold the baby back. As the baby's head emerges, it is usually with face downward, but then there is quick rotation to face the mother's thigh in order for the shoulder to be delivered. (Remember that the vaginal opening is oval, with the long diameter running in the longitudinal axis of the body). About one minute after the head is delivered, another contraction will cause delivery of the shoulders and rest of body. There should be some difficulty with shoulder delivery. Usually the top of shoulder appears first, and a very gentle downward pressure on the baby's head toward the floor with help bring the shoulder out. Thereafter, a slight upward pressure on the baby's head may help bring out the other shoulder. During the delivery process, support the baby on your arms to prevent its falling. And after the head appears check to see if the cord is wrapped around the neck; if it is, quickly loosen it or slip it over the baby's head to avoid risk of strangling. Usually, the baby will start to breathe and cry within two or three minutes. Holding the infant securely by the ankles and back, raise his body enough to permit mucus to drain from chest and throat. [Fig.6]. Wipe his mouth with a clean cloth or gauze, and pull the tongue gently forward to open the airway. To help get the baby breathing, do not slap but rather stroke the back vigorously or stroke upward from the bottom of the neck toward the chin. If breathing still does not start, cover the baby's mouth and nose with your mouth and puff gently and briefly, at a rate of about 20 a minute. Usually the baby will breathe after a few puffs. Then, place the child between the mother's thighs and cover to keep him warm. Do not cut the umbilical cord until the placenta is expelled. [Fig. 7]. Expulsion of the placenta, usually occurs within a few minutes after the delivery. Do not try to hurry the expulsion process by pulling on the cord or placenta. Contractions, which stopped after the birth, starts again to expel the placenta. You can gently massage the mother's abdomen to help the uterus to contract. If the mother bleeds after the placenta is expelled, use a sanitary napkin to help absorb the blood. Wrap the placenta in a towel and retain it so it can be checked by a doctor to make certain all of it has been expelled. Cutting the cord: [Fig. 8]. There is no urgency about this. In no circumstances should the cord be cut until it has stopped pulsating, which usually happens about five minutes after delivery. To sever the cord, first, using clean cloth strips or tape, tie a square knot reinforced with an extra tie - around the cord about four inches from the baby's abdomen, and tie another, reinforced knot about two in inches further away. Tie the knots securely so there is no danger of the baby haemorrhaging when the cord is cut. Cut between the two knots, using a scissors or other clean surgical instrument which has been immersed in boiling water or soaked in alcohol. Cover the cord and on the baby with a sterile dressing. Keep mother and baby warm. Notify the mother's obstetrician or other physician. In case of complication, get the mother to a physician as quickly as possible. The physician, will need to use instruments for delivery or a cesarean section may be required. Most of the complications are early found out by the obstetrician [VOG] with the help of scanning. ############ You & Your Doctor by Dr. S. N. Nanayakkara Speech disorder Q: My son who is now 15 years has been stammering from his childhood. Since of late his problem seems to be gradually worsening. I have shown him to paediatricians, psychiatrists and at last to a speech therapist. But nothing seems to be coming out from their treatment methods. I am desperate on this issue. Could you advise me where should I go next for treatment? A: Stammering is a speech disorder in which there is lack of co-ordination of the normal mechanism of speech so that sufferer has difficulty in producing certain sounds particularly the "Plosive" consonants, such as 'B' and 'P'. There is no drug treatment for stammering. Speech therapy also works only if started at early childhood to avoid the firm establishment of this habit of speech. The embarrassment so often caused by having a stemmer also tends to breakdown the self confidence of the sufferer, which further aggravates the condition. Clinical Hypnotherapy is the best treatment mode for stammering. This too, to be done by a medically qualified doctor who knows Hypnotherapy as a treatment procedure, after having thoroughly investigated the physical state of all systems of the body. ############ Secret to a healthy future The Ministry of Health is in the process of developing a ten year master plan to strengthen the health system in Sri Lanka. Here are some observations from a reader A country could be considered as prosperous only when the following conditions are satisfied: (1) Good Health, (2) Availability of human resources, (3) Full employment, (4) Availability of healthy food, including clean drinking water, (5) Comfortable housing, (6) Hazard free environment, (7) Abuse free society. i.e. Drugs, Sex, Child labour etc. The main aspect is health and its awareness by the public. If a country's economy is good and the health is poor, it serves no purpose. In