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Health Problems & Solutions

A Herald of Diabetes

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The young woman who walked in for a consultation had a scarf wound around her neck. “I came to show you this,” she said, taking it off. There was a dark patch on the back of her neck with ridges and bumps, the skin raised and velvety. “I have already tried fairness creams,” she said. “They only make it worse.”
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The diagnosis was easy. She had a peculiar skin lesion known as acanthosis nigricans.

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The cosmetically disfiguring and aesthetically displeasing lesions usually occur on the neck (where they are clearly visible), armpit, groin, knees or elbows, in short areas with skin folds. Very rarely, it can be found on the fingers or around the lips or in the nipple area. It can occur at any age and in both men and women. It is seen in children and even in babies. The lesions appear gradually and do not itch or pain. This means that they remain unnoticed until they have spread over a large area. Initially it looks like dirt so people try to scrub it off, damaging the skin in the process. Others try to camouflage it unsuccessfully with talcum powder and make up.

Nearly 20 per cent of the population has acanthosis nigricans and the numbers are rising rapidly because obesity is the commonest risk factor. More and more people are becoming overweight in India and the world.

An inactive lifestyle causes weight gain and these two factors together cause relative insulin resistance, which results in elevated glucose levels, an abnormal lipid profile and high blood pressure. These changes are grouped together as the “metabolic syndrome X”. Acanthosis nigricans is one of the early markers of this syndrome. The American diabetic association classified it as a risk factor for the development of diabetes in 2000. In children and adolescents, symptoms of syndrome X or frank diabetes begin to appear within two years of the appearance of acanthosis nigricans.

The disease can also be hereditary and in typical inherited acanthosis nigricans, skin lesions are confined to one half of the body. They spread and increase till a certain age and then remain stationery or regress. In other families the lesions, though present in almost all family members, are not really hereditary. The biggest difference is that they are present on both sides of the body. The family usually has an inactive lifestyle, members are obese and go on to develop diabetes.

Medications can also cause these skin changes as a side effect. The most common offenders are hormones — like oral contraceptive pills (OCP), hormone replacement therapy (HRT), insulin, pituitary extract, growth hormone or systemic corticosteroids. Unfortunately, pituitary extract or steroids may be added to unregulated “natural herbal supplements” or “tonics” so the person may not even know that he or she is ingesting such substances. Sulpha drugs (antibiotic)and nicotinic acid (for high cholesterol) can also cause these.

Certain types of acanthosis nigricans are peculiar to women. It is associated with the polycystic ovary syndrome and appears at adolescence. Such girls are obese and have irregular periods and facial hair.

If you develop acanthosis nigricans, it is worthwhile consulting a physician. Although you may be obese, and that is the commonest cause of these skin changes, some investigations and tests need to be done. This is because the skin changes can (though this is rare) be associated with cancer, particularly in the abdomen. It can appear before any other obvious sign of a tumour. It can also be a part of the spectrum of autoimmune diseases like systemic lupus erythematosus, scleroderma, Sjögren syndrome, or Hashimoto thyroiditis.

There really is no specific treatment for the skin changes in acanthosis nigricans. The disease itself is harmless. The main danger lies in the complications associated with obesity and insulin resistance. Tackling the underlying problem makes the skin lesions fade. Here is what you can do to tackle it:

• If it is due to medication or health supplements, stop taking them.

• Reduce your weight with diet and exercise. Try to reach your ideal body weight (height in meter squared multiplied by 23).

• Eat more protein, fresh fruits and vegetables. Starches and sugars provide empty calories and aggravate insulin resistance.

• Sweat trapped in the folds can make the lesions malodorous. Bathe twice a day with a medicated soap like Neko if that is the case.

Evening primrose oil or fish oil supplements may help.

• Some prescription creams or lotions help lighten the affected areas. These contain modified vitamin A products and are often prescribed for acne.

• Fairness creams do not help.

• Surgical dermal abrasion can be done.

Source:  The Telegraph ( Kolkata, India)

 

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Health Problems & Solutions

Some Health Quaries & Answers

When the bee stings....CLICK & SEE
Q: I live near a park and have often been stung by bees. Apart from being painful, I have heard that bee stings are also dangerous. How should a sting be treated?

A: The bee sting has a venom sac attached. If this sac breaks, chemicals are released into your body that cause pain, redness, local swelling and also allergic reactions. If you get stung, pull out the sting using your fingernail or a stiff card. Take care not to damage the venom sac. Wash the area with soap and water and apply ice. If the area is red and irritated, apply calamine lotion or hydrocortisone ointment. If there is swelling, see a doctor. You might be prescribed antihistamines.

