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| Sunday, 15 June 2003 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius Arthritis by Dr. Sampath R. Nanayakkara Arthritis is a common ailment in Sri Lanka. It is a disease condition of your joints caused by many factors. Many types of arthritis have been described. Rheumatic (Rheumatic) Arthritis, Rheumatoid (Rheumatoid), Osteoarthritis are among the commonest. Rheumatic Arthritis is a serious condition which occurs most frequently in children between the ages of 6 and 15, though it is also seen in young adults. It is one of the stages of the same disease - RHEUMATIC FEVER. The history of presentation of Rheumatic Arthritis is as follows: Symptoms The child usually has a sore throat or bout of Tonsillitis and then recovers from it. About 12-14 days later he starts to feel generally unwell. He runs a slight fever and develops joint pain, mainly involving the large joints. The characteristic feature is "FLITTING NATURE" of the joint pair, that is to say, it starts from on joint such as the knee, ankle, elbow or wrist and then a day or two later, it shifts to another joint. This 'flitting' nature may go on for weeks. The root cause for this condition is Hypersensitivity to a constituent of a Germ (Bacteria - named Streptococcus) responsible for the original throat infection. The most dangerous part of this condition is developing into a disease of the Heart Valves later. Rheumatoid Arthritis Women are more frequently affected than men. It is usually insidious in onset. There is often a family history. The small joints of the hands and feet are most commonly affected, both sides of the body symmetrically. Other large joints i.e. hips, knees etc may also be involved. Pain in the joint is progressive with early morning stiffness and swelling of the joints. There may be fever. . Finger joints may show sausage like swelling with diminished movements and very painful to pressure. Usually the last (or distal) finger joints are spared. The disease may progress with relapsers from time to time for many years and ultimately end up with fixed deformities . Wasting of the small muscles of the hands is common, mainly around the affected joint. . Inflammation of the soft tissues around the joints causes swelling. The joints less commonly involved are ankles, rib joints etc and neck joints. Sixty per cent of patients who suffer from this disease are able to continue a full active life. There are number of advanced blood tests to diagnose this disease correctly. The primary reason for this disease is formation of Antibodies in your body against your own tissues of the joints. As such the objective of the treatment should be to keep the disease under control and prevent going into disabilities and deformities. Osteoarthritis It is the commonest disease among this group, which is an age related disease due to degenerations, damage and wastage of the joint surfaces as you become older. It is also related to obesity and previous joint injury (i.e. Sports Injury). It is almost universal after the age of 60 yrs. It is present commonly in finger joints of the hands, knee joints, neck joints, back spine and hips. There is pain mainly with the movement of the joint and worse towards the end of the day. Stiffness, immobility, deformity and occasional pain or numbness due to involvement of the adjacent nerve root are common presentations. There may be fluid in the joint (water in the joint). The characteristic feature is the 'wearing off' of stiffness after exercise of that joint. To prevent this disability occurring in the old age, one should lead an active life with daily exercise, preferably 30-45 minutes per day, wearing good shock absorbing walking shoes and keeping your weight down. ######### Nutrition of the mother and her foetus From the time a woman and her partner decide to have a baby, she should start on supplements of some vitamins. Why so early? The embryo is fully grown by the end of the 10 week after the last menstrual period (or 8 weeks after fertilization), with specialised tissues such as muscle and nervous system. A deficiency of some of the B complex of vitamins such as folic acid, vitamin B12 and pyridoxine (Vitamin B6) interfere with cell multiplication and may result in abnormalities such as spina bifida. The mother may not be aware that she has conceived before the embryo has reached the status of a foetus. Therefore, it is advisable to start on supplements of folic acid about a week before marriage and continue daily till the end of the pregnancy. All precautions should be taken to prevent intra-uterine growth restriction (IUGR) of the fetus because IUGR leads to a baby of low birth weight (LBW), i.e. less than 2.5 kg. An LBW baby grows slowly and will be physically and mentally underdeveloped when he/she reaches school age. IUGR implies that fetal growth is being inhibited and the fetus does not attain its growth potential. An IUGR infant would therefore have grown bigger if growth inhibiting factors had not been operative in utero. IUGR may be due to i. small size of the mother before conception. A woman should have a BMI (or Body Mass Index) of more than 19 before she becomes pregnant. BMI is calculated by dividing the body weight (in kgs) by the square of the height expressed in metres. A person of body weight 45 Kg and height 1.5 metres (150 cms) will have a BMI divided by 1.5 of 45 (or 2.25) i.e. BMI will be 20. If his/her weight is 40 kg the BMI will be 40/2.25 or 17.8. A BMI of less than 18 in an adult is taken as a sign of chronic under nutrition. A woman of height 150 cm should increase her weight to 45 kg before she decides to have a baby. ii. Another reason for IUGR is insufficient weight gain during pregnancy. The weight of a woman increase due to growth of fetus, placenta and ammoiotic fluid, and of maternal tissues such as uterus, breast, blood volume and extra-cellular fluid and fat laid down under the skin. The optional weight gain is still under discussion. In developed countries pregnancy weight gain has been estimated to be about 12.5 kg. The average weight gain among Sri Lankan women is less than 8 kg. A woman weighing 44 to 55 kg will probably deliver an infant of weight more than 3 kg if her weight gain during the 40 weeks is 10.5 kg. A weight gain of less than 0.5 kg per week after the 30th week is considered as a risk factor for IUGR. A mother not gaining adequate weight should receive nutrition counselling at her regular clinic. iii. Acute infections affect the foetus because the mother's temperature rises. In chronic infections organisms might affect cell growth in the fetus by crossing the placenta. Malaria is a common cause of IUGR where malaria is endemic. iv. Iodine deficiency leads to lowered thyroid hormone production in mother and a poorly developing fetus. Consumption of adequately iodised salt will prevent iodine deficiency. Hypothyroid mothers should increase their dose of thyroxine during pregnancy. v. Iron deficiency can cause IUGR. Most pregnant women are anaemic and it is difficult to satisfy the full requirement of iron by adjusting the diet alone. About 60 mg ferrous sulphate or equivalent should be taken daily throughout pregnancy, alongwith a 100 mg tablet of vitamin C. Eating fresh fruit after every meal or taking a tablet of vitamin C will ensure absorption of the iron in the meal. Therefore a woman should take supplements of iron, folic acid, calcium and vitamin C daily throughout pregnancy, the calcium after breakfast and the rest after dinner. She should eat the same foods as she did before the pregnancy, but increase the size and number of the servings. She should see a doctor every month and have her weight recorded on a chart toward the end of pregnancy she should rest an hour or two after lunch and reduce her work out-put during the last two weeks. She should take regular exercise (walking) throughout pregnancy. She should avoid infections of all types and be de-wormed at the beginning of the pregnancy. Her diet should include fish. Certain fatty acids in fish are needed for healthy growth of brain, nervous system and retina. Above all, she should be happy. (Nutrition Society of Sri Lanka) ######### The pill: good or bad? More than 50 million women around the world are using the Pill to plan the size of their families and the intervals between their children. For most of them the Pill is a safe and easy way to prevent pregnancy. In choosing a form of contraception women should weigh carefully the advantages and disadvantages of all the methods. They should not think of contraception as a treatment for ill-health. It is simply a part of everyday life for many of those who want control over their fertility. There is probably no other aid to good health which has been more thoroughly tested than the Pill, so it comes as no surprise that side-effects bad as well as good, have been detected. No one can tell who will experience minor side-effects, but there is some information available to help women decide whether they might be at serious risk if they took the Pill. How does the Pill work? The Pill contains synthetic hormones similar to those produced naturally in the ovaries. In most Pills these hormones prevent the release of an egg from the ovary, which means the woman is very unlikely to become pregnant while taking the Pill. The most common Pill the combined one, contains a mixture