Medical dilemma:

Abortions steal a march on contraceptive pills

by Nilma DOLE

Sri Lanka’s second leading cause of maternal deaths is unsafe abortions, said President of the College of Obstetrician and Gynaecologists, Dr. Sarath Amarasekera.

Our health services are the best in the South East Asian region but our people are still not aware of the free services available to prevent such tragedies.

“Our health services offer free contraceptive methods and our medical experts give one-on-one advice but we still have a high rate of abortions. Unfortunately, it is the married women who have had one or two children previously who are doing it,” said Dr. Amaraserkera who works closely with the Ministry of Health to conduct several awareness workshops around the country. According to a survey done, about 167 maternal deaths occurred in 2008 revealing that these unsafe abortions were done to those who went to quacks and not medically qualified doctors.

The doctor, who has had over 30 years of experience in the sector said, “These women did it as a last resort because of economic reasons as they were unable to provide for another baby, some even doing it without the knowledge of their husbands.” Hence, the doctor said that it is imperative that we learn from these mistakes and go to medically qualified doctors for advice before it’s too late.

“We should learn from this and create awareness about the various types of contraception methods available in the market and most of them which are offered free by the Health Ministry and the Family Planning Associations around the country,” said Dr. Amarasekera.

“There are two types of contraceptive methods which are permanent and temporary,” said the doctor. He said, “In permanent contraceptive methods, there is tubal ligation for women and vasectomy for men.”

These types are highly effective and usually appropriate for couples who have made their family and want to stop with the children they have.

For temporary types of contraception, there is a wide variety of contraceptive pills available in the market. “Women now have a choice to use any pill that is best for them because of the availability of different brands especially ones with minimal side effects,” said the doctor.

Also, IUDs (Intrauterine devices) is when an object is placed in the uterus to prevent fertilisation of the egg by sperm, inhibits tubular transport, and prevents implantation of the fertilised egg cell. “Another contraceptive method is the injection of a silicon matchstick-like rod called Jadelle which is effective for three to five years,” said Dr. Amarasekera.

He said that Jadelle is currently being used by the Health Ministry and some Family Planning Associations for alternative contraceptive methods. “There are also condoms and other contraceptive methods which are effective but couples should seek medical advice if they aren’t sure of what type of contraception is suitable for them”, he said.

Dr. Amarasekera said, “As for side effects of temporary contraceptive methods, there is no 100 percent guarantee that contraceptive methods come with minimal side effects.”

The doctor said that medically qualified doctors are always available in every health clinic and hospitals islandwide for an assessment on the side effects and advice on contraceptive methods.

There are emergency contraceptive pills that are also available for those sudden unplanned pregnancy cases.

At the grassroot level, primary health care workers and midwives are the messengers of family planning. “These public health workers explain to couples about contraceptive methods and the choices they can have when it comes to having a family. We should give due credit to these primary health care workers for working tirelessly to help in health matters in the villages and this is the main reasons how our people have been aware of family planning,” said the doctor.

He advised that prevention is better than cure and advised anyone having affairs and relationships to take contraceptives to prevent unsafe abortions in the long run. “This is a delicate situation for the woman as well as the couple so strict supervision and medical advice should be sought,” he said.

The College has also been working with the Education Unit at the Health Ministry to produce a short film called ‘Vishwasaya’ aimed at educating the public in a more creative manner where they realise the gravity of unplanned pregnancies and in what way it could have easily been prevented.

As for advice, Dr.Amarasekera said, “Health is a specialised topic, so please go to a qualified medical expert who is familiar with your requirements and can offer the best service possible.”

Types of Birth Control

1. Continuous Abstinence

2. Natural Family Planning/Rhythm Method

3. Barrier Methods

Contraceptive Sponge

Diaphragm, Cervical Cap and Cervical Shield

Female Condom

Male Condom

4. Hormonal Methods

Oral Contraceptives - Combined pill (“The pill”)

Oral Contraceptives - Progestin-only pill (“Mini-pill”)

The Patch

Shot/Injection

Vaginal Ring

5. Implantable Devices

Implantable Rods

Intrauterine Devices

6. Permanent Birth Control Methods

Sterilisation Implant

Surgical Sterilisation

7. Emergency Contraception

Childhood diabetes :

What is diabetes?

by Dr. Ramesh GOYAL

Diabetes is a disease that affects how the body uses glucose, the main type of sugar in the blood. Glucose comes from the foods we eat and is the major source of energy needed to fuel the body’s functions. After you eat a meal, your body breaks down the foods you eat into glucose and other nutrients, which are then absorbed into the bloodstream from the gastrointestinal tract.

The glucose level in the blood rises after a meal and triggers the pancreas to make the hormone insulin and release it into the bloodstream. But in people with diabetes, the body either can’t make or can’t respond to insulin properly.

Signs and symptoms of Type 1 diabetes

A person can have diabetes without knowing it because the symptoms aren’t always obvious and they can take a long time to develop.