Sri Lanka the main killer is heart diseases with diabetes taking the second place. Stroke, high blood pressure, cancer and AIDS are also on the increasing trend. Health in our country could be improved to a satisfactory level by the following steps: (1) The Government should be made aware of the requirements: Statistics should be available on type of diseases prevailing at particular districts or areas, availability of suitable drugs in sufficient quantities, availability of suitably qualified medical practitioners, general environmental conditions etc. (2) The following matters should be looked into: (a) Availability of healthy food, drugs etc. at affordable prices, (b) Preventive measures to control spreading of diseases in epidemic levels (c) Availability of adequate medical services, (d) Allocation of funds. Health Services could be categorised as follows: i. Special and costly service - Coronary By-pass surgery, Open heart surgery, Kidney transplant etc., ii. Specialised Service-Heart diseases, Diabetes, Cancer etc., iii. Emergency Service, iv. Normal Service. Hospitals The Government should develop maintenance of at least 4-5 well equipped super hospitals with all facilities such as scanning, operations, ambulance service etc. These super hospitals could be established on provincial basis and Co-operative hospitals with moderate facilities could be established on district basis. This will reduce the overcrowding at large hospitals. Hospitals for specialised treatment such as cancer, tuberculosis, mental ailments etc. should also be properly maintained. Preventive measures This involves: (a) Environmental Study of: Pollution of water and air, healthy sanitary conditions, control of factory waste products, usage of pesticides in agriculture etc. (b) Child health: Children should be taught at their very young age about the importance of general cleanliness, with special attention paid to food and clothing. They should also be educated about the diseases caused by domestic animals such as dogs, cats and others like pigs, rats and snakes. (c) public eating houses: Strict control and regular checks should be carried out at food outlets ensuring contaminated and outdated food or food banned for consumption are not served to the gullible public. (d) Diseases: Diseases are spread mainly due to public ignorance. proper steps should be taken to educate the younger people. Alternative medicine: The Government should give equal prominence to alternative medicines such as ayurveda, homeopathy, acupuncture, acupressure, pranic healing etc. Adequate facilities should be given to our students to specialise in such fields of medicine. It is important to introduce these treatments at every hospital. Slow poisoning The Government should educate the public on the adverse effects of the following that cause slow poisoning: (1) Narcotics, (2) Liquor, (3) Cigarettes, (4) Tobacco, (5) Sweetened drinks in excessive quantities, (6) Drugs taken without medical advice, (7) Drugs used continuously over long period of time. Fake doctors It is regrettable to note the increased number of fakes who pose off as "Specialists" and gain employment in government and private medical institutions. - S. R. Balachandran ############ The bitter truth about sugar by Dr. D. P. Atukorale Sugar is the generic term used to identify simple carbohydrates which includes monosarccharides such as fructose, glucose or glactose and disaccharides such as maltose and sucrose (white table sugar). When fructose is the primary monosaccharide in your diet the glycemic index registers as healthier since this simple sugar is slowly absorbed from the gut and then converted into glucose in the liver and helps to get a gradual rise and fall of blood glucose levels. If glucose is the primary monosaccharide consumed, the glycemic index will be higher and less healthy for the individual as glucose is pumped across the intestinal wall directly into the blood stream. Glycemic index of foods such as pulses, oats pasta and granary bread is low as these are slowly absorbed and these achieve a better post prandial blood glucose. When the blood glucose level is too low, the person feels lethargic and can cause clinical hypoglycaemia. When the blood sugar levels are too high, this creates diabetic health problems. Excess blood glucose may initiate yeast overgrowth, blood vessel thickening (atherosclerosis), heart disease and other health problems. Sugar feeds cancer Cancer patients may have a better outcome if they control the cancer preferred fuel namely glucose. If the cancer growth can be slowed down, the patient can allow his immune system to reduce the bulk of the tumour mass to catch up to the disease. Controlling one's blood sugar levels through diet, supplement exercise, meditation and prescription of drugs when necessary can be one of he most crucial components to cancer recovery program. Obesity in children Obesity in children correlates strongly with intake of sugar and sweetened drinks. Each additional serving of sugar sweetened drink per day increases the risk of obesity by 60 percent. The ideal diet to prevent heart disease (IHD) is based on complex carbohydrates and not on simple carbohydrates. Complex carbohydrates include fruits grams, vegetables and