of an oestrogen and a progestagen. The woman takes one Pill everyday for 21 days followed by a break of seven days during which she will bleed. Some Pill packets contain iron or vitamin pills to be taken during this intervals that the habit of taking a pill everyday is not interrupted. The early combined Pills contained high doses of oestrogen and progestagen. Since then research has shown that many of the most serious complications of the Pill are associated with the size of its hormone dose. Now most combined Pills contain less oestrogen, usually between 20 and 50 micrograms, and less progestagen, and the proportion of Pill-users who report serious side-effects in smaller. The so-called mini-Pill contains only progestagen and is taken everyday without a break. It does not always prevent the release of an egg, but it does hinder progress towards fertilization by interfering with the passage of sperm through the mucus at the entrance to the uterus. The mini-Pill is however, associated with menstrual irregularities and is less reliable than the combined Pill, which is almost completely effective if taken correctly. When the new low-dose combined Pill was introduced in the late 1970s, the mini-Pill lost some of the attraction it had held as an alternative for women who were advised against taking a Pill with a high dose of oestrogen. There are, in addition, Pills in which the proportions of the hormone dose are varied as the monthly cycle progresses. These are called triphasic or biphasic according to whether the different hormone doses occur in three phases or two. Frequently asked questions Q: Can every woman take the Pill? A: Most young healthy women who do not smoke may use the Pill. The risks which Pill-takers do run are highest for women who smoke or who are over 40. Cancer of the breast or genital tract, thrombosis (blood clots in deep veins), cerebrovascular accident (stroke), focal (very localised) migraine, familiar hyperlipidaemia (inherited increase in blood fat levels). Q: Can adolescents take the Pill? A: No one fully understands how the Pill affects the body of a young adolescent or the long-term implications of its use. However, present experience suggests that if a young girl is sexually active and unable to use another method of contraception, taking the Pill is preferable to using no method at all since the social, medical and psychological consequences of pregnancy or abortion can be very serious. In addition the Pill offers some protection against pelvic inflammatory disease which often follows sexually transmitted disease (STD) and which can have serious consequences for health and future fertility. As a general rule the Pill should not be taken for contraception by young women before they have established regular menstrual cycles. Q: Is the Pill associated with blood clots? A: One rare but serious possible side-effect from taking the Pill is spontaneous clotting of the blood in an artery or a vein. This may occur in the brain (called a stroke), in the blood vessels of the heart (heart attack), or in the veins of the legs (venous thrombosis). Q: Is the Pill associated with cancer? A: Research during the past five years shows that the Pill protects women against cancer of the ovary and of the endometrium (lining of the uterus). Information recently published suggests that there is a slightly increased possibility of cancer of the cervix developing in certain women, but the evidence for this is not conclusive. Where cervical smears are available they may help to identify early cervical abnormalities and so minimize the risk. Courtesy: International Planned Parenthood Federation ######### Vegetarians are healthy and live longer Is meat consumption essential for our diet? No, says Dr. D.P. Atukorale who believes...... The world has changed and we are in a position to consume a wholesome diet which includes grains, vegetables, fruits nuts etc., without slaughtering animals for flesh. Physiologically and anatomically man is 'made' to eat a vegetarian diet and not to eat meat. Vegetarian are healthier than meat-eaters and their life-span is longer than non-vegetarians. Incidence of chronic diseases such as heart attacks, hypertension, obesity, diabetes, malignancy, osteoporosis, kidney ailments such as kidney stones psychiatric illnesses such as alcoholic dependence, strokes, stress and food poisoning is lower among vegetarians as compared to non-vegetarians. Vegetarians live long and healthy lives and now we are in a position to consume vegetarian food which is available all over the world without slaughtering or encouraging to slaughter animals (by eating their flesh). Animals too, have a right to live in this world just like humans. All