Parents of a child with typical symptoms of type 1 diabetes may notice that their child:

Urinates frequently and in larger volumes as the kidneys respond to high levels of glucose in the bloodstream by flushing out the extra glucose in urine.

*Is abnormally thirsty and drinks a lot of water in an attempt to keep the level of body water normal, considering that he or she has lost a lot of fluid by urinating.

*Loses weight (or fails to gain weight as he or she grows) in spite of a good appetite. This is because the body breaks down muscle and stored fat in an attempt to provide fuel to the hungry cells.

*Feels tired often because the body cannot use glucose for energy properly.

Living with diabetes is a challenge, no matter what a child’s age, but young children and teens often have special issues to deal with. Young children may not understand why the blood samples and insulin injections are necessary. They may be scared, angry, and uncooperative.

Insulin works like a key that opens the doors to cells and allows the glucose in. Without insulin, glucose can’t get into the cells (the doors are “locked” and there is no key) and so it stays in the bloodstream. As a result, the level of sugar in the blood remains higher than normal. High blood sugar levels are a problem because they can cause a number of health problems.

What is Type 1 Diabetes?

There are two major types of diabetes: type 1 and type 2. Both type 1 and type 2 diabetes cause blood sugar levels to become higher than normal. However, they cause it in different ways. Type 1 diabetes (formerly called insulin-dependent diabetes or juvenile diabetes) results when the pancreas loses its ability to make the hormone insulin.

Here, the person’s own immune system attacks and destroys the cells in the pancreas that produce insulin. Once those cells are destroyed, they won’t ever make insulin again. Although no one knows for certain why this happens, scientists think it has something to do with genes, though not entirely that. A person probably would then have to be exposed to something else - like a virus - to get type 1 diabetes.

Type 1 diabetes can’t be prevented, and there is no practical way to predict who will get it. There is nothing that either a parent or the child did to cause the disease. Once a person has type 1 diabetes, it does not go away and requires lifelong treatment. Children and teens with type 1 diabetes depend on daily insulin injections or an insulin pump to control their blood glucose levels.

Type 2 diabetes (formerly called noninsulin-dependent diabetes or adult onset diabetes) is different from type 1 diabetes. Type 2 diabetes results from the body’s inability to respond to insulin normally. Unlike people with type 1 diabetes, most people with type 2 diabetes can still produce insulin, but not enough to meet their body’s needs.

But in some cases, other symptoms may be the signal that something is wrong. Sometimes the first sign of diabetes is bedwetting in a child who has been dry at night. The possibility of diabetes should also be suspected if a vaginal yeast infection (also called a candida infection) occurs in a girl who hasn’t started puberty yet.

If these early symptoms of diabetes are not recognised and treatment is not started, chemicals called ketones can build up in the child’s blood and cause stomach pain, nausea, vomiting, fruity-smelling breath, breathing problems, and even loss of consciousness. Sometimes these symptoms are mistaken for the flu or appendicitis. Doctors call this serious condition diabetic ketoacidosis, or DKA.

A1C Test

Checking your blood sugar at home tells what your blood sugar level is at any one time. But if you want to know how you have done overall, the A1C (also known as glycated haemoglobin or HbA1c) test that gives you a picture of your average blood glucose control for the past 2 to 3 months. The results give you a good idea of how well your diabetes treatment plan is working.

The A1C test is like a cricket player’s season batting average. Both A1C and the batting average tell you about a person’s overall success. Neither a single day’s blood test results nor a single game’s batting record gives the same big picture.

You should have had your A1C level measured when your diabetes was diagnosed or when treatment for diabetes was started. To watch your overall glucose control, your doctor should measure your A1C level at least twice a year. This is the minimum. There are times when you need to have your A1C level tested about every 3 months. If you change diabetes treatment, such as start a new medicine, or if you are not meeting your blood glucose goals, you and your doctor will want to keep a closer eye on your control.

Living with Type 1 diabetes

Living with diabetes is a challenge, no matter what a child’s age, but young children and teens often have special issues to deal with. Young children may not understand why the blood samples and insulin injections are necessary. They may be scared, angry, and uncooperative. Even when they faithfully follow their treatment schedule, teens with diabetes may feel frustrated when the natural adolescent body changes during puberty may make their diabetes somewhat harder to control.

Parents can help their children lead happier, healthier lives by giving constant encouragement.

Monitoring and controlling glucose levels is something they need to get used to. They should: 1.Check blood sugar levels a few times a day by testing a small blood sample.

2. Give themselves insulin injections, or have an adult give them injections, or use an insulin pump.

3. Eat a balanced, healthy diet and pay special attention to the amounts of sugars and starches in the food they eat and the timing of their meals.

4. Get regular exercise to help control blood sugar levels and help avoid some of the long-term health problems that diabetes can cause, like heart disease.

5. Work closely with their doctor and diabetes health care team to help achieve the best possible control of their diabetes and be monitored for signs of diabetes complications and other health problems that occur more frequently in children with type 1 diabetes.