legumes (beans) in their natural forms and sugar found in complex carbohydrates are absorbed slowly thereby helping to keep the blood sugar levels constant and so they do not stimulate your body to produce excessive amounts of insulin. In contrast simple carbohydrates sugar and other concentrated sweeteners like honey and alcohol which your body converts to sugar are absorbed rapidly causing your blood sugar to rapidly increase. In response your body secretes insulin to lower blood sugar levels to normal. Some other effects of insulin Besides regulating your blood sugar level, insulin stimulates the secretation of lipoprotein lipase which is an enzyme that increases the uptake of fat from your blood stream into fat in your body's cells. As a result when your body produces more insulin you are more likely to convert the dietary calories into body fat. Eating refined sugar (both white and brown) causes your blood sugar to rise rapidly. In response your pancreas begin to churn out insulin causing your blood sugar level to fall rapidly. As your blood sugar level begins to fall, the pancreas begins to stop secreting insulin but not fast enough so your blood sugar level may dip even lower than it was when you started and when this happens you may feel tired and run down. ############ The 'vegetarian athlete' For centuries people believed that meat was important for athletes and the 19 century German Chemist Liebig proposed that the energy for all muscular movement came from protein. But by 1850, scientists knew that the important fuels for physical activity were actually carbohydrate and fat, not protein at all. Long before meat based diets fell out of favour for athletes there were successful vegetarian athletes. In 1906 Prof. Irving Fisher of Yale University was intrigued with physical endurance of "meat - abstainer" athletes. Prof. Fisher studied three groups (a) meat eating athletes (b) vegetarian athletes and (c) a group of sedentary vegetarian nurses and physicians in Michigan. His results showed a remarkable superiority of vegetarians over meat eating athletes in all the tests of endurance. Today some of the best athletes continue to defeat the idea that meat is essential for strength. Muscle is mostly water, but it does contain about 25 per cent protein. The amount of protein consumed varies widely among athletes. Two surveys found that football players and tri-athletes consume more protein than the typical non athletes - about two and half times the RDA for proteins. In endurance sports, amino-acids are catabolized (used up) at a faster rate. Based on nitrogen balance studies, it seems that 1.5 gm of protein per kilogram of body weight would be adequate for most athletes. To get these proteins athletes don't need any protein drinks or supplements and it is perfectly reasonable to meet these needs on a vegetarian diet. Iron intake Because iron is the key to providing adequate oxygen for energy production, low levels of serum iron can hamper physical performance in athletes. Exercise increases blood volume and muscle mass both of which require iron, so athletes require more iron. The iron levels of both male and female athletes are below those of general population. Blood iron levels also decreases because of haemo - dilution. Many athletes experience a phenomenon called sports anaemia. It is advisable to increase the serum iron level by eating more plants rich in iron than consuming iron rich animal food. Athletes should take more iron rich plant food in their diet and iron from plant foods don't increase the risk of heart disease and cancer unlike haemo iron which is available in meat. Carbohydrates are stored in the muscles and liver as glycogen. Muscle glycogen is an important source of fuel for very intense exercises of short duration because it can be burned for energy without oxygen. After a strenuous workout glycogen are generally depleted and a high carbohydrate diet is necessary to build them up again. Athletes can increase calorie intake by consuming frequent meals, high calorie snacks and some refined carbohydrates. Athletes need greater amounts of other nutrients including some of the B vitamins such as thiamine, riboflavin, niacin, and vitamin B6 (pyridoxine). The vegetarian athletes can meet their increased demands by including plenty of whole grains, legumes, nuts, seeds, fruits and plenty of leafy green vegetables. Vitamin B12 and folic acid are both needed for red blood cell formation. Exercise speeds up the destruction of blood cells and therefore the need for these vitamins is higher. Vegetarians generally have a high intake of folic acids which is abundant in whole grains, vegetables and fruits such as avocado, vegetarians may have to use foods fortified with vitamin B12 as RDA for vitamin B12 is twice which most people need. Vitamin C needs of athletes are high when performing physical labour at high temperatures. Most people can obtain their vitamin C by consuming a few additional sources of vitamin C rich fruits and vegetables every day. Vegetarian athletes have no trouble in getting adequate vitamin E which is found in whole grains vegetables and vegetable oils and fruits such as avocado. - Sent by: Dr. D. P. Atukorale |
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