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Xanthoma ...CLICK & SEE

Q: I have yellow deposits near my eyelids. They are soft and painless but look very ugly.

A: These are called xanthomas. They are caused by deposits of fat under the skin. Although they can occur anywhere —such as the elbows, knees and buttocks — eyelids are the commonest place. Xanthomas are harmless but indicative of high cholesterol, diabetes, liver cirrhosis or certain cancers. The pills you take to lower cholesterol may cause xanthomas to shrink. You can have them surgically removed, but if you do not get high cholesterol or diabetes treated (the reason they appeared in the first place), xanthomas can recur.

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Teething trouble

Q: My daughter is a year old and has no teeth. My sister’s daughter was born with two teeth. Is there reason for worry?

A: One out of 2,000 children have “natal teeth” at birth. Usually teeth appear between six and 12 months but teeth can appear as early as one month or be delayed beyond the first birthday and that is normal. However, in rare cases, the delay can also be due to Down’s syndrome, thyroid disease or bone disease. You need to consult both a paediatrician and a dentist.

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Painful jog ...CLICK & SEE

Q: I recently started jogging and have developed knee pain. My friends have all advised me to stop. They say all runners develop knee pain. Is this true?

A: Runners are not more prone to osteoarthritis of the knee but they do tend to develop pain around the patella (knee cap). This is due to failure to warm up adequately and stretch properly before and after exercising. The quadriceps (the big muscles in front of the knee) also require to be strengthened.

If you develop pain after jogging, apply an ice pack. It will reduce inflammation and pain.

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Party pooper

Q: I frequently develop diarrhoea after I eat at social functions. I cannot refuse to eat without giving offence. Is there a preventive tablet that I can take?

A: You may not be able to tolerate the oil or the colouring and other condiments added to the food. The mineral water provided might also not be of ISI standard. You can avoid diarrhoea, if you stick to vegetarian food, avoid fried items and not drink any water. The safest food is curd rice.

If you do develop diarrhoea, take equal quantities of rice and moong dal and cook it in a pressure cooker with salt. Eat only this for 24 hours.

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Idiot box blues

Q: My son used to do well in school (he is in Class VII). Now he complains of inability to recall what he has studied and poor mathematical ability. He does his homework in front of the television.

A: Why do you allow him to do homework in front of the television? He cannot possibly solve maths problems correctly while watching serials or cartoons. The rapidly flashing images also deplete the brain chemicals responsible for attention, learning and memory.

Physical activity for an hour a day improves memory. Encourage your son to play outside for an hour and then start his homework in a quiet room with no television. I think you will notice a vast improvement.

Keep walking

Q: I am 86 years old and active. Unfortunately my family members keep telling me to “take rest”. They feel that since I worked hard all my life, I should now just sit quietly. I think if I sit long enough I will die.

A: You are right. Walking and other physical activity keeps you mentally agile and physically fit. It also prevents blood clots from forming in your legs and causing strokes and heart attacks. So keep moving as long as you are able to.

Yellow liver

Q: I heard that jaundice causes liver cancer. Is this true?

A: Jaundice” just means that the blood has high levels of bilirubin. It can be due to several reasons — infection, blood destruction, gall bladder disease etc. One of the causes is primary cancer of the liver or secondary tumour deposits there.

Jaundice because of hepatitis B infection can also cause liver cancer. This can be prevented by immunisation with three doses of hepatitis B vaccine.

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Source: The Telegraph ( Kolkata, India)

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Some Health Quaries & Answers

Go back to nature



Q: I use a treadmill to exercise regularly. I always get a pain in my calves and thighs afterwards. It is very discouraging and makes me want to stop.

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A: Treadmills are excellent machines to use for exercise. Unfortunately, the movements are different from natural movement on the ground because the surface you are running on moves along with you. This results in slightly different groups of muscles in the leg being used and a different running style from the natural form. This may account for the pain you develop. The pain can be tackled by doing warm-up exercises before you hit the treadmill and cool down exercises such as flexion and stretching afterwards. Alternatively, you can go back to the natural form and run on the road.

Cosmetic cure?


Q: Although I am only 30 years old I look much older. My face is wrinkled and pimply and I have a prominent jawline. I am ashamed of the way I look. Should I go in for cosmetic surgery?

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A: You are very young and I do not think cosmetic surgery or Botox is the answer. In another 10 years the same things will recur, making the cosmetic surgery a waste of time and money.