the carbohydrates, proteins (including essential amino-acids) fats (including essential fatty acids), all the minerals including trace metals, fibre (which is not available in animal food) and vitamins are available in vegetarian diet. Therefore, consumption of meat and fish is not essential to humans and in fact consumption of meat can be harmful and can lead to chronic diseases as mentioned earlier. A vegetarian diet will help you to live a healthy and long life free of chronic diseases like heart attacks and cancer. ######### Reasons for smoking by grown ups More facts on smoking It is interesting to consider why people smoke. It is known that society by and large is made up of smokers. When a person visits, there are ash-trays provided, cigarettes are offered on the general assumption that people smoke. Even advertisers suggest that smoking is a normal thing, and that it is impossible to completely enjoy the pleasure of certain situations without a cigarette. Thus people follow the social pattern. Others smoke because it is a social habit. To offer and to accept cigarettes establishes a bond, and in this way it resembles food and drink. As such the smoker may smoke to be one of the company. Yet others do so merely for pleasure, for after the initial coughing, nausea and even vomiting, most smokers get pleasure from the taste and aroma of tobacco smoke. The majority of smokers claim that it sedates them "settle my nerves" they would say, and also that it acts as a stimulant when they need to think and work. There is experimental evidence that these effects are due to nicotine and that both these claims are true, depending on the dose, on what the smoker is doing, and on his particular psychological and physical make up. Tobacco smoking in Sri Lanka Tobacco is used in this country for smoking as cigarettes, beedi, cigars dry and wet, and pipe and also it is chewed with betel leaf. Two distinct types of cigars are manufactured, the dry and the wet. The wet cigar which is smoked and sometimes chewed is used mainly by old people. This is actually going out of fashion. The cheroot is not commonly used. Really the cigar and the cheroot will differ only in the finish. The beedi consists of beedi tobacco mixture with a wrapper leaf to hold the contents. The wrapper leaf belongs to the diospyrus family. Effects of smoking Smoking affects the movements and the secretions of the intestines, causing nausea, discomfort and loss of weight. The incidence of stomach ulcers is about twice as high in smokers than in non-smokers, and also the incidence of cancer of the bladder, prostate, and the liver is greater in smokers. A rare form of blindness known as tobacco "amblyopia" affects heavy smoker. Smoking by parents causes and increased incidence of pneumonia and bronchitis in children under one year old, and this may risk the life of the child, or leave it with residual damage for the rest of its life". Cigarette smoking alters the pharmacological effects of drugs or their pharmacokinetics. Tobacco can induce the metabolism in humans of therapeutic agents, such as disprin, anti-fever drugs, caffeine and vitamin C. Tobacco smoke can also modify the clinical effects of drugs. Involuntary or passive smoking Involuntary smoking is the inhalation of tobacco combustion products in smoke - filled atmospheres by a non-smokers. This type of exposure is, in a sense, "smoking", because the non-smoker breathes many of the same components of tobacco smoke that smokers ingest. It is also "involuntary" because this exposure is an unavoidable consequence of breathing in a smoke-filled environment. The chemical components in a smoke filled atmosphere are derived from two sources - mainstream and sidestream smoke. Mainstream smoke is the smoke which is generated by cigarette while it smoulders. Mainstream and sidestream smoke contribute different concentrations of many substances to the atmosphere. For several reasons different amounts of tobacco combustion differ depending on whether the cigarette is being puffed or is smouldering, and certain substances are partially absorbed from the mainstream smoke by the smoker. Many substances, including nicotine and carbon monoxide are found in much higher concentrations in sidestream smoke than in mainstream smoke, and major concern has arisen over the levels of carbon monoxide present in smoke-filled atmospheres. Under conditions of unusually heavy smoking and poor ventilation, carbon monoxide levels have exceeded that maximum permissible eight-hour, exposure limit. Although smoking increases CO level in the body, the effects of CO absorbed by non-smokers are not yet fully known. |
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