Cataracts and Macular Degeneration

Authors: Sachdeva S, Dhull AK

Overview of Cataracts and Macular Degeneration
Cartoon characters see spots or stars before their eyes, and everyone laughs. But there's nothing funny about sight-robbing cataracts and age-related macular degeneration (AMD). Both of these eye diseases are hallmarks of aging, but that doesn't mean you must surrender your sight to them as you get on in years. Adding vision-valuable foods to your diet may help you protect your eyes from the damage that occurs over time.In this article we'll look at the causes of cataracts and AMD, as well as some alternative treatments -- in other words, ones that don't involve surgery -- for relief from this age-related problem.

Understanding Cataracts

The reality is sobering. If you live long enough, chances are you'll get cataracts. As the population ages, the numbers creep ever upward -- each year, more than a million people are diagnosed with cataracts severe enough to require surgery. Almost two-thirds of all 60-year-olds have them.A cataract starts off as a cloudy spot on the clear lens of your eye (which is located behind your colored iris), almost as if you smeared grease on it. Some cataracts develop so slowly, you aren't even aware of them.But often, the cataract gets worse, or you get more of them. You may begin to notice double or blurred vision, sensitivity to light (glare may be especially troublesome), and changes in color perception. The upshot will be progressively more-frequent changes in your eyeglass prescription, until the glasses no longer seem to help the problem. Your distance vision gradually decreases and near vision improves (also called second sight).Your eye doctor will probably detect your cataract and, if it gets severe enough, suggest the latest in eye surgery.Until the late 1970s, cataract surgery. was certainly no picnic. It never really restored normal vision, and you had to wear thick eyeglasses, declaring to the world your advancing age. Now, cataract surgery is a mere hour-long affair ( in fact the actual procedure taking only 10 to 15 minutes), usually performed on an out-patient basis and is totally suture less. The cloudy natural lens is removed and replaced with a plastic intraocular lens. In the vast majority of cases, the operation is extremely successful: The implanted lens restores sight lost to the clouded-over lens and corrects most of the need for eyeglasses after surgery. But wouldn't preventing cataracts in the first place be even better? Well, tell those eye surgeons to hold their scalpels and lasers, because cataracts may not be the inevitable consequence of aging we've come to expect.

Understanding Macular Degeneration

Cataracts may affect more people, but macular degeneration is the most common cause of age-related blindness. That's why researchers are furiously working to better understand how to prevent and treat this eye disease, as well.The macula is an area of the retina, which is in the back of your eye. The retina is like the screen onto which the lens focuses the light (and hence the images) that enters the eye. But only a small area of the retina, the macula, contains the specialized cells responsible for the sharp central vision that you need to read, drive, and perform many other daily activities requiring clear, crisp focus. As the macula degenerates, some of the messages from your eye to your brain that tell you what you're seeing can't be transmitted, and your vision slowly becomes blurred or distorted; you may see shapes, but not fine lines, and you may experience a blank spot in your central vision. Eventually, you lose your vision altogether. There is currently no effective treatment to restore vision once the macula begins to degenerate.

Researchers have discovered that the retina of the eye is constantly bathed in vitamin C, at levels much higher than those normally found in the blood. Some researchers speculate that the vitamin C is there for protection and that the amount may need bolstering as we age. Perhaps antioxidant nutrients, therefore, could help prevent this condition, too.

Fig: Amsler grid to detect ARMD

Treatment Options
Where there's exposure to ultraviolet (UV) light (such as from the sun), there's potential for cell damage. The eye is certainly no exception. In fact, the more UV exposure, the more cataracts -- up to three times the risk.
The eye is constantly exposed to light and air -- typically polluted air as well -- and that's just the recipe for oxidative damage. When cells are oxidized, they set off chain reactions that can destroy whatever is in their path -- including healthy cells in the lens or the macula of the eye.Suddenly, a dietary connection to eye disease no longer seems so farfetched. Research into the possible connections between nutrition and vision has grown by leaps and bounds over the past decade. It is now evident that antioxidants may work to slow the progression of cataracts and may even help prevent them. The antioxidant nutrients linked to decreased cataract incidence include beta-carotene, vitamin C, and vitamin E.In one study, women who ate lots of fruits and vegetables had a whopping 39 percent lower risk of developing severe cataracts (the kind that require surgery) than those who didn't eat much produce. Among the strongest protectors were spinach, sweet potatoes, and winter squash, all high in beta-carotene. Another study found daily intake of 180 milligrams of vitamin C from foods (nearly three times the recommended daily amount) reduced the odds of developing cataracts by nearly 50 percent.With macular degeneration, National Eye Institute researchers were thrilled with the remarkable results from a six-year study. At least 25 percent of the people at risk for developing advanced macular degeneration experienced a protective effect from supplements containing vitamins C and E, beta-carotene, and zinc. The nutrients certainly don't cure the disease, nor will they restore vision already lost. However, they may help to slow progression of macular degeneration, a wonderful prospect for people suffering from this vision-robbing disease.Another interesting finding from recent research is that people with higher macular concentrations of two beta-carotene cousins, called lutein and zeaxanthin, seem to experience greater protection from damage caused by sunlight and other environmental factors. Research shows that people eating a diet with the most lutein+zeaxanthin (as much as 5.8 milligrams (mg) per day) had a significantly lower risk for AMD than those whose diet contained the least amount (as low as 1.2 mg per day). Lutein and zeaxanthin are found in yellow-colored vegetables, spinach, turnip greens, collard greens, romaine lettuce, broccoli, zucchini, corn, garden peas and Brussels sprouts. Research also suggests higher intakes of omega-3 fatty acids, which are found in higher-fat fish, soybeans, wheat germ, and canola oil, may help protect the eyes from AMD.Admittedly, we are still in the infancy of learning about the connection between nutrition and eye disease. And not all the results from the research have been promising. But the possibilities are indeed worth looking into.Taking precautions and augmenting them with foods and supplements can provide benefits to the eyes, if not an all-out cure.
A Feast for the Eyes
Vitamin C, vitamin E, and beta-carotene can protect your eyes from cataracts and macular degeneration. Below, we list some foods that provide these nutrients:

