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Dr K K Aggarwal

Environmental Impact on Eye Health

By Dr K K Aggarwal
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Expanding areas of arid land, air pollution and greater exposure to ultraviolet (UV) radiation all present potential health hazards to the eyes.

The cornea, eyelid, the sclera and even the lens—are all exposed directly to the environment. Rising temperatures and shifting atmospheric circulation patterns force dry air into regions. Drier air means that more people are likely to suffer from dry eye, a condition in which tears aren’t produced properly or evaporate too quickly. There is no evidence that drier conditions cause dry eye but they can accelerate symptoms in people who are prone to dry eye.

Air pollution has long been linked to respiratory disorders; more recently it’s been shown to play a role in eye disease.

Exposure to wood or charcoal cooking fires—ubiquitous in many developing countries—appears to accelerate the scarring caused by trachoma. Recurrent infections over a lifetime lead to scarring inside of the eyelids, which in turn causes the eyelashes to turn inward and brush against the cornea, eventually resulting in damage that impairs vision.

Ozone depletion can lead to higher levels of UV light exposure, which is a known risk factor for cortical cataract. Chronic exposure to the sun’s damaging rays can alter the orderly arrangement of proteins in the lens of the eye or damage lens epithelium, causing the lens to become cloudy. Wearing a hat can reduce UV exposure by 30%. Sunglasses, even simple plastic lenses that offer full UV protection, can reduce exposure by nearly 100% and should be used judiciously.

Entire community should take note of the severe damage that can be caused to the eyes. It becomes all the more important to note these precautions as Indians tend to be vitamin D deficient.

Precautions to stay healthy during the winter months

By Dr K K Aggarwal
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  • To prevent winter depression, one should either sit in the sunlight for long or stay in indoor spaces with illuminated light.
  • Early morning blood pressure is higher in winter than in the summer months. Therefore, people with high blood pressure should ask their doctor to increase their blood pressure medicine during the winters.
  • There are more heart attacks in the winter months than in the summer months and therefore, any chest pain especially in the morning in winter should not be ignored.
  • During the winter season, one should avoid food that is excessively sweet, sour or salty
  • Everyone should ask their doctor for pneumonia and flu vaccine.
  • Pneumonia during the winters can be deadly in very young and old people. The flu vaccine should be given to all those who are at high risk, especially, people with asthma, diabetes and heart diseases.
  • During the winters, one should avoid sleeping in closed rooms with electric gadgets like heaters on
  • One should check the earthing of all the electric devices especially the geyser
  • One should avoid using sugar while preparing sweets; instead one can use either Stevia or jaggery especially in Gajar Ka Halwa.
  • One should avoid switching from one temperature to another without giving their body time for adjustment.
  • Vitamin D is essential for good health. Each person should spend 40 minutes in the sunlight each day, especially before 10 am and after 4 pm.

Prevention is always better than cure. A little extra care can help make the holiday months, more enjoyable and heart healthy.

Patients can practice yoga but with precautions

By Dr K K Aggarwal
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Yoga is a science, which shifts one from sympathetic to parasympathetic mode. It is a combination of Hatha Yoga (asanas or postures), breathing and meditation. Meditation means concentrating on the object of concentration and giving preference to the object of concentration over thoughts. Mindfulness meditation, breathing awareness can shift from sympathetic to parasympathetic mode.

Breathing exercises in yoga can be both slow & deep breathing and fast breathing. Kapalbhati and bhastrika are fast breathing exercises.

In modern system of medicine, every movement in an exercise is accompanied by the opposite movement. The same is true for yoga. For every movement, there is a reverse movement.

Often when patients come to us for consultation or follow up, they ask if it is safe for them to do yoga. Yes, patients can do yoga but they should do it under the guidance of a trained yoga instructor. Teaching yoga is the job of an expert. In the hands of an untrained person, yoga may be risky. Also, it is important that patients observe specific precautions pertaining to their illness while doing yoga. They should practice yoga slowly and take care to not overdo any asana and avoid some postures that may aggravate their health problems

Here are some precautions, which patients should follow while doing yoga:

• Yoga is not included as an aerobic exercise.

