Dandruff and Prevention

Authors: Gupta S, Dhull AK

Don't toss out all those dark suits just yet. There's a better way to deal with dandruff. As a matter of fact, you may be able simply to wash it away.

You may not realize it, but you are constantly shedding dead skin cells from all over your body. It's the skin's natural way to rejuvenate itself. In fact, you get a whole new suit of skin about every 27 or 28 days. The old stuff just sort of flakes away. You just don't tend to notice the tiny skin cells dropping off your arms, your legs, and even your scalp.Dandruff results from the same shedding of skin cells. But if the shedding process is normal, what happens to make dandruff so embarrassingly noticeable?Scientists have discovered that dandruff occurs when a yeast-like fungus called malassezia goes wild on your scalp. The microscopic malassezia fungus, a normal inhabitant on a healthy human head, feeds on the fatty oils secreted by hair follicles in the scalp. But sometimes, for reasons that are as yet unclear, the fungus grows out of control, causing irritation that actually speeds up cell turnover on the scalp. As a result, the normal process of cell turnover, which usually takes a month, may take less than two weeks when out-of-control malassezia has irritated the scalp. So many dead cells are shed at the same time that, when they mix with the oil from the hair follicles, they tend to form greasy clumps big enough to be clearly visible to the naked eye. The oil also makes the clumps more likely to get stuck in your hair (and on your shoulders), rather than floating quickly away.

Scientists have discovered that dandruff occurs when a yeast-like fungus called malassezia multiplies on your scalp.

How to Get Rid of Dandruff
Even if your malassezia has multiplied like wildfire, you don't have to live with the resulting dandruff. Take the following steps to sweep those flakes away once and for all.

Shampoo each day to keep it away

What easier way to get rid of dandruff than to wash it down the drain? Getting rid of excess oils (which may contribute to the overgrowth of malassezia in the first place) and flakes through daily shampooing may be the easiest way to tame your mane.

Switch shampoos

If your regular shampoo isn't doing the trick, even with daily washing, it's time to switch to an antidandruff shampoo. Check the ingredients in over-the-counter dandruff shampoos, and look for one that contains zinc pyrithione, which can reduce the fungus; selenium sulfide, which can limit cell turnover and possibly even decrease the amount of fungus; salicylic acid, which works as a sort of scrub to slough off dead skin; or ketoconazole, which works against a broad array of fungi.

Go for three

Your favorite dandruff shampoo may stop working after a while, and those little flakes may return. Don't blame the shampoo. You simply may have built up a resistance to its active ingredient. To prevent this, try rotating three brands of dandruff shampoo (each with a different formulation), using each for a month. In other words, use one shampoo for a month, then switch to a second brand for a month, then to a third brand for a month, then back to the original shampoo for a month, and so on.

Lather twice

The first lathering and rinsing gets rid of the loose flakes and the oily buildup on your hair and scalp. It sort of clears the area so the second lathering can get to work. Leave the second lathering of shampoo on your hair at least five minutes before rinsing it off. That gives the shampoo a chance to penetrate the skin cells and do what it's supposed to do.

Try tar

If the antidandruff shampoos aren't working, it's time to bring out the big guns, namely the tar shampoos, which have been a proven remedy for more than 200 years. The tar decreases cell turnover quite effectively, though there are some drawbacks. Tar shampoos have a strong odor, may stain the shaft of lighter-colored hair (it can take weeks of using a milder shampoo to get rid of the discoloration), and may irritate the skin.

Use a rinse

If you decide to go with a tar shampoo, rinse your hair with lemon juice, a conditioner, or creme rinse to get rid of any lingering odor from the shampoo. Using a hair conditioner after washing with any antidandruff shampoo is a good idea anyway, because the medicated shampoos tend to stiffen hair and make it less manageable. Many of them also dry the scalp, which can add to flaking; a conditioner can help seal in nourishing moisture.

