Aching joints

Hung-over of chikungunya

by Shanika Sriyananda

He limps. With swollen ankles Mr. Perera in his 50s suffers from aching joints. Numbness in the hands and sometimes in the feet too has compelled him to be confined to his room for days. He has lost his appetite, and suffers from high fever (102-103 degrees) which continues for over four days.

While you are in the street, you could observe the majority of people - young and old - having walking difficulties. Their speed is slow. Not that they suffer from major ailment but it is due to a mosquito borne disease which attacks joints.

Though it is not deadly, it makes the patients feel that they are terribly ill.

Thanks to those who pay scant attention to their environs, the disease meaning 'bent joints' have spread its wings to most parts of the country. And the limping majority put it down to chikungunya.

There is neither a pill nor a syrup that could bring relief to chikungunya patients. The health experts' advice is to have good rest.

But there the practical problem arises. How many chikungunya patients have the privilege to get plenty of rest. Absence of leave from workplaces makes them reach the acute stage of the disease, which attack the patient's joints.

Consultant Epidemiologist of the Epidemiology Unit Dr. Ananda Amerasinghe says that chikungunya cases are coming down naturally with the number of mosquito breeding places reducing, but those who are already infected with the disease, will have to suffer for weeks. "This situation is mainly due to lack of proper rest. If the patients do not take rest the virus will attack the joints and they have to suffer for six to eight weeks", he cautions.

Dr. Amarasinghe says that suffering is greater in the older people due to inflammation of joints. "The other most important thing is to have regular meals though the patient may lose his appetite. When the system is weak the virus tends to attack easily and a weak body will retain the virus longer", he adds.

According to Dr. Amarasinghe, self medication will make the disease worse and the best advice is to get medical advice when the disease attacks the joints.

"Once a person gets chikungunya there is a guarantee according to the nature of the disease that he would not get the disease for three decades and sometimes for the rest of his life", he says.

Dr. Amarasinghe says to avoid the 'sufferings' of chikungunya is to avoid working hard.

***

Chikungunya is a viral disease which spreads from the bite of a mosquito called Aedes aegyphi. This mosquito breeds in fresh water.

The best advice given by the epidemiologists to prevent further spreading of the disease is destroying the mosquito breeding places.

Warm and humid climate and water reservoirs serve as breeding ground for chickungunya. Cleanliness has to be advocated. A clean environment keeps the mosquitoes at bay. It is very essential to keep oneself safe from mosquito bites.

Using mosquito repellents containing Deet or Permethrin can prove an effective cover from getting targeted by the mosquitoes. Both are chemicals used in keeping mosquitoes and ticks, away. They are insect repellents that can be used on the clothes.

They play an active role in blinding the senses of the insects to keep away from getting victimized. They can also be used on mosquito nets. They are effective participants in the prevention of mosquito borne diseases like dengue and malaria. Skin irritations owing to their usage are uncommon.

It is also very important to drain out any stagnated water around the residence. Any containers or flowerpots containing water has to be emptied. Clothing that aids in minimal exposition of the body has to be adopted like full sleeves shirts or tops and pants.

Victims should be safeguarded against further bites. They are easy and simple. Tried out, so that you and your family and your neighbours would be free of all the mosquito borne diseases including dengue and chikungunya.

* Water in containers should be replaced at least once in three days. Water tanks should be emptied and left to dry for at least one hour before refilling them with clean water.

* Steps must be taken to avoid mosquito bites. Mosquito nets, mosquito repellant creams and coils mey be used.

* Bleaching powder can be mixed in water, which will not be used for drinking.

* Care should be taken not to allow stagnant water in and around houses.

The fever normally comes down in about a week's time but however the prevalence of the other sympti like insomnia, headache and particularly the joint pains are said to prolong for weeks. In older victims the joint pains are said to torture for even a couple of months

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Dementia and psychology

by Dr. R. A. R. Perera

Unfortunately dementia or forgetting is becoming more common as our population becomes older. Dementia causes clinical problems that interfere with work, social activities and relationships.

The main feature is memory loss which impairs judgement, thinking and personality change. Psychologists diagnose memory loss by a test called Mini Mental State Examination. This assesses orientation for time and place, short term memory, language and attention span.

The main task of a psychologist is to differentiate dementia from depression and a confused state due to other reasons, especially medications.

Some of the medications used for other illnesses can cause a confused state, which will show as dementia. A person with dementia can have both depression and a confused state due to other medications or due to illness. Main causes of dementia are Alzheimer's disease and vascular problems like high blood pressure.

If dementia is progressing and causes problems to the family members and others, a psychological intervention like behavioural therapy is a useful non-pharmacological treatment. But sometimes medication is necessary despite their considerable risks in older people.

Alzheimer's disease is a condition of brain degeneration leading to irreversible decline of cognitive functions and personality changes. Some drugs (used in arthritis, cholesterol reducing drugs, vitamin E and estogens used in hormone replacement therapy) can cause delay in development of dementia.

In the area of prevention, the reduction of vascular risk factors such as high blood pressure, diabetes, obesity, high cholesterol states, and smoking, reduce strokes and heart diseases but also contribute to a lessening risk in developing dementia.

As patients age and some start to lose their mental faculties, legal issues arise concerning their decision-making capacity, especially regarding decisions and consent about a particular medical procedure.

In SriLanka the consent for medical treatment is usually obtained from the patient's relatives. If the patient has appointed a surrogate decision-maker before the patient became incompetent, that person may consent or refuse medical procedure.

If no one has been appointed by the state or by the patient - the most common case - a relative or carer has the legal authority to consent. Decision-makers for the patient must act in the patient's best interest and if there is a doubt about this, their decisions can be reviewed and overturned by the state.

A clarification: Latest epidemic of heart disease in South Asia

I refer to the article entitled Atherocoronary Metabolic Syndrome (AAMS) by Professor Rohan Jayasinghe (RJ), consultant cardiologist, Gold Coast Hospital, Australia appearing in a recent newspaper.

I fully agree with R.J. (a) that the pattern of coronary heart disease (CHD) occurring among Sri Lankans is somewhat different from that of white Caucasians and (b) that unlike in the West, CHD is common in the young (those below the age of 40 years) and this has been documented in Sri Lankan medical literature in 1975. The commonest coronary risk factor in this young myocardial infarct group is smoking although at the time this was reported, hypertension, diabetes (DM) and obesity were not common in this group of young infarcts studied.

I don't agree with RJ that (a) traditional risk factors for CHD such as diabetes, hyperlipidaemia hypertension and smoking are not common among Sri Lankans, especially among the CHD patients we come across in urban areas, where CHD is quite common at present. (b) I also don't agree with R.J. that Homocysteinaemia (high plasma levels of amino acid homocysteine which is a well-known coronary risk factor) is a significant risk factor for CHD among Sri Lankans.

Although Homocysteinaemia has been reported among Sri Lankan CHD patients in SLMA journal it is a rare coronary risk factor among Sri Lankans. It is noteworthy that plasma homocysteine estimation (which is a very expensive test) is not routinely done in Sri Lankan heart patients at present, especially in those admitted to the government hospitals.

We cardiologists arrange to do this test in the private sector and it costs about Rs. 1500 to do the above test. I routinely arrange to do this test in young heart attack patients. Can R.J. quote any reference from a recognized scientific journal to prove his hypothesis for the welfare of the Sri Lankan scientific community, that homocysteinaemia is common in Sri Lanka? (c) I also don't agree with R.J. that cholesterol subtype called LPa is responsible for the present epidemic of CHD in Sri Lanka.

As far as I am aware there is no scientific evidence to show that elevated blood levels of LPa are common among Sri Lankans.

Estimation of LPa is not done in Sri Lankans in the government sector and in private sector, it costs Rs. 2000 per patient to estimate the blood level of LPa, and as far as I am aware no Sri Lankan has done a scientific study and I would be very grateful if R.J. could quote any reference from a recognized medical journal to prove that the present epidemic of CHD in Sri Lanka especially among the young is due to elevation of plasma level of LPa.

In my experience, low serum HDL levels are quite common among our CHD patients as in other Asian countries and low serum HDL level is a well documented coronary risk factor and R.J. has not mentioned in his article that low HDL levels are common in Asian CHD patients.

To conclude as far as I am aware there is no scientific evidence to show that the present epidemic of CHD in Sri Lanka is due to (a) high blood levels of homocystein and (b) high blood levels of abnormal cholesterol called LPa.

It is high time that an epidemiological survey is done to find out the risk factors responsible for the present epidemic of CHD in Sri Lanka especially in the young patients with CHD.

Dr. D. P. Atukorale

Tea 'healthier' than water

Drinking three or more cups of tea a day is as good for you as drinking plenty of water and may even have extra health benefits, say researchers of the European Journal of Clinical Nutrition dispels the common belief that tea dehydrates.

Tea not only rehydrates as well as water does, but it can also protect against heart disease and some cancers, UK nutritionists found. Experts believe flavonoids are the key ingredient in tea that promote health.

These polyphenol antioxidants are found in many foods and plants, including tea leaves, and have been shown to help prevent cell damage. Tea replaces fluids and contains antioxidants so its got two things going for it.

They found clear evidence that drinking three to four cups of tea a day can cut the chances of getting a heart attack. Other health benefits seen included protection against tooth plaque and potentially tooth decay, plus bone strengthening.

Dr. Ruxton said: "Drinking tea is actually better for you than drinking water. Water is essentially replacing fluid. Tea replaces fluids and contains antioxidants so its got two things going for it." "Also, a cup of tea contains fluoride, which is good for the teeth," she added.

"Studies on caffeine have found very high doses dehydrate and everyone assumes that caffeine-containing beverages dehydrate. But even if you had a really, really strong cup of tea or coffee, which is quite hard to make, you would still have a net gain of fluid.

"In terms of fluid intake, we recommend 1.5-2 litres per day and that can include tea. Tea is not dehydrating. It is a healthy drink."

The Tea Council provided funding for the work. Dr Ruxton stressed that the work was independent. She said the increasing popularity of soft drinks meant many people were not drinking as much tea as before.

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