Until scientists have perfected ways to better treat and possibly even prevent or cure diabetes, parents can help their children lead happier, healthier lives by giving constant encouragement, arming themselves with diabetes information, and making sure their children eat properly, exercise, and stay on top of blood sugar control every day. Doing so will enable children do all the things that other children do while helping them grow up to be healthy, well-adjusted, productive adults.

(The writer is a Consultant in Diabetology and Endocrinology)

Courtesy: B Positive

World Alzheimer’s Day - Sep 21:

Dementia and global economy

Every year on World Alzheimer’s Day, September 21 2010, thousands of events are hosted around the world to raise awareness about dementia and inform, community and individuals about the growing prevalence of the disease and the effect it is having on the global economy.

World Alzheimer’s Day is organised by Alzheimer’s Disease International (ADI), the umbrella organisation of 71 Alzheimer’s disease organisations worldwide. The theme this year is: “It’s time for action”. ADI will release the World Alzheimer Report 2010 with comprehensive figures on the global impact of dementia its cost, including direct medical costs, non-medical costs and costs of informal care.

Clinically detected signs in Alzheimer’s Disease are associated with substantia nigra

Early-onset Alzheimer’s: When symptoms begin before 65

When Alzheimer’s begins in middle age, misdiagnosis may be more likely. Rare disorder affects work, finances and family.

Early-onset Alzheimer’s is an uncommon form of dementia that strikes people younger than age 65, says Glenn E. Smith, Ph.D., a neuropsychologist.

How common is early-onset Alzheimer’s?

Of all people with Alzheimer’s disease, only 5 to 10 percent develop symptoms before age 65. So if 4 million Americans have Alzheimer’s, at least 200,000 people have the early-onset form of the disease. Early-onset Alzheimer’s has been known to develop between ages 30 and 40, but that’s very uncommon. It is more common to see someone in his or her 50s who has the disease.

What causes it?

It often runs in families. Many people with early-onset Alzheimer’s have a parent or grandparent who also developed Alzheimer’s at a young age. A significant proportion of early-onset Alzheimer’s is linked to three genes.

These three genes are different from the APOE gene - the gene that can increase your risk of Alzheimer’s in general. But you can have the APOE gene and never develop Alzheimer’s. Conversely, you can have Alzheimer’s and not have the APOE gene. The genetic path of inheritance is much stronger in early-onset Alzheimer’s. If you have one of those three genes, it would be very unusual for you not to develop Alzheimer’s before age 65.

If early-onset Alzheimer’s runs in my family, should I get tested for it?

That’s a personal decision that only you can make. There are pros and cons to genetic testing. Anyone who’s considering it should never proceed without genetic counselling - to examine these pros and cons beforehand.

Does early-onset Alzheimer’s progress at a faster rate?

There’s a perception that it does, but it’s not backed up by hard data. It depends on what endpoint you’re using in your measurement. If you use admission to a nursing home, that may occur earlier for the early-onset group - but only because their spouses have so many other things on their plates.

For example, people who have early-onset Alzheimer’s often still have children at home. They or their spouses may have elderly parents that need care, too. That generation often is sandwiched between caring for their ailing parents and caring for their teenage children at the same time. Adding in a spouse with Alzheimer’s can simply be too much to handle.

What types of problems occur more often in early-onset Alzheimer’s?

Alzheimer’s disease has a tremendous impact at any age. But we don’t expect to see dementia at a young age, so problems emerging at work or home may be mistakenly ascribed to lack of motivation or diligence, or possible psychiatric problems. People with early-onset Alzheimer’s may lose relationships or be fired instead of being identified as medically ill or disabled.

The loss of intimacy is something that comes up a lot with early-onset Alzheimer’s. Many people who develop late-onset Alzheimer’s have already been widowed. But couples in their 40s or 50s are often in the middle of their married lives. Spouses face the possibility of spending many years of their lives without an active partner. Losing the romantic component and changing to a caregiver status complicates the relationship.

Are there financial issues as well?

People with early-onset Alzheimer’s often have to quit work, and this loss of income is a serious concern. Finances get even tighter if their spouses also quit their jobs to become full-time caregivers.

Some medical benefits and many social-support programs won’t provide assistance unless the person with Alzheimer’s is over age 65. Younger people may need special waivers to get into such programs.

How important is it to obtain an accurate diagnosis?

Accurate diagnosis is critical so that you can explain your condition to your employer and perhaps arrange a lighter workload or more convenient schedule. For family reasons it is even more crucial. The diagnosis is fundamental in helping the family react with appropriate understanding and compassion. In addition, a complete evaluation will rule out reversible forms of dementia that might improve with treatment.

What advice do you have for those with early-onset Alzheimer’s and their families?

The key treatments in Alzheimer’s are education and support. This is especially true given the unique social challenges of early-onset Alzheimer’s. Getting connected to services such as support groups can help you identify resources, gain a deeper understanding and learn ways to adapt to the situation.

Courtesy: MayoClinic.com