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Dr K K Aggarwal

May 12

18

Heart Patients Beware Of Summer

By Dr KK
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There is a change of weather both in the politics and the arrival of summer. With the increase in the relative humidity, more and more cases of heat disorders are being reported in the city.

Dehydration can precipitate heart attack in susceptible individuals. The normal fluid requirement is 30 ml per kg weight, but it needs to be increased in the summer because of the loss of fluid from sweating. Besides water, sodium (Na) or salt is also lost. A person, therefore, needs to take more fruit during the summer period.

Not passing urine in 8 hours, dry armpits, feeling exhausted or feeling weak are the warning signals. Dehydration can make the blood thick and precipitate heart attack in patients with uncontrolled blood pressure or diabetes.

Walking is a necessity for heart patients and the same should be continued even during peak summer but the timing should be so chosen that peak heat periods are avoided. One can walk early in the morning or late in the evening. People taking anti-allergic pills should take special precautions as they are more likely to get heat stroke.

Heat stroke is a medical emergency leading to charring of organs because of extreme internal heat. A person’s temperature may rise to more than 105oF.

Preventing summer disorders

  • The most common summer disorders are dehydration, heat cramps, heat exhaustion and heat stroke on one hand and acidity, infections, diarrhea, cholera, typhoid and jaundice on the other hand.
  • Heat cramps, exhaustion and stroke all result from prolonged exposure to heat but differ in the severity of the illness.
  • Heat cramp is a milder form of illness where a person has weakness dehydration, and salt deficiency. The treatment is replacing fluid and salt orally.
  • Heat exhaustion, on the other hand, is a relatively serious condition with fever, dehydration, weakness but presence of sweating. If not diagnosed and treated in time, with rapid fluid replacement heat exhaustion can end-up into heat stroke, where the body’s thermoregulatory mechanisms fail leading to a sudden rise in internal temperature and charring of organs and ultimate death.
  • Heat stroke is a medical emergency and requires bringing down of temperature within minutes. Absence of sweating, dry armpit, not passing urine for 8 or presence of high grade fever in summer season should not be ignored and medical attention taken immediately.
  • Diarrhea, cholera, typhoid and jaundice are all food- and water-borne diseases due to poor hygiene and shortage of water supply in the community. All of them can become serious if not attended in time. Of these, diarrhea and cholera are infections of small intestine and require replacing with lemon water mixed with sugar and salt. The deficiency of fluid may be up to 6 to 8 liters. A person needs to be hospitalized only if the number of loose motions is more than 12.
  • For prevention of these diseases, follow the principle – Heat it, Boil it, Cook it, Peal it or Forget it.

In the era of medical tourism, with a large number of Western patients coming for treatment inIndia, Indian doctors should respect the religious sentiments of patients from other religions.

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May 12

17

Early and Mild Rheumatoid arthritis

By Dr KK
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What is early and mild rheumatoid arthritis?

Patients with disease of less than six months duration who meet the ACR criteria for RA and typically have less than six inflamed joints, no extraarticular disease, and no evidence of erosions or cartilage loss on plain radiographs.

Can mild rheumatoid arthritis be seropositive?

A patient need not be “seronegative” to be categorized as having mild disease.

In mild rheumatoid arthritis can anti CCP antibodies be negative?

Absence of rheumatoid factor or antibodies to cyclic citrullinated peptides is a favorable prognostic factor.

What is the initial treatment of a patient with early and mild rheumatoid arthritis?

Initial therapy of patients with mild disease includes an NSAID at full therapeutic dose, unless contraindicated.

When to start DMRD in early and mild rheumatoid arthritis?

Disease modifying antirheumatic drugs should be started in all patients whose disease does not remit after six weeks to three months of treatment with NSAIDs alone.

Which is the first–line DMRD in early and mild rheumatoid arthritis?

Hydroxychloroquine or sulfasalazine because of their relative safety.

When should more drugs be added in early and mild rheumatoid arthritis?

Patients with persistent or increasing disease despite treatment for 3–6 months of full dose NSAIDs and either hydroxychloroquine or sulfasalazine require additional treatment.

What else can be tried in the treatment?

Additional therapies may include simple analgesics (paracetamol), bisphosphonates, nutritional supplements and cardiovascular risk reduction strategies.

When to give intra–articular steroid injections?

They can be given for one or a few joints if infection has been excluded. Oral glucocorticoids should be avoided or used in low dose.

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May 12

16

Even 3-4 mm BP Reduction Matters

By Dr KK
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Every year, 17th May is dedicated to World Hypertension Day (WHD). The theme for 2012 is Healthy Lifestyle – Healthy Blood Pressure.

If you change the oil in the car regularly, and don’t wait until it’s performing poorly to change it, then why treat the body any differently.

Cardiovascular disease (CVD) is the leading cause of death and hypertension is the most common, reversible risk factor for CVD.

High blood pressure goes hand-in-hand with, heart disease, stroke, kidney disease, overweight/obesity and diabetes.

In the United States alone 7.2 crore people age 20 and older have high blood pressure.  Of those with high blood pressure, nearly 30 percent don’t know they have it, and 65 percent don’t have it under control. In India the number is over 10 crore.

Worldwide, an estimated 97.2 crore people had hypertension in the year 2000. By 2025, an estimated 156 crore people will have it.

High blood pressure is easily detected and usually controllable. Normal blood pressure is systolic below 120 and diastolic below 80. Hypertension is systolic blood pressure at or above 140 mm Hg and/or diastolic blood pressure at 90 mm Hg or higher. “Pre-hypertension” is systolic pressure of 120–139 mm Hg, and/or diastolic pressure of 80–89 mm Hg.  This is the point at which lifestyle changes are recommended to reduce blood pressure.

There are dramatic benefits from small decreases in blood pressure, even in people without hypertension by current definitions.

1.     3–4 mm Hg systolic increase in blood pressure would translate into a 20 percent higher stroke death rate and a 12 percent higher death rate from ischemic heart disease.

2.      In patients with obesity, diabetes and hyperlipidemia, the impact of these small changes in blood pressure on CVD is even greater.

3.      Hypertension “does not typically cause a symptom; that’s why it’s called the ‘silent killer. There is a long lag period from the beginning of the problem to the time when patients are aware of the
damage it’s caused.

4.      One should have the blood pressure checked routinely.

5.      One should live a healthy lifestyle to prevent hypertension.

6.      One should keep weight in a good range.

7.      One should be physically active.

8.      One should eat a diet high in fresh fruits and vegetables and low in saturated fat and sodium.

9.      One should avoid tobacco at any cost.

10.   Those who choose to drink; should do so in moderate amounts (no more than an average of one drink a day for women or two for men).

11.   This who already have high blood pressure, should keep it controlled under a physician’s care.


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May 12

15

Diabetes Can Be Delayed By 14 Years

By Dr KK
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A defined Diet and Exercise Programme in people at high risk of diabetes, if followed for six years, can delay the onset of diabetes for 14 years as per a report published in the edition of “The Lancet”.

In the study called China DA Quing Diabetes Prevention Outcome Study, 577 adults with high blood sugar levels at risk of diabetes from 33 clinics in China were randomly assigned to any of the three lifestyle interventions. One group on diet, second on exercise, and the third on combination. They were compared with the control group without any diet or exercise programme.

The interventions included reducing the amount of food, sugar and alcohol and putting more vegetables and increasing the level of physical activities.

Lifestyle interventions reduced the incidence of diabetes by 51% over the six years of the programme and over the whole 20 years period, the incidence of diabetes was reduced by 43% in those people who have been in diet and exercise programme.

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May 12

14

Heat Index Should Be Communicated To The Public

By Dr KK
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‘Heat index’ measures the combined effects of temperature and humidity on the ability of the body to lose heat. It determines how hot it really feels. Periods of high heat index adversely affect human health.

The human body normally cools itself by sweating through evaporation, which carries heat away from the body. But, high relative humidity reduces the evaporation rate and so heat is removed from the body at a lower rate causing it to retain more heat than it would in dry air. As a result, the body temperature increases leading to heat-related illnesses such as heat exhaustion, heat cramps and heat stroke.

‘Heat cramps’ is the mildest form of heat disorder, presenting with cramps due to salt and water dehydration. ‘Heat exhaustion’ is a milder form of heat disorder where sweating is still present. But, ‘heat stroke’ can be lethal if not diagnosed and treated in time. Patients with heat stroke manifest with high fever, dehydration and absence of sweating. The rectal temperature often shoots more than 106°F. Oral and axillary temperatures may not be reliable in such situations. The affected person may be dehydrated to up to 8 to 10 litres of fluid.

This summer, with temperatures already crossing 42.6°C, cases of heat stroke are likely to increase in the coming days.

Sportspersons should avoid workouts during peak sun hours and should take adequate fluids to prevent dehydration. Salted lemon water and mango ‘panna’ are the drinks of choice.

  • Heat stroke is common in elderly and in people who take anti–allergic tablets.
  • Altered consciousness in a patient with fever should make one suspect underlying heat disorders.
  • One may lose 500 to 1000 ml of fluids everyday due to summer sweating. This amount, therefore, may need to be taken extra. However, patients with kidney diseases or heart failure need to consult their doctors to decide the amount of extra fluid they need to take.
  • Absence or presence of sweating can be detected by armpit test. A dry armpit may mean severe dehydration.
  • In summer, everyone should pass urine once in 8 hours. Not passing urine in 8 hours may mean severe dehydration.
  • One should avoid eating cut–open fruits and vegetables during this season to prevent disorders like jaundice, typhoid, gastroenteritis and cholera.

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May 12

13

Eat Less To Remember More

By Dr KK
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“Eat less to remember more” is the prescription of the day for the elderly.

A study published in Proceedings of the National Academy of Sciences, by Dr. Agnes Floel, assistant professor of Neurology at the University of Munster, has shown that memory and thinking skills improved among healthy, overweight subjects who cut their calorie intake by 30 percent over a three–month period.

Calorie restriction boosts memory and cognition by reducing insulin resistance and inflammation, which may be linked to age–related cognitive decline.

Improvements in memory could be especially important, because memory losses are an early indication of Alzheimer’s disease and its precursor, mild cognitive impairment.

The 49 men and women in the study had a mean age of 60.5 years and a body mass index of 28. Those in the calorie–restriction group were not told what to eat but were advised to cut portions and not to eat less than 1,200 calories daily.

The calorie restrictors lost an average of five pounds, with those who most closely adhered to the dietary recommendations losing an average of eight pounds. This subset with the largest weight loss also showed the biggest improvements in memory performance.

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May 12

12

Summer Foods – Follow the Hygiene Rules of “Heat It Boil It Cook It Peel It Or Forget It

By Dr KK
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In summer there occur pitta (metabolism) aggravation. One need to eat easily digestible foods.

In summer follow the hygiene rules of “Heat it boil it cook it peel it or forget it”

In summer increase the liquid intake by 500 ml to cover sweat loss. Most summer fruits are high in water contents including water melon and kharbooja or musk melon.

To prevent heat disorders one should increase the intake of unripe mango panna, onion, cucumber or kheera. Mango panna, mint or pudina chatni, mango and imli (tamarind) water all prevents heat stroke. Cucumber should be added with black or rock salt. Unripe mango is called king of summer fruits.

Unripe mango panna can be prepared by adding masala (spices), bhuna jeera (roasted cumin), black or rock salt, green coriander, heeng (asafetida), jaggery and red pepper (mirch). They all increase the digestive fire and reduce summer acidity.

One can boil mango and add coriander, mint, salt, jaggery water, roasted cumin, imli (tamarind) water or black peeper. Earlier mango panna was made by roasting mangoes (like shaker kandi). Roasting preserves nutrition and fibers. For acidity one can add mishri
(crystallized sugar lumps) not jaggery. Ajwain (carom seeds) 2 tea spoon full and 1 tea spoon full saunf (fennel seeds) can also be added after slow heating them in with water.

Bel sharbat (wood apple) is a cooling summer drink and is taken with black salt, roasted cumin, and unrefined sugar or desi khand. The seeds of bel are should not be grinded in mixi. Bel is mentioned in Rig Veda as a poor man’s fruit. It is helpful in all fields of digestion and removes digestive toxins. Its seeds make a coating in intestine. It is good in ulcerative colitis along with other herb Kutaj Ghan Vati.

All summer drinks can be made sugary (desi khand, honey of gur), sour (lemon) or salty  (rock salt)

 All vegetables in summer are also watery like karela, ghia (green gourd), tinda (round gourd), tori (ridge gourd), petha (pumpkin). They are easy to digest.

One should eat milk khoa paneer less in summer. To take milk one should add 1tsf amba haldi and 1 tsf sautnth  especially for arthritis.

For summer acidity one can take amla powder and mishri powder in equal quantity and add it to 50 ml milk to be taken with black gram sattu every two hours ( 2 tea spoon full) Cumin is digestive.

In summer constipation one should take trifla with water in morning and in night with milk. One can also take harad with desi ghee after deep frying the powder with jaggery at night

Anjeer (fig) is another summer fruit. One should take it after soaking in water for 212 hours. It’s cooling and good for preventing summer nose bleed.

In summer taking almonds and munacca or raisins (without seeds) with milk is good for heat prevention.

(Dr K K Aggarwal and Dr Vibha)

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May 12

11

All Kids Need Cholesterol Tests As Per New AAP Guidelines

By Dr KK
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As per new guidelines from the American Academy of Pediatrics (AAP) published in Pediatrics.

  1. Cholesterol checks should be part of periodic well–child visits for all children
  2. Screen cholesterol at least once between the ages of 9 and 11 and again at 17 to 21. Pediatricians previously had been directed to screen cholesterol only in children with risk factors like a family history of heart disease or high cholesterol. Routine screening need only be a non–HDL cholesterol measurement that doesn’t require fasting.
  3. Dietary management is often effective and should be the first line of attack against elevated cholesterol. Short–term use of plant sterol or stanol esters –– such as those in some margarines –– have been shown safe at doses up to 20 g per day, but longer–term use has not been tested and should be reserved for children who do not respond to diet alone.
  4. Statins should be considered for those with LDL levels at 190 mg/dL or higher for children who are at least 10 years old and have not responded after six months of lifestyle management or at an LDL of 160 to 189 mg/dL if risk factors are present.
  5. One should emphasize on breastfeeding and a diet low in saturated fat after a child’s first year.
  6. Advise parents on protecting children from tobacco exposure
  7. Start active anti–smoking advice to children at ages 5 to 9.
  8. Track weight–for–height, reviewing growth with parents and refer when above the 85th percentile without reductions for more than six months after age 4.
  9. Start routine annual blood pressure checks at age 3.
  10. Encourage physical activity and limiting time spent sedentary or in front of a screen to two hours or less per day.
  11. Start measuring fasting glucose at age 9 to 11.
  12. Detecting and intervening on these risks early should give children a healthier future.

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