For vitamin C: Broccoli*, Brussels sprouts*, Cantaloupe, Cauliflower, Citrus fruits and juices, Papaya, Strawberries, Tomato juice.

For vitamin E: Almonds, Corn and safflower oils, Eggs, Peanuts, Sunflower seeds.

For beta-carotene: Apricots, Cantaloupe, Carrots*, Leafy, dark greens* (kale, spinach, turnip and collard greens), Mangoes, Peppers, red bell, Sweet Potatoes, Squash winter.

*These also supply lutein and zeaxanthin.
Tips for Saving Your Sight
There are plenty of simple steps you can take to ensure the health of your eyes, such as:
· Limit your sun exposure between the hours of 10 A.M. and 4 P.M., when sunlight is most intense.
· Wear a wide-brimmed hat when in the sun.
· Choose sunglasses with UVA and UVB protection (they are labeled voluntarily by the manufacturer), and wear them.
· Stop smoking. Smoking increases the amount of oxidative damage inflicted on your eyes.
· If you have diabetes, keep your blood glucose under control. High blood glucose levels can damage the lens of the eye.
· Eat a diet rich in fruits and vegetables. Aim for five to nine servings per day. Be sure to include those rich in vitamin C and beta-carotene.
· See an ophthalmologist regularly for early detection.

DISCLAIMER: This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Health Mirror, the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

In case of any queries please feel free to contact Dr Sumit Sachdeva or Dr Anil K Dhull

Cholesterol and Preventive Measures

What is Cholesterol?
Cholesterol is a waxy, fat-like compound that belongs to a class of molecules called steroids. It's found in many foods, in your bloodstream and in all your body's cells. If you had a handful of cholesterol, it might feel like a soft, melted candle. Cholesterol is essential for:
· Formation and maintenance of cell membranes (helps the cell to resist changes in temperature and protects and insulates nerve fibers)
· Formation of sex hormones (progesterone, testosterone, estradiol, cortisol)
· Production of bile salts, which help to digest food
· Conversion into vitamin D in the skin when exposed to sunlight.

Most of the body's cholesterol is manufactured in the liver

The formation of cholesterol involves a series of complicated biochemical reactions that begin with the widespread 2-carbon molecule Acetyl CoA: Acetyl CoA (C2) --> mevalonate (C6) --> isopentenyl pyrophosphate (C5) --> squalene (C30) --> cholesterol (C27). Cholesterol is made primarily in your liver (about 1,000 milligrams a day), but it is also created by cells lining the small intestine and by individual cells in the body.

Functioning of Cholesterol
Have you ever been about to take a big bite of your triple chocolate fudge cake when someone leaned over and said "you better watch your cholesterol"? That's happening to all of us more frequently. According to The American Heart Association, high levels of cholesterol are a risk factor for coronary heart disease, the nation's number one killer. Over 100 million Americans have cholesterol levels that exceed the recommended total and 20 percent of Americans have levels that are considered high.

You can check nutrition labels, like this one from a can, for cholesterol information.