Be sensitive to your sensitivity

There are some people who just shouldn't use a tar shampoo. Why? Because they're so sensitive. Rather, their scalp is, and a tar shampoo can irritate and inflame their hair follicles, causing a condition called folliculitis. The cure? Switch to a milder shampoo.

Stop those itchy fingers

Try to resist the temptation to go after those itchy patches like a dog chasing fleas. You may end up with wounds to your scalp caused by your fingernails. If you break the skin on your scalp, discontinue use of medicated shampoo for a while. Switch to a mild shampoo, such as a baby shampoo, and use it daily until the scratches are healed.

Shower away sweat

After exercise or strenuous work that makes you perspire, shower and shampoo as soon as possible. Sweat irritates the scalp and speeds up the flaking of skin cells.

Go easy on the sticky stuff

Although you needn't give up the various mousses, sprays, and gels that hold your hairstyle in place, try to use them less often. These hair products can contribute to oily buildup.

Is It Dandruff?
You may have something that's like dandruff, but isn't dandruff. Flaking of the skin may also be caused by seborrheic dermatitis or psoriasis.

Seborrheic dermatitis is a chronic disorder characterized by inflammation of the skin, along with scaling. It may strike the eyebrow and hairline areas, the sides of the nose, the ears, and the central chest.

Psoriasis is characterized by red, scaly patches on the skin and is the result of unusually rapid turnover of cells. Prescription medications are available to control both conditions.So if you still have trouble with dandruff after attempting the home remedies discussed here, see your doctor.

Dandruff can be an embarrassing problem, but you can shake those pesky flakes for good by following a careful regimen.

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 the authors or write to Health Mirror

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

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

Is alcohol more dangerous than ecstasy?

Scientists in Britain are proposing a complete revamping of drug classifications in the wake of findings that reveal some major discrepancies between a drug's legality and its safeness. A study surveying health, crime and science professionals regarding the dangers of a set of 20 legal and illegal drugs, published in The Lancet in March 2007, found that alcohol and tobacco, which are legal in Britain and the United States, are considered by experts to be more dangerous than ecstasy and marijuana, which are illegal in both countries.
In Britain, under the Misuse of Drugs Act, illegal drugs (including prescription drugs sold on the street) are classified as A, B or C. Class A is supposed to be the most harmful, and Class C is supposed to be the least harmful. For instance, heroin is a class A drug, and marijuana is a class C drug. The study was intended to achieve harm rankings for 20 drugs, 15 illegal substances and five legal substances that have shown potential for harm, using a systematic, scientific approach. The researchers surveyed two separate groups of experts including medical doctors, mental health professionals, scientists and forensics experts. Each group returned similar ranking results for the 20 drugs based on three primary features:
· physical harm to the person using the drug
· the drug's potential for abuse and/or dependence
· the drug's ill effects on society
Probably the most notable discrepancy is the position of alcohol, a legal drug, at 13 places above ecstasy, an illegal, class A drug. And LSD, also a class A drug, was ranked considerably less harmful than benzodiazepines, a class C group of drugs.
The results seem to call into question exactly which method the British government is using to determine the relative harmfulness of drugs. According to the authors of the study, "Tobacco and alcohol together account for about 90 percent of all drug-related deaths in the U.K." Yet both of those substances are legal. In the United States, a study published in the journal of the American Medical Association in 2000 shows that 95 percent of drug-related deaths in the United States are from alcohol and tobacco use.
With little documentation that attempts to explain the current governmental ranking criteria, the study proposes a method for classifying drugs that uses scientific assessment. The classifications would be based on the three indicators of harm as presented to experts in the study -- personal, physical harm; abuse/dependence potential; and social harm. In the study, the rankings for each of the criterion were combined, with the researchers taking the mean of the three scores, to obtain the overall rankings listed above.
Of course, the legal status of drugs like alcohol and tobacco skews the results. Their legal status makes them far more available, so an accurate side-by-side comparison with a drug like heroin on all three criteria is impossible. Availability will always affect social effects of any given drug. Drugs that are easily available, legal and non-stigmatized logically will result in more widespread use, more adverse reactions and more money spent on police assistance and/or hospital care as a result of those adverse reactions.
Still, availability most likely wouldn't skew the abuse potential or the personal, physical harm associated with a drug. So the study does at least reveal some possible inconsistencies in British (and U.S.) drug law. Ultimately, the researchers believe that the foundations of drug policy need to be more transparent, since those foundations effect everything from public education to criminal sentences to treatment programs to methods of control and enforcement. They point out that without a clear, scientific basis for determining a drug's legal status and harmfulness, it's hard to establish credibility in the policies that dictate how a "drug war" is carried out, and it's hard to determine how effective those policies really are.