• Fast breathing exercises stimulate the sympathetic system. Slow breathing stimulates the parasympathetic system. Therefore, cardiac clearance needs to be taken for all breathing exercises.

• In three situations in Hatha Yoga (headstand, handstand, shoulder stand), the total body weight is put on head, wrist and shoulder. This requires medical clearance, especially for heart patients.

• When you get up from a sitting position, nine times weight is put on the knees. Hence, patients of osteoarthritis should avoid sitting down, low height beds or chair or Indian toilets. Yoga may prevent osteoarthritis, but once developed, Hatha Yoga practices need to be modified.

• The Lotus position, forward and backward bends need orthopedic clearance in selected patients.

• Forward spine exercises may require orthopedic clearance in selected cases as they may precipitate sciatica, if done incorrectly.

• Painful and/or difficult yoga postures should be avoided

• Patients with cervical disc disease, glaucoma should avoid doing inversion postures (head stand, shoulder stand).

• If pain or paresthesia worsen, stop and consult a doctor

Cough Hygiene

By Dr K K Aggarwal
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1. When you cough or sneeze, you tend to expel out respiratory waste, which can be droplets (larger than 5 micron) or airborne droplet less than 5 micron, both have a different implications. 2. Droplets remain suspended in the air only for a limited period and exposure of less than 3 feet is usually required for human to human transmission of droplet-borne respiratory organisms. In flu, this can be up to 6 feet. The examples of droplet infections are patients with meningitis, influenza, rubella (German measles) etc.

3. No precautions need to be taken by a person who is 6–10 feet away from the patient but if a person is sitting or working even at a distance of 3–6 feet from the patient, he/she should wear a simple mask.

4. In contrast, airborne droplet nuclei that carry respiratory secretions smaller than 5 micron can remain suspended in the air for extended period and can cause infections to people who are standing even more than 10 feet away. The example of airborne droplet nuclei infections are TB, measles, chickenpox and SARS (Sudden Acute Respiratory Syndrome).

5. Patients with these disease require to be placed in an isolation room and all those people who are looking after these patients must use a safe N95 mask.

6. In normal house with windows open, there is a constant exchange of air, which prevents spread of infections but in AC setups with no air exchange, the infections can spread from one person to another.

7. When sitting in an air conditioned atmosphere, the setting of the AC should be such that the same air is not circulated and fresh air is allowed to exchange. Split ACs, therefore, are more dangerous than the window ACs. 8. In an office with split AC, if one of the many employees is suffering from any of the droplet nuclei disease, the infection can be transmitted to others. Therefore, patients with confirmed TV, measles, chickenpox and SARS should not be allowed to work in split AC atmosphere.

Economy-class syndrome

By Dr K K Aggarwal
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All doctors should diagnose and treat venous thromboembolisms, which include deep-vein thrombosis and pulmonary embolism. These are potentially fatal conditions that occur when a blood clot that’s formed at one point of the venous circulatory system detaches and travels to the lungs. A pulmonary embolism occurs when this kind of clot, which usually forms in the veins of the leg, obstructs the pulmonary artery in the lungs or one of its branches. This can cause acute right heart failure or sudden death. The problem of deep-vein thrombosis gained notoriety when passengers on long-haul flights develop deep vein thrombosis and lung embolism now called as “economy-class syndrome.” It results from long hours of minimal movement for example airline passengers sitting in their seats for hours and not being able to move. Treating the condition at an early stage can help save lives and prevent complications such as pulmonary embolism or recurrent deep vein thrombosis. Deep vein thrombosis claims the life of at least one airline passenger a month at Heathrow.

Precautions:

• Get up and walk about at least once an hour.

• While seated, flex your ankles and move your feet around to stimulate blood circulation.

• Remain hydrated.

• Consider wearing support stockings or elastic wraps to keep blood from settling in the veins in your legs.

• A simple aspirin tablet taken a few hours before take-off thins the blood during long periods of inactivity. The number of victims would fall significantly if more passengers followed this advice.

• Severe risk for thrombosis should be given injections with low molecular weight heparin (LMWH), a form of prophylaxis already in common use in hospital patient.

• One should abstain from alcoholic beverages and caffeine.