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| Sunday, 17 July 2005 |
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Features |  |
| News Business Features Editorial
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Health Guide
Do your legs hurt while walking? by Dr. Ruwan Fonseka, Consultant Vascular & Transplant Surgeon, National Hospital Colombo On average, a normal adult can walk more than a mile without much difficulty. The legs will hurt but one should be able to continue without being forced to stop. There are many causes of leg pain but here we will discuss pain due to decrease in blood supply (ischemia). Early features of ischemia * Pain is the most important feature and occurs in muscle groups, not in the joints or bones. * There is no pain at rest and it develops after a quantum of exercise. * Pain will be of a severe degree forcing one to stop the exercise. * Resting for 2-5 minutes relieves pain, only to return after a similar quantum of exercise. This condition is called intermittent claudication, and is advisable to see your doctor. Late features of ischemia. (Develop when early features are neglected.) * The distance you could walk will progressively decrease. If the distance falls below 100 m you need urgent attention. * The nature and site of pain will change. It will be shifted to the toes, felt even at rest (usually when in bed) and relief will be sought by hanging the feet off the bed or by adopting difficult positions to sleep. * Painful ulceration and gangrene develop in the terminal stages of ischemia. People, who neglect ischemia will later, suffer from Peripheral Vascular Disease (PVD). Arteries are a set of tubes that carry oxygenated blood from the heart to almost every cell in the body. As tissues depend on a continuous supply of blood for their survival any narrowing of arteries will cause a reduced function or result in the death of the tissue. Development of atheromatous plaques in the inner layer of arteries is the commonest cause of such narrowing. Further complications on these plaques can completely occlude the artery at the site or dislodged parts can float downstream as emboli and occlude more distal arteries. High risk groups to develop PVD are smokers, diabetics, hyperlipidaemics and those who eat high fatty foods. Meanwhile, the other risk factors are renal disease, obesity and those who have family history of prematurity. PVD is a disease which is preventable even before the development of the symptoms. Smoking is the commonest and easiest preventable cause. It is not the type (filter tipped, mild, rollups, cigars, pipes) or the dosage (number smoked) dependant. There is a special type of PVD that is seen in young male smokers called Thromboangiitis obliterans or Buerger's disease. Here the arteries and veins are both affected and it is more difficult to treat and most of the young men end up with amputation. Only a few may succeed in abstaining without professional help, and if willpower alone is insufficient to completely stop smoking, one should discuss this matter with a doctor. In Sri Lanka only a minority of nicotine addicts will seek professional help. It is needless to emphasise diabetics and hyperlipidaemics will always need professional help to control these conditions. It is well documented that strict control will prevent the development of PVD. This is a disease which can be kept at bay by taking some simple measures like exercise. All the primary preventive measures are also important here. In addition most important it is to continue exercising to keep the arteries open and stimulate new arteries to grow, resulting in a natural bypass. During this period one must take special care of toes and feet to prevent minor injuries. This is because blood supply is insufficient to repair the injured areas, though in patients with early symptoms the supply is adequate to maintain the integrity of healthy tissues. Arteriography (X-rays after injecting a dye) is the oldest form of imaging which is still widely used to detect PVD. However this is an invasive procedure and now less invasive investigations such as MRA (Magnetic resonance angiography) and non invasive Colour Duplex scanning is widely available in Sri Lanka. With these data a vascular surgeon will be able to plan to manage a patient with PVD. Surgery (bypass, angioplasty, endarterectomy, embolectomy) and X-ray guided (balloon angioplasty, stenting) are the two main forms of revascularising a PVD patient. These are all available at the National Hospital. Ten ways to boost your energy Like a car, your body runs on fuel, but feeling energetic takes more than simply filling up your tank with kilojoules. Use the following check list to ensure you stay revved-up and ready to go: 1. Exercise Regular physical activity energises the body in a number of ways. Firstly, it can help improve the oxygen supply to the brain and other parts of the body. Exercise also makes us perspire, which helps us feel cleansed and revitalised. Another advantage of regular exercise is its effect on sleep. Devotees of regular daytime exercise seem to sleep better than couch potatoes and therefore feel more rested in the morning. To get real benefit, exercise for half an hour or more, three or four times a week. 2. Eat light Big meals put a great strain on the body's digestive processes, and this can rob the rest of the body of energy. Keep meals large enough to satisfy your appetite, but not so big that they leave you feeling lethargic. 3. ...but don't skip meals Low blood sugar saps our physical and mental energy. And one sure way to keep your blood-sugar level in your boots is to miss meals. While you may not be hungry, eating something at meal times - even just fruit - can help to stabilise your blood-sugar level. But keep away from the really sweet stuff. 4. Go easy on caffeine Caffeine, found in coffee, tea and colas, certainly gives a quick lift, but it has a direct stimulatory effect on the brain and can wipe out the chance of getting quality sleep. The later in the day you consume caffeine, the more likely it is to disturb your slumber. 5. Drink plenty of water Food generates waste. And without water, the body cannot properly rid itself of these waste products made during the process of creating energy. Help the body flush waste, get into the habit of drinking plenty of water throughout the day. 6. Cut down on the booze There seems to be no doubt that moderate, regular alcohol consumption by men over 40 and postmenopausal women can reduce the risk of heart disease in the long-term. Alcohol is one of the things that can cause our blood sugar to soar, then plummet precipitously. 7. Learn to power nap About 90 per cent of mammals get their quota of sleep as an accumulation of naps during the day and night. Unless you are an insomniac, a well-timed nap can do wonders for your energy levels and productivity. 8. Sitting comfortably? If you spend a significant proportion of your time at a desk, make sure you are sitting comfortably. Choose a chair that is sturdy and adjustable, allowing you to alter the height and back of the seat. Your hips and knees should be level, your feet placed comfortably flat on the floor. Position the back of the chair to give adequate support to your lower back. 9. Think positive Attitude can have a powerful influence on how dynamic we feel. There is nothing like dreading a particular task to make us feel tired and unmotivated. Fortunately, there's a neat mental trick we can play on ourselves to help us over any negative mental hurdles. 10. Relax Sometimes the hardest thing to do is nothing. But that is just what some of us need every once in a while to give our body the opportunity to get back on its feet. Courtesy: Men's Health Antenatal clinic a must You & Your Baby with Dr. Hemantha Dodampahala, Consultant Gynaecologist and Obstetrician, De Soyza Maternity Hospital If your pregnancy test is positive today, you need to take care of yourself for another 280 days. Here, you need the support of your husband as well as other members of your family to go on a happy 'journey' till you hear the first cry of your baby. Antenatal care is vital during pregnancy and a greater responsibility lies on your shoulders. Frequent visits to an Antenatal Care Clinic (ACC) is a 'must' in your routine during pregnancy. In the ACC your health will be closely monitored till you deliver the baby. This will minimise several risks when the doctors could detect even minor ailments. Evidence show that close monitoring of the pregnant women at the ACCs have produced better results. Most of them who attended the clinics regularly gave birth to healthy babies and remain healthy. Antenatal clinics were introduced to Sri Lanka in the 90s and over 95 per cent of pregnant women attend ACCs now. But, still certain parts of the country record poor attendance. These unplanned deliveries mostly end up in neonatal deaths and-still births, and fatalities to mothers in some cases. Once your pregnancy is confirmed you will be examined by the field family health worker first. After assessing the basic details, he/she will refer you to an ACC where the doctor will examine you. There you will be referred to the nearest secondary or a tertiary care hospital. Your regular visits to the ACC will help you to find access to a qualified consultant gynaecologist in the nearest hospital. Your unidentified health problems will be 'detected' by the medical officer and you will be refered to a consultant for a second opinion, if he has any doubts. If you suffer from a heart problem, blood pressure or any other illnesses you will be referred to a consultant. While providing care for you, the medical team at the ACC will keep you informed about the dos and donts during pregnancy, general health problems and problems related to delivery and how to overcome them. Apart from giving advice about child care breast feeding and family planning, the clinic will provide you with most of the necessary nutritional supplements. It will provide vitamins, folic acid, iron and calcium and even three-posha, a nutritional supplement issued free to pregnant mothers and babies. Most of the pregnant mothers do not take the vitamins given at the clinics due to their poor knowledge about the benefits. Vitamins are necessary for your growing baby and it will help to increase the performances of the baby. So, it is advisable to take the vitamins given at the clinic and if you find any side effects, inform your doctor, who will advise you how to minimise the risks. If your visit to the ACC is for the first time, you need to provide basic information - your age, number of children you have and the previous delivery details. Then they will examine the size of the baby and monitor his heart beat, and your heart and lungs to decide the next step to take if there are any risks involved. If you are referred to a tertiary care hospital, you need not be worried because you have been referred mainly on certain doubts and it is advisable to clear all doubts to have a good mental status during pregnancy. Do not think that you are ill when referred to a consultant for further check-ups. At the clinic your blood will be checked for haemoglobin, and urine for sugar and protein levels. Your blood group will also be checked. After the first visit, you will be asked to visit the clinic every month and closer to the date of delivery you need to visit the clinic once in two weeks. When you complete eight months of pregnancy you need to visit the clinic weekly until the delivery. If you miss one clinic day you must ensure that you go for the next one. Holistic Healing : Rejuvenation of senses by Dr. Danister L. Perera, Registerer, Sri Lanka Ayurvedic Medical Council The environment and human physiology have many natural cycles and rhythms that should be taken into account in our daily patterns of living. The basis of much of the Ayurvedic daily routine described Vata, Pitta and Kapha, and the functions they control, become more enlivened at different times of the day. For optimal health and healing, we need to align our behaviour to gain maximum support from the natural, rhythmic swings of Vata, Pitta and Kapha activity. Simply stated we want "support of nature" for our most important physiological activities. Eat your largest meal during lunch when Pitta makes digestion strongest. Go to bed during Kapha period when your sleep will be easy and deep. Sleep through Pitta time so as not to disrupt your natural internal cleansing cycle and to allow full rejuvenation of your mind and senses. Disregarding the laws of nature leads to illnesses. Living in accord with natural law brings the full support of the healing power of nature that underlies the growth and development of all living things. This is one of life's basic lessons and a guiding principle of Ayurveda. You can use the following charts to help identify the dosha that is most imbalanced. This is important because this dosha imbalance is the root cause of symptoms that appear on the material level of your body. The Ayurvedic approach is not to treat symptoms but to treat the underlying imbalances in Vata, Pitta and Kapha. When these imbalances disappear, usually symptoms disappear. When the Vata is in a balanced mode it keeps mental alertness, normal elimination, enthusiasm and exhilaration, sound sleep, strong immunity, proper formation of body tissues. Once it is provoked it is resulting dry or rough skin, insomnia, constipation, fatigue, tension headaches, intolerance of cold, underweight, anxiety, worry. Pitta's normal state is responsible for maintaining normal heat and thirst mechanisms, strong digestion, lustrous complexion, sharp intellect and contentment. If it is aggravated, it creates rash, skin inflammations, heartburn, visual problems, excessive body heat, premature greying, baldness, hostility and irritability. Balanced Kapha sustains muscular strength, vitality and stamina, strong immunity, affection, generosity, courage, stability of mind, healthy, normal joints. Vitiated Kapha causes oily skin, slow digestion, sinus congestion, nasal allergies, obesity, lethargy and dullness Following are the times when Vata, Pitta and Kapha and their corresponding physiological functions are most active: 2:00 am to 6:00 am - Vata - wake up, Bathe, Meditate 6:00 am to 10:am - Kapha - Exercise and work (avoid sleeping into this period) 10:00 am to 2:00 pm - Pitta - Digestion is strongest. So have lunch as your largest meal 2:00 pm to 6:00 pm - Vata - Tendency of tiredness, afternoon herbal tea, meditate 6:00 pm to 10:00 pm - Kapha - Evening walk, relax, Read. 10:00 pm to 2:00 am - Pitta - Sleep.. |
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