Sources
·"Alcohol, tobacco among worst drugs." CNN.com. Mar. 23, 2007.http://www.cnn.com/2007/HEALTH/03/23/drugs.report.ap/index.html
·"Annual Causes of Death in the United States." Drug War Facts.http://www.drugwarfacts.org/causes.htm
·"New 'matrix of harm' for drugs of abuse." Bristol University. Mar. 23, 2007.http://www.bris.ac.uk/news/2007/5367.html
· Nutt, David, et al. "Development of a rational scale to assess the harm of drugs of potential misuse." The Lancet, 2007; 369:1047-1053.http://www.thelancet.com/journals/lancet/article/ PIIS0140673607604644/fulltext
·"Scientists want new drug rankings." BBC News. Mar. 23, 2007.http://news.bbc.co.uk/1/hi/health/6474053.stm?ls
· HSW team http://recipes.howstuffworks.com/alcohol1.htm
· Photo courtesy: Carolina Brewing Company

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

How Caffeine Works

Around 90 percent of Americans consume caffeine in one form or another every single day. More than half of all American adults consume more than 300 milligrams (mg) of caffeine every day, making it America's most popular drug by far. The caffeine comes in from things like coffee, tea, cola, chocolate, etc.
Have you ever wondered what it is that makes caffeine so popular? What does this drug do that causes its use to be so widespread? In this article, you will learn all about caffeine. ­
The caffeine from your morning coffee changes your ­brain's chemistry.

What is Caffeine?
Caffeine is known medically as trimethylxanthine, and the chemical formula is C8H10N4O2. When isolated in pure form, caffeine is a white crystalline powder that tastes very bitter. The chief source of pure caffeine is the process of decaffeinating coffee and tea.
Medically, caffeine is useful as a cardiac stimulant and also as a mild diuretic (it increases urine production). Recreationally, it is used to provide a "boost of energy" or a feeling of heightened alertness. It's often used to stay awake longer -- college students and drivers use it to stay awake late into the night. Many people feel as though they "cannot function" in the morning without a cup of coffee to provide caffeine and the boost it gives them.
Caffeine is an addictive drug. Among its many actions, it operates using the same mechanisms that amphetamines, cocaine, and heroin use to stimulate the brain. On a spectrum, caffeine's effects are more mild than amphetamines, cocaine and heroin, but it is manipulating the same channels, and that is one of the things that gives caffeine its addictive qualities. If you feel like you cannot function without it and must consume it every day, then you are addicted to caffeine.

Q: How is caffeine used medically?
A: Medically, caffeine is useful as a cardiac stimulant and also as a mild diuretic (it increases urine production).

Caffeine in the Diet
Caffeine occurs naturally in many plants, including coffee beans, tea leaves and cocoa nuts. It is therefore found in a wide range of food products. Caffeine is added artificially to many others, including a variety of beverages. Here are the most common sources of caffeine for Americans:
· Typical drip-brewed coffee contains 100 mg per 6-ounce cup. If you are buying your coffee at Starbucks or a convenience store or drinking it at home or the office out of a mug or a commuter's cup, you are consuming it in 12-, 14- or 20-ounce containers. You can calculate the number of milligrams based on your normal serving size.
· Typical brewed tea contains 70 mg per 6-ounce cup.
· Typical colas (Coke, Pepsi, Mountain Dew, etc.) contain 50 mg per 12-ounce can. Things like Jolt contain 70 mg per 12-ounce can.
· Typical milk chocolate contains 6 mg per ounce.
· Anacin contains 32 mg per tablet. No-doz contains 100 mg per tablet. Vivarin and Dexatrim contain 200 mg per tablet.
By looking at these numbers and by knowing how widespread coffee, tea and cola are in our society, you can see why half of adults consume more than 300 mg of caffeine per day. Two mugs of coffee or a mug of coffee and a couple of Cokes during the day are all you need to get you there. If you sit down and calculate your caffeine consumption during a typical day, you may be surprised. Many people consume a gram or more every single day and don't even realize it.