You need to jog, cycle or at least walk for an hour a day. Then do 20 minutes of yoga. Stress levels will decrease and you will be able to cope with the demands of your work. The exercise will also improve the muscle tone of your face and the rest of your body. Also, practise smiling whenever you are sitting and do not let your mouth and face droop down.

Ovarian cancer

Q: I get an itchy white discharge soon after my periods. I am afraid it may be a sign of cancer. My mother died of ovarian cancer.

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A: Ovarian cancer is rare and accounts for only 1.5 per cent of cancers in women. The incidence increases to 6 per cent if there is a first degree relative with the disease. What you have described sounds more like a yeast (monilia) infection, which is common and can be easily treated with both topical applications, pessaries and /or oral tablets. Consult a gynaecologist. Get an ultrasound scan of the pelvis done to reassure yourself about the size, position and function of the ovaries.

Black mark

Q: The skin of my neck, armpit and elbow are black in colour. It does not itch nor is it painful. It just looks as though I have not had a proper bath.

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A: That is probably Acanthosis Nigricans, velvety black, non-itchy lesions which can occur in the neck, arm pit, groin and elbow. It is associated with obesity and diabetes . Get yourself tested for diabetes. If you are overweight, try to exercise and lose weight. Avoid using powder or cream . It will get aggravated.

Period problem

Q: I do not get my periods even after a year unless I take tablets. Recently I noticed a milky white discharge from both breasts as well. My parents want me to get married. My grandmother says everything will become alright if I have a baby.

A: You obviously have a problem and that is why your menstruation is not spontaneous and there is discharge from the nipple. You need to consult a gynaecologist and / endocrinologist. They will check your hormone levels — LH, FSH, prolactin and thyroid.

Shampoo right


Q: I have oily hair. I shampoo it every day but now the hair has become very brittle and is breaking off. It seems to be coming out by the handful.

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A: Oil on the scalp protects it from injury. If you use harsh shampoos the hair will get damaged. There is a right way and a wrong way of shampooing. A small quantity of a mild shampoo should be taken in the palm of the hand. The two palms should be rubbed together and the shampoo applied on the surface of the head. It should be washed off immediately and a conditioner for greasy hair should be applied on the surface of the hair. The conditioner should be left in for about five minutes before being washed off.

Hair loss can occur owing to hormone imbalance, iron, zinc or calcium deficiency.

Source : The Telegraph ( kolkata, India)

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Some Health Quaries & Answers

Walking Shoes:

Q: I bought a new sports shoe, even though it was a little tight. The salesperson told me that it would loosen with use. Now I have a pain in the second toe and the nail has become black in colour.

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A: The shoe salesman reinforced a common misconception that a tight shoe will eventually become loose. By the time that occurs though, you may have corns and calluses on your feet. If the shoe is tight, there may not be enough space for the second toe. After wearing the shoe, press down with your finger and see. If the toe is jammed up against the front of the shoe, the nail may be damaged during exercise.

Always buy shoes in the evening as your feet are then slightly swollen from the day’s activity. The shoes should be comfortable the minute you try to walk.

Hepatitis attack

Q: I had jaundice last month. I am worried since my wife is pregnant. Do I need to take any precautions?

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A: Jaundice is a generic term, which means that the yellow pigment (bilirubin) in your blood has increased and is probably being excreted in your urine, discolouring that too. From your letter I think you meant that you had infective viral hepatitis. This too is of several types A, B, E etc. Hepatitis E is dangerous for pregnant women while hepatitis B can be passed on to the baby. You can prevent hepatitis A and B with immunisation. Consult your physician and your wife’s obstetrician so that steps can be taken to safeguard her health and that of your baby.

In mom mode

Q: I delivered a baby three months ago and have not had my periods as yet. When can I expect to start menstruating again?

A: Menstruation can start one and a half months after delivery or be delayed for a year. Mothers who breastfeed their children tend to start menstruation later. However, ovulation can occur even without it. If you do not wish to become pregnant, use contraception regularly even if you are feeding the baby and have not yet had your periods.

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Sugar swings

Q: I have diabetes and am on medication. Sometimes my blood sugar is very low and on other days it is very high. Is there a way to control this?

A: Once you have been diagnosed with diabetes and started medication, it is important that you make a few lifestyle changes. You should not abandon your prescribed diet. You need to avoid fasting even on auspicious days. The tablets will work provided your food intake is regular and according to the diet chart provided by your doctor. You need to exercise for 40 minutes a day to increase your body’s efficiency in reducing blood sugar.

Chew   tobacco?

Q: Is it safer to chew tobacco instead of smoking it?

A: The harmful chemicals in tobacco are released into the mouth when you chew it. In fact, the risk increases when tobacco combines with the acidic lime in paan. It causes cancer of the throat, mouth, esophagus and stomach. Tobacco in any form — chewed, smoked or as snuff — is harmful.

Source: The Telegraph ( Kolkata, India)

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Some Health Quaries & Answers

To walk or not to walk:

Q: I am pregnant with my first child. My relatives tell me not to exercise but rest all day. The doctor, however, has advised walking, morning and evening.

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A: Exercise is important during pregnancy. It’s not harmful; on the contrary it has a positive impact on the health of the mother and baby. It enables both to withstand prolonged labour by increasing endurance. It boosts immunity, reduces stress and depression, and helps the mother to rapidly regain her pre-pregnancy physique.

Walking on level ground at a steady pace for 40 minutes in the morning and evening is safe and adequate. But be sure to wear good, supportive flat footwear and drink lots of water.

Abortion pills :

Q: I induced an abortion with tablets last year. After that my periods became irregular and I have not been able to conceive.

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A: Medical abortion is safe but must be done under a doctor’s supervision. A scan should be undertaken before taking the pills to ensure all the recommended criteria for a safe termination are met. The pregnancy should be less than 49 days, you can’t adopt this method if you’ve had a caesarian previously, the pregnancy should be in the uterus and not the tubes, and it should not be twins. The pills must be taken on two separate occasions, two days apart. After the abortion has occurred, a repeat scan must be done to ensure it has worked. If you have not followed these recommendations and had bought the tablets over the counter, consult a gynaecologist.

Blood in stools

Q: I have abdominal pain and diarrhoea with blood. The doctor did a stool test and said it is amoebic dysentery.

A: Amoebic dysentery occurs in tropical countries like India and causes diarrhoea with abdominal pain and blood in the stools. It can be distinguished from bacterial diarrhoea by the absence of fever. Treatment requires five to seven days of metronidazole. But consult your doctor for duration and dosage of the medicine. Failure to complete the course may result in chronic infection.

All diarrhoeas with blood and mucous are not due to dysentery. There are non-infective causes like polyps, diverticulitis, ulcerative colitis as well as cancer. If the results of a complete course of medication isn’t satisfactory, consult a gastroenterologist.

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Hospital bug

Q: My son is admitted to the ICU with pneumonia. I am worried about the “superbug”. I noticed that a great deal of the time, simple hygienic measures like washing hands between patients is not followed by the medical staff. Neither do visiting relatives and friends follow the rules. What’s more, some of them sit on the patient’s bed.

A: Hand washing reduces the spread of infection (and possibly the superbug) in the community and in a hospital setting by 50 per cent. It is proven to be the single most effective method to reduce infection. A sanitising liquid can also be used.

Unfortunately, these simple methods are often not followed by lay people or even the medical fraternity. There is nothing much you can do except keep a bottle of sanitising liquid with you and request visitors to use it. You may offend some people, but at least it will reduce your son’s chances of infection.

Chicken pox :

Q: Is there any way to prevent chicken pox? Or is it one of the inevitable diseases of childhood?

A: Varicella vaccine to prevent chicken pox has been available since 1995. Immunised children do not get the disease. Although in most children, it may be mild and recovery complete in five to seven days, it isn’t possible to predict if your child will be one of the unfortunate 10 per cent that develop complications.

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Diabetic drug

Q: My doctor gives me metformin for diabetes, which I have to take three times a day. My grandmother too was on metformin. I wonder if there isn’t anything better and if I should change my doctor.

A: Metformin is one of the oldest diabetic drugs on the market, and the safest and mildest. It prevents low blood sugars from occurring accidentally and this protects against heart attacks and strokes. Also, since it is taken after food, you are unlikely to take a tablet and then forget to eat.

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If you do not like to take pills thrice a day, you may ask your doctor for the longer acting, sustained release formulations. This will increase your dosage intervals.

Leg cramps :

Q: My son complains of pain in the leg at night. We have tried iron tonics, zinc supplementation and calcium, but nothing works. He wakes up with pain every night.

A: Add a tablespoon of rock salt in a bucket of hot water. Ask your son to stand in it for 10 minutes every night before sleeping.

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Source : The Telegraph (kolkata, India)

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