What we don't often hear is the important fact that some cholesterol is vital to human life. In this article, we will take a look at cholesterol, both why it is needed for normal human--and animal--functions and why at high levels and in many individuals, it can be deadly.
Blood Cholesterol vs. Dietary Cholesterol
It may surprise you to know that our bodies make all the cholesterol we need. When your doctor takes a blood test to measure your cholesterol level, the doctor is actually measuring the amount of circulating cholesterol in your blood, or your blood cholesterol level. About 85 percent of your blood cholesterol level is endogenous, which means it is produced by your body. The other 15 percent or so comes from an external source -- your diet. Your dietary cholesterol originates from meat, poultry, fish, seafood and dairy products. It's possible for some people to eat foods high in cholesterol and still have low blood cholesterol levels. Likewise, it's possible to eat foods low in cholesterol and have a high blood cholesterol level.
So, why is there so much talk about cholesterol in our diet? It's because the level of cholesterol already present in your blood can be increased by high consumption of cholesterol and saturated fat in your diet. This increase in dietary cholesterol has been associated with atherosclerosis, the build-up of plaques that can narrow or block blood vessels. If the coronary arteries of the heart become blocked, a heart attack can occur. The blocked artery can also develop rough edges. This can cause plaques to break off and travel, obstructing blood vessels elsewhere in the body. A blocked blood vessel in the brain can trigger a stroke.
The average American man eats about 360 milligrams of cholesterol a day; the average woman eats between 220 and 260 milligrams daily. So how are we doing? The American Heart Association recommends that we limit our average daily cholesterol intake to less than 300 milligrams. Obviously, people with high levels of cholesterol in the blood should take in even less.
Good vs Bad Cholesterol
Comments about "good" and "bad" cholesterol refer to the type of carrier molecule that transports the cholesterol. These carrier molecules are made of protein and are called apoproteins. They are necessary because cholesterol and other fats (lipids) can't dissolve in water, which also means they can't dissolve in blood. When these apoproteins are joined with cholesterol, they form a compound called lipoproteins. The density of these lipoproteins is determined by the amount of protein in the molecule. "Bad" cholesterol is the low-density lipoprotein (LDL), the major cholesterol carrier in the blood. High levels of these LDLs are associated with atherosclerosis. "Good" cholesterol is the high-density lipoprotein (HDL); a greater level of HDL--think of this as drain cleaner you pour in the sink--is thought to provide some protection against artery blockage.
A high level of LDL in the blood may mean that cell membranes in the liver have reduced the number of LDL receptors due to increased amounts of cholesterol inside the cell. After a cell has used the cholesterol for its chemical needs and doesn't need any more, it reduces its number of LDL receptors. This enables LDL levels to accumulate in the blood. When this happens, the LDLs begin to deposit cholesterol on artery walls, forming thick plaques. In contrast, the HDLs--the "good" guys--act to remove this excess cholesterol and transport it to the liver for disposal.
A third group of carrier molecules, the very low-density lipoproteins (VLDL) are converted to LDL after delivering triglycerides to the muscles and adipose (fat) tissue.
The levels of HDL, LDL and total cholesterol are all indicators for atherosclerosis and heart attack risk. People who have a cholesterol level of 275 or greater (200 or less is desirable) are at significant risk for a heart attack, despite a favorable HDL level. In addition, people who have normal cholesterol levels but low HDL levels are also at increased risk for a heart attack.
Risk Factors
There are a number of factors that influence a person's cholesterol levels. They include diet, age, weight, gender, genetics, diseases and lifestyle.
Diet

There are two dietary factors associated with increases in blood cholesterol levels:
Eating foods that are high in saturated fats, even if the fats themselves do not contain cholesterol. (These include foods containing high levels of hydrogenated vegetable oils, especially palm and coconut oils, avocados and other high-fat foods of vegetable origin).
Eating foods containing high levels of cholesterol. (This group includes eggs and red meat--the most maligned of the cholesterol culprits--as well as lard and shrimp. These foods can significantly raise blood cholesterol levels, especially when combined with foods that are high in saturated fat).
It's important to note that only foods of animal origin contain cholesterol. Lack of awareness of this fact has led to some confusing labels at the grocery store. For example, some items that are high in saturated fats from plant sources bear labels claiming that they are 100 percent cholesterol free. The statement may be true, but it's generally misleading because it implies that the product is definitely beneficial to your health.
Age

The blood levels of cholesterol tend to increase as we age--a factor doctors consider when deciding treatment options for patients with certain cholesterol levels.
Weight

People who are overweight are more likely to have high blood cholesterol levels. They also tend to have lower HDL levels. The location of the excess weight also seems to play a role in cholesterol levels. A greater risk of increased cholesterol levels occurs when that extra weight is centered in the abdominal region, as opposed to the legs or buttocks.
Gender

Men tend to have higher LDL levels and lower HDL levels than do women, especially before age 50. After age 50, when women are in their post-menopausal years, decreasing amounts of estrogen are thought to cause the LDL level to rise.
Genetics

Some people are genetically predisposed to having high levels of cholesterol. A variety of minor genetic defects can lead to excessive production of LDLs or a decreased capacity for their removal. This tendency towards high cholesterol levels is often passed on from parents to their children. If your parents have high cholesterol, you need to be tested to see if your cholesterol levels are also elevated.
Diseases

Diseases such as diabetes can lower HDL levels, increase triglycerides and accelerate the development of atherosclerosis. High blood pressure, or hypertension, can also hasten the development of atherosclerosis, and some medications used to treat it can increase LDL and triglycerides and decrease HDL levels.
Lifestyle
Factors that negatively affect cholesterol levels also include high levels of stress, which can raise total cholesterol levels, and cigarette smoking, which can lower a person's HDL level as much as 15 percent. On the other hand, strenuous exercise can increase HDL levels and decrease LDL levels. Exercise also can help reduce body weight, which, in turn, can help reduce cholesterol. Recent research has shown that moderate alcohol use (one drink per day for women, two drinks a day for men) can raise HDL cholesterol and therefore reduce the risk of heart attack. Despite such research, it is difficult to recommend the habitual use of alcohol, because there are also negative health consequences associated with alcohol use and a high potential for abuse.
Always remember that risk factors for high cholesterol and cardiovascular disease don't exist in a vacuum--they tend to amplify each other. Reducing the risk of a cardiovascular disease involves eliminating all of the risk factors that we can control and seeking medical advise for those we can't.
Testing and Prevention
You should get your cholesterol tested every three to five years, more often if you have high cholesterol levels. Please refer to the table below for guidelines for total cholesterol, LDL and HDL levels.

Blood Type Relationships

Type of Cholestrol & Desirable Values in IU

Total Cholesterol Below 200

HDL Cholesterol Above 45

LDL Cholestrol Below 130

LDL/HDL Ratio Below 3.0

What can I do to reduce my cholesterol?
There are several steps you can take to reduce your cholesterol levels. The first is to eat a low-fat, low-cholesterol diet. That means keeping your total fat consumption--saturated, polyunsaturated and monounsaturated--to fewer than 30 percent of your daily intake of calories. Remember to keep your cholesterol intake to fewer than 300 milligrams per day. Saturated fats contained in butter, whole milk, hydrogenated oils, chocolate shortening, etc. should comprise no more than one third of your total fat consumption. To reduce your total fat and cholesterol intake, limit your consumption of meats such as beef, pork, liver and tongue (always trim away excess fat). In addition, avoid cheese, fried foods, nuts and cream, and try to curb your intake of eggs to no more than four per week. Try to eat meatless meals several times a week, use skim milk and include fish in your diet. Eat a wide variety of vegetables, pasta, grains and fruit. Another good tip is to look at the package label of the foods you buy, and restrict your choices to foods containing 3 grams of fat or less per serving.
There is evidence that water-soluble fibers can aid in lowering cholesterol; these foods include the fiber in oat or corn bran, beans and legumes, pectin found in apples and other fruits, and guar that is used as a thickener. Although highly touted by the media and health food stores, the phospholipid Lecithin has not been confirmed as a reducer of blood cholesterol levels.
If you are overweight, trying to lose weight and including aerobic exercise in your routine can help raise those desirable HDL levels. Diet and exercise alone can decrease cholesterol levels by up to 15 percent.
It probably comes as no surprise to you that, if you smoke, you should quit to avoid a wide range of health problems, including lower HDL levels and increased risk of heart attack.

Foods That Lower Cholesterol Overview
A diet rich in fruits and vegetables is a great start toward lowering cholesterol.
The first line of defense against too much blood cholesterol is a diet that is rich in foods that lower cholesterol. A healthy diet should include plenty of vegetables, fruits, whole grains, and fiber, and be low in saturated fat, trans fat, and cholesterol. For the vast majority of Americans, eating healthy and losing excess weight are ideal ways to lower elevated cholesterol levels and keep those levels within a healthy range for life.
Even those foods or supplements that may have a beneficial effect on cholesterol need to be part of an overall heart-smart diet. Having oatmeal for breakfast and a glass of wine at dinner is fine, but if you add whole milk and butter to the oatmeal or have a Porterhouse steak with the wine, you're not doing your heart any favors.
So choose your foods wisely, and if a particular food or supplement appears to help, be sure to include it. But remember: Moderation is key. Don't overdo it with any supplement or food because, in some cases, that can cause just as many problems as high blood cholesterol.
Foods That Claim to Lower Cholesterol
Many foods and supplements claim to lower cholesterol. But do they really? Sometimes the answer is no, and sometimes the answer is that we don't know. In some instances, studies that support claims that a food lowers cholesterol are conducted by the very people who are selling the product, or the studies are poorly designed. In other instances, the studies conducted to test whether a food lowers cholesterol are just inconclusive.
The foods discussed on the following pages are ones that doctors don't recommend for a variety of reasons. If you are interested in taking a chance that these foods will work for you, talk with your doctor first. And keep a record every time you have your blood cholesterol tested to see if you experience any progress while taking these foods or supplements.
Flaxseed is a plant-based supplement that contains omega-3 fatty acids.

Foods That Claim to Lower Cholesterol
Flaxseed
Guggul
Lecithin
Policosanol
Red Yeast Rice Soy Garlic
Olive Oil
Fish oil
Plant Sterols
Whole grains
Dietary fibre
However studies are going on to rule out the authenticity of the claims for different food ingredients.

Medicating High Cholesterol
Sometimes positive changes in diet, lifestyle and exercise are not enough. In these cases, doctors may consider the use of medication that lowers cholesterol. The decision to have a patient begin medication is often based on high levels of LDL cholesterol and other risk factors for cardiovascular disease. For example, medication may be indicated if your LDL level is over 190 or is over 160 and you have several other risk factors for cardiovascular disease.
Drugs that reduce LDL blood levels can prevent or reduce the build-up of artery blocking plaques and can limit the possibility of the release of those plaques as dangerous blood clots. There are several types of drugs that can help reduce blood cholesterol levels. The most commonly prescribed are the statins, HMG-CoA reductase inhibitors, including:
· Lovastatin
· Simvastatin
· Atorvastatin, a new, highly potent drug

These drugs work within the liver to directly prevent the formation of cholesterol and can lower LDL cholesterol by as much as 40 percent. Research also shows that these drugs can reduce the risk of death from cardiovascular disease. Another major drug category is the resins, which bind bile acids, causing the liver to produce more of them and using up cholesterol in the process. By "tying" it up, these drugs make cholesterol less available in the blood. They include:
· Cholestyramine
· Colestipol
· The B vitamin Niacin, in high doses, can lower triglycerides and LDL levels and increase HDL levels. Niacin has been proven to reduce a person's risk of having a second heart attack.
Last are the drugs in the fibrates category, which lower triglycerides and can increase HDL levels. These include:
· Gemfibrozil
· Fenofibrate
The decision to take cholesterol- or lipid-lowering drugs is not taken lightly by your doctor. These drugs can be fairly expensive and are often required for many years or even the rest of your life. It is also important to note that some of these drugs can have dangerous side effects, such as damage to the liver.
Adopting a healthy lifestyle and visiting your doctor regularly can help curb your risks of problem cholesterol. Have your cholesterol levels checked by a physician, rather than risk incorrectly interpreting numbers in self test kits currently on the market. Remember, cholesterol is necessary for life but it can also be very harmful and requires monitoring. So, watch your cholesterol and keep in mind that, for every 1 percent drop in your cholesterol level, your risk of heart attack is lowered by 2 percent.

How Alcohol Lowers Cholesterol
For many people, a little alcohol, such as the ritual evening cocktail, is a sure cure for the day's troubles. These same individuals might not be surprised to learn that when consumed in moderation, alcohol may also offer some protection against heart disease. Research has shown that moderate consumption of alcohol can raise HDL cholesterol.
It may also decrease blood clotting and insulin resistance and is linked to lower levels of certain markers of inflammation, such as C-reactive protein, all of which may reduce the risk of heart disease. A modest alcohol intake may also reduce the risk of diabetes. This should be good news for those who imbibe in moderation -- that is, up to one drink per day for women and up to two drinks per day for men. (One drink consists of 1.5 ounces of hard liquor, 5 ounces of wine, or 12 ounces of beer.)
In the early 1990s, epidemiologists -- experts who specialize in the study of large populations to determine how various diseases occur and spread and how they can be controlled -- looked at data from countries around the globe and noticed that the coronary death rate for people in France was considerably lower than for people in the United States, despite French people's well-known love of high-fat foods.
In fact, the phenomenon called the French Paradox relates to the fact that the French have fewer heart attacks than Americans. This is a situation that could not be explained simply by comparing cholesterol levels in the two countries. Experts felt that this difference was due primarily to the French diet, which contains more red wine, fruits, and vegetables. Although red wine contains antioxidants and other compounds that may help prevent blood clots or the oxidation of LDL cholesterol, it has not been shown that only red wine is protective. In fact, most studies have linked moderate consumption of alcohol in general -- including wine, beer, and hard liquor -- to a reduced risk of heart disease.
But experts raise a red flag at the idea of encouraging the consumption of alcohol in order to raise HDL cholesterol or lower coronary rates. Not only are there better ways to raise HDL cholesterol (for example, regular physical exercise), but also not everyone can handle alcohol well.
Many doctors are concerned about safe levels of alcohol consumption for patients. They point out that consumption of as few as three to five alcoholic drinks per day is associated with adverse health effects, and heavy alcohol consumption may raise blood pressure, increase blood triglycerides, damage the liver, cause birth defects (when alcohol is consumed during pregnancy), and increase the risk of developing certain forms of cancer. Also, the majority of those who develop drinking problems drink relatively small amounts.


DISCLAIMER: This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Health Mirror, the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

In case of any queries please feel free to contact Dr Anil K Dhull

7th April~World Health Day 2008

Theme: The theme for the year 2008 is "PROTECTING HEALTH FROM CLIMATE CHANGE". It highlights the need to understand the adverse impact of varied climate changes that are prevalent in present times and protect public health from the same. Raising concern on the harmful effect of climatic variability will help in tackling weather related disasters and vector-borne diseases such as malaria and dengue. Possible activities to stregthen the defense against climatic change are proper use of natural resources like water, taking proper action during health emergencies and controlling infectious diseases.

History: In the year 1948, the World Health Organization held the first World Health Assembly. The Assembly decided to celebrate 7th April of each year, with effect from 1950, as the World Health Day. World Health Day marks the founding of the World Health Organization and is an opportunity to draw worldwide attention to a subject of major importance to global health each year.

Other Important Days:
January: Blood Donor Month
24 th Jan: Women's Healthy Weight Day
February: Children's Dental Health Month
4th Feb: World Cancer Day
March: Save your Vision Month
13th Mar: World Kidney Day
April: Alcohol Awareness Month
7th April: World Health Day
May: Allergy and Asthma Awareness Month
12th May: International Nurses Day
June: Scleroderma Awareness Month
5th June: World Environmental Day
July: Cord Blood Awareness Month
1st July: Doctors Day
August: Children's Eye Health and Safety Month
23rd Aug: Health Unit Coordinator Day
September: Healthy Aging Month
28th Sept: World Heart Day
October: Breast Cancer Awareness Month
12th Oct: World Arthritis Day
November: Healthy Skin Month
14th Nov: World Diabetes Day
December: Drunk & Driving Prevention Month
1st Dec: World AIDS Day


In case of any queries please feel free to contact Dr Anil K Dhull

Sleep Functioning and Great Tips

Sleep is one of those funny things about being a human being -- you just have to do it. Have you ever wondered why? And what about the crazy dreams, like the one where a bad person is chasing you and you can't run or yell. Does that make any sense?
If you have ever wondered about why people have to sleep or what causes dreams, then read on. In this article, you'll find out all about sleep and what it does for you.

Dreaming occurs in the fifth stage of sleep.

Characteristics of Sleep

We all know how sleep looks -- when we see someone sleeping, we recognize the following characteristics:
If possible, the person will lie down to go to sleep.
The person's eyes are closed.
The person doesn't hear anything unless it is a loud noise.
The person breathes in a slow, rhythmic pattern.
The person's muscles are completely relaxed. If sitting up, the person may fall out of his or her chair as sleep deepens.
During sleep, the person occasionally rolls over or rearranges his or her body. This happens approximately once or twice an hour. This may be the body's way of making sure that no part of the body or skin has its circulation cut off for too long a period of time.
In addition to these outward signs, the heart slows down and the brain does some pretty funky things.
In other words, a sleeping person is unconscious to most things happening in the environment. The biggest difference between someone who is asleep and someone who has fainted or gone into a coma is the fact that a sleeping person can be aroused if the stimulus is strong enough. If you shake the person, yell loudly or flash a bright light, a sleeping person will wake up.
For any animal living in the wild, it just doesn't seem very smart to design in a mandatory eight-hour period of near-total unconsciousness every day. Yet that is exactly what evolution has done. So there must be a pretty good reason for it!
Reptiles, birds and mammals all sleep. That is, they become unconscious to their surroundings for periods of time. Some fish and amphibians reduce their awareness but do not ever become unconscious like the higher vertebrates do. Insects do not appear to sleep, although they may become inactive in daylight or darkness.
By studying brainwaves, it is known that reptiles do not dream. Birds dream a little. Mammals all dream during sleep.
Different animals sleep in different ways. Some animals, like humans, prefer to sleep in one long session. Other animals (dogs, for example) like to sleep in many short bursts. Some sleep at night, while others sleep during the day.

Really?
Cows can sleep while standing up, but they only dream if they lie down.
Whales and dolphins are "conscious breathers," and they need to keep breathing while they sleep, so only one half of the brain sleeps at a time.

Sleep and the Brain
If you attach an electroencephalograph to a person's head, you can record the person's brainwave activity. An awake and relaxed person generates alpha waves, which are consistent oscillations at about 10 cycles per second. An alert person generates beta waves, which are about twice as fast.
During sleep, two slower patterns called theta waves and delta waves take over. Theta waves have oscillations in the range of 3.5 to 7 cycles per second, and delta waves have oscillations of less than 3.5 cycles per second. As a person falls asleep and sleep deepens, the brainwave patterns slow down. The slower the brainwave patterns, the deeper the sleep -- a person deep in delta wave sleep is hardest to wake up.
At several points during the night, something unexpected happens -- rapid eye movement (REM) sleep occurs. Most people experience three to five intervals of REM sleep per night, and brainwaves during this period speed up to awake levels. If you ever watch a person or a dog experiencing REM sleep, you will see their eyes flickering back and forth rapidly. In many dogs and some people, arms, legs and facial muscles will twitch during REM sleep. Periods of sleep other than REM sleep are known as NREM (non-REM) sleep.
REM sleep is when you dream. If you wake up a person during REM sleep, the person can vividly recall dreams. If you wake up a person during NREM sleep, generally the person will not be dreaming.
You must have both REM and NREM sleep to get a good night's sleep. A normal person will spend about 25 percent of the night in REM sleep, and the rest in NREM. A REM session -- a dream -- lasts five to 30 minutes.
Medicine can hamper your ability to get a good night's sleep. Many medicines, including most sleeping medicines, change the quality of sleep and the REM component of it.
Missing out on a good night's sleep can seriously affect what happens when you're awake.

Dreams and Improving Sleep Habits
Why do we have such crazy, kooky dreams? Why do we dream at all for that matter? According to Joel Achenbach in his book Why Things Are:
The brain creates dreams through random electrical activity. Random is the key word here. About every 90 minutes the brain stem sends electrical impulses throughout the brain, in no particular order or fashion. The analytic portion of the brain -- the forebrain -- then desperately tries to make sense of these signals. It is like looking at a Rorschach test, a random splash of ink on paper. The only way of comprehending it is by viewing the dream (or the inkblot) metaphorically, symbolically, since there's no literal message.
This doesn't mean that dreams are meaningless or should be ignored. How our forebrains choose to "analyze" the random and discontinuous images may tell us something about ourselves, just as what we see in an inkblot can be revelatory. And perhaps there is a purpose to the craziness: Our minds may be working on deep-seated problems through these circuitous and less threatening metaphorical dreams.
Here are some other things you may have noticed about your dreams:
Dreams tell a story. They are like a TV show, with scenes, characters and props.
Dreams are egocentric. They almost always involve you.
Dreams incorporate things that have happened to you recently. They can also incorporate deep wishes and fears.
A noise in the environment is often worked in to a dream in some way, giving some credibility to the idea that dreams are simply the brain's response to random impulses.
You usually cannot control a dream -- in fact, many dreams emphasize your lack of control by making it impossible to run or yell. (However, proponents of lucid dreaming try to help you gain control.)
Dreaming is important. In sleep experiments where a person is woken up every time he/she enters REM sleep, the person becomes increasingly impatient and uncomfortable over time.

How Much Sleep Do I Need?

Most adult people seem to need seven to nine hours of sleep a night. This is an average, and it is also subjective. You, for example, probably know how much sleep you need in an average night to feel your best.
The amount of sleep you need decreases with age. A newborn baby might sleep 20 hours a day. By age four, the average is 12 hours a day. By age 10, the average falls to 10 hours a day. Senior citizens can often get by with six or seven hours a day.

Tips to Improve Your Sleep
Exercise regularly. Exercise helps tire and relax your body.
Don't consume caffeine after 4:00 p.m. or so. Avoid other stimulants like cigarettes as well.
Avoid alcohol before bedtime. Alcohol disrupts the brain's normal patterns during sleep. Try to stay in a pattern with a regular bedtime.

In case of any queries please feel free to contact: Dr Anil K Dhull

Nerve Blocks, Miracle in Pain Relief

Nerve blocks are used in the diagnosis and treatment of some painful conditions, and to provide pain relief during many conditions.

What drugs are used?
The most common drugs are local anaesthetic agents, which block all types of nerve conduction. They prevent pain and may also prevent movement in the area until the block wears off.
A variety of local anaesthetic drugs is available:
Bupivacaine ("Marcaine", "Sensorcaine") is a common longer-acting anaesthetic, widely used for epidurals, spinals and other blocks;
Cocaine is still used as a local anaesthetic in special cases;
Lidocaine (also called "Xylocaine","Lignocaine") is the most common of the short-acting local anaesthetics, and is used in many procedures;
Mepivacaine is similar to Lidocaine.
Ropivacaine is a new longer-acting agent which appears to be safer than Bupivacaine; and
Tetracaine is used mainly for spinals.
Other drugs may be added to the local anaesthetic, including epinephrine (adrenaline), to decrease bleeding, and sodium bicarbonate, to decrease the acidity of the drug, in an attempt to make it work faster.
For spinals and epidurals, narcotic painkillers such as morphine and fentanyl can be used, usually in addition to a local anaesthetic.
Will it hurt?
Most local and regional anaesthetic techniques involve using a syringe and needle to inject drugs in the correct place. Unfortunately, this can often be uncomfortable, and the local anaesthetic may sting during injection. Most patients consider this discomfort a small price to pay for pain relief during and after surgery.
During the operation, patients may still be able to feel touch and pressure. Occasionally (e.g. during delivery of a baby by Caesarean Section), patients may feel tugging. But patients should not feel pain during the operation.
Will it work?
When the right amount of the right drug is injected in the right place, it will eventually work and provide good pain relief. The problem areas are usually putting the drug in the right place and waiting long enough for it to work. In some cases, the correct spot is easy to identify (e.g. spinal anaesthesia) while, in other cases (e.g. epidural, sciatic nerve block), it is harder to find the correct spot. Most blocks take 5-20 minutes to work.
Commonly used blocks are usually 90-99% likely to work, depending on the type of block and the skill of the anaesthetist.
What are the potential side effects and/or complications?
In general, local or regional anaesthesia is very safe, and usually safer than a general anaesthetic. However, the potential for side effects or complications exists with any form of anaesthesia.
The most common side effect of a block is a temporary weakness or paralysis of the affected area. This is often useful to the surgeon, and wears off after a while.
The complications that may arise depend on the specific block. They usually occur when the local anaesthetic is injected in the wrong place. If a large volume (10-20 mls.) of local anaesthetic is injected into a vein by mistake, it may cause convulsions and even cardiac arrest. This is why physicians always inject local slowly; sucking back on the syringe to check the local is not going into a vein. Major nerve blocks are safe when performed by physicians trained in the technique, and in resuscitation, in an area equipped with oxygen, suction, drugs, and other essential equipment.
Why choose a local or regional anaesthetic?
Surveys indicate that anaesthetists would often choose local anaesthesia if they required surgery themselves, for the following reasons:
local anaesthesia avoids some of the risks and unpleasantness, such as nausea and vomiting, which sometimes occurs with general anaesthesia;
local anaesthesia often lasts longer than the surgery, providing pain relief for several hours after the operation;
local anaesthesia may reduce blood loss; and
some patients feel more "in control" when they are awake during surgery.

BLOCKS FOR VARIOUS PARTS OF THE BODY
Local infiltration for cuts and small procedures
For small cuts and the removal of small skin lesions, local anaesthetic is injected around the site. This may require several injections, but it is usually simple, safe and effective.
Blocks for eye surgery
The idea of having an eye operation while awake seems unpleasant to many patients. However, it is actually one of the best and most successful types of local anaesthesia. With the latest advances in cataract surgery, the operation is being done with smaller incisions, requiring less anaesthetic. For some operations, only eye drops are required. Other procedures require local anaesthetic to be injected around or behind the eye.
Very rare complications include: injecting into the fluid surrounding the brain, causing seizures; puncturing the eye; or a blood clot forming behind the eye, which may delay surgery.
Blocks for hand and arm surgery
Various types of block can be used:
Local infiltration. Injection of local anaesthesia around a cut or for a small operation works well and is very safe.
Blocks of individual fingers, or of nerves at the wrist are also safe and reliablle.
Intravenous Regional Blocks. A tourniquet is put around the upper arm. Local anaesthetic is put into a vein in the hand to numb the arm. This works well, but after about 40 minutes to an hour, the tourniquet becomes painful. Sometimes a second, lower tourniquet solves this problem. The anaesthetist has to be careful to ensure that the tourniquet remains inflated until the local anaesthetic is absorbed into the tissue.
Axillary block. This involves blocking the major nerves as they enter the arm, usually by placing a needle in the arm pit. A small electrical shock may be used to help find the right position to inject the local anaesthetic.
Spinal and epidural anaesthesia
Spinal anaesthesia involves putting local anaesthetic in the patient's back to "freeze" the lower part of the body. It is usually very safe and effective. It may be associated with less blood loss, and less risk of dangerous blood clots, than general anaesthesia.
Spinal anaesthesia is suitable for many procedures in the lower half of the body. Common uses for spinal anaesthesia include:
Caesarean section
hernia repair
hip and knee surgery
transurethral resection of prostate (TURP)
most procedures on the foot or leg
In general, spinal anaesthesia provides excellent pain relief during all these procedures. Patients may feel some stretching or tugging during delivery of the baby by Caesarean section, or during handling of the bowels in a hernia repair. Major orthopaedic surgery may include cutting bone and hammering to insert artificial joints, and some patients dislike the noise and/or vibration this causes. Spinal anaesthesia is especially useful during TURP surgery, as it allows the patient to detect side effects of the washing solution used in the bladder (it makes their vision fade temporarily) and it encourages clotting in the cut blood vessels.
Technically, there are two types of "spinal" anaesthesia: true spinal, or "intrathecal" anaesthesia, and epidural or extradural anaesthesia.
The first technique involves injecting local anaesthetic into the CSF, the fluid which surrounds the spinal cord. This produces a very intense nerve block very quickly, with only a small amount (half teaspoon) of local anaesthetic. The major disadvantage of a spinal anaesthetic is a drop in blood pressure, caused by temporary blockage of the nerves that control blood flow into the legs, so that blood collects in them. This can be treated with intravenous liquids and drugs, if necessary.
Headaches after spinal anaesthesia used to be a major problem. Now, with the use of very small specially-designed needles, headaches are very rare. If they occur, they can be treated with rest, adequate liquids to drink, simple pain-killers such as Paracetamol or Tylenol, and if necessary by an procedure called an "epidural blood patch".
Epidural or extradural anaesthesia uses a larger volume of anaesthetic, positioned in the fat and veins further away from the spinal cord. This block takes effect more slowly, which can be an advantage in some cases. For example, an epidural is less likely to produce a severe drop in blood pressure than a true spinal block. The other major advantage is that a small tube or catheter can be placed in the epidural space to allow the block to be continued over a period of hours or days, while a true spinal block only lasts a few hours.
The major disadvantage of epiduralanalgesia is that larger amounts of local anaesthetic are used (about 20 mls.) which can cause serious complications if they are put in the wrong place. In a vein, the local anaesthetic may cause convulsions or cardiac arrest. In the CSF, it may spread too high, which may stop the patient breathing. Fortunately, all of these complications can usually be treated by an anaesthetist, without long-lasting problems.
Pain relief in labour
If relaxation and breathing exercises prove ineffective, nitrous oxide ("laughing gas") or narcotics (demerol, pethidine, morphine) may help. However, epidural analgesia is the most effective form of pain relief in labour, and it can even be extended for use in forceps delivery or Caesarean section.
A small, sterile plastic tube is placed in the patient's back by an anaesthetist. Local anaesthesia is inserted, providing pain relief. Sometimes narcotic pain killers are added for increased effect. Pumps can be used to keep the epidural "topped up".
Side effects may include temporary weakness in the legs, difficulty passing urine, and/or a decrease in blood pressure.
Rare complications may include headache, decreased breathing, and/or seizures. Cases of paralysis may occur as a result of: injecting the wrong drug; a clot or infection in the epidural space; and/or inadequate treatment of complications, but this is an exceedingly rare complication.
Women who have epidurals in labour may be more likely to have forceps deliveries or Caesarean sections. They may also be more likely to have backache after delivery than women who did not have epidurals.
Epidural analgesia may avoid the potential complications of an emergency general anaesthetic, and is especially useful for women with high blood pressure, twins, or breech presentation.
Other types of nerve block
There is a wide variety of other nerve blocks, including blocks at the ankle, around the groin, in the buttocks, underneath ribs and in various locations on the face. Nerve blocks are also used in the diagnosis and treatment of some painful conditions, such as the use of epidural steroid injections for some types of back pain.
CONCLUSION
All medical procedures have risks and benefits. For many operations, the risk/benefit ratio for local or regional anaesthesia is better than for general anaesthesia. Patients should ask whether their operations can be done under local or regional anaesthesia, and discuss this issue with their physicians.

DISCLAIMER: This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Health Mirror, the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

In case of any queries feel free to contact Dr Anil K Dhull