Caffeine and Adenosine
Why do so many people consume so much caffeine? Why does caffeine wake you up? By understanding the drug's actions inside the body you can see why people use it so much.
As adenosine is created in the brain, it binds to adenosine receptors. The binding of adenosine causes drowsiness by slowing down nerve cell activity. In the brain, adenosine binding also causes blood vessels to dilate (presumably to let more oxygen in during sleep).
To a nerve cell, caffeine looks like adenosine. Caffeine therefore binds to the adenosine receptor. However, it doesn't slow down the cell's activity like adenosine would. So the cell cannot "see" adenosine anymore because caffeine is taking up all the receptors adenosine binds to. So instead of slowing down because of the adenosine level, the cells speed up. You can see that caffeine also causes the brain's blood vessels to constrict, because it blocks adenosine's ability to open them up. This effect is why some headache medicines like Anacin contain caffeine -- if you have a vascular headache, the caffeine will close down the blood vessels and relieve it.
So now you have increased neuron firing in the brain. The pituitary gland sees all of the activity and thinks some sort of emergency must be occurring, so it releases hormones that tell the adrenal glands to produce adrenaline (epinephrine). Adrenaline is the "fight or flight" hormone, and it has a number of effects on your body:
· Your pupils dilate.
· Your breathing tubes open up (this is why people suffering from severe asthma attacks are sometimes injected with epinephrine).
· Your heart beats faster.
· Blood vessels on the surface constrict to slow blood flow from cuts and also to increase blood flow to muscles. Blood pressure rises.
· Blood flow to the stomach slows.
· The liver releases sugar into the bloodstream for extra energy.
· Muscles tighten up, ready for action.
This explains why, after consuming a big cup of coffee, your hands get cold, your muscles tense up, you feel excited and you can feel your heart beat increasing.

Caffeine and Dopamine
Caffeine also increases dopamine levels in the same way that amphetamines do (heroine and cocaine also manipulate dopamine levels by slowing down the rate of dopamine re-uptake). Dopamine is a neurotransmitter that, in certain parts of the brain, activates the pleasure center. Obviously, caffeine's effect is much lower than heroin's, but it is the same mechanism. It is suspected that the dopamine connection contributes to caffeine addiction.
So you can see why your body might like caffeine in the short term, especially if you are low on sleep and need to remain active. Caffeine blocks adenosine reception so you feel alert. It injects adrenaline into the system to give you a boost. And it manipulates dopamine production to make you feel good.
The problem with caffeine is the longer-term effects, which tend to spiral. For example, once the adrenaline wears off, you face fatigue and depression. So what are you going to do? You take more caffeine to get the adrenaline going again. As you might imagine, having your body in a state of emergency all day long isn't very healthy, and it also makes you jumpy and irritable.
The most important long-term problem is the effect that caffeine has on sleep. Adenosine reception is important to sleep, and especially to deep sleep. The half-life of caffeine in your body is about 6 hours. That means that if you consume a big cup of coffee with 200 mg of caffeine in it at 3:00 PM, by 9:00 PM about 100 mg of that caffeine is still in your system. You may be able to fall asleep, but your body probably will miss out on the benefits of deep sleep. That deficit adds up fast. The next day you feel worse, so you need caffeine as soon as you get out of bed. The cycle continues day after day.
This is why 90% of Americans consume caffeine every day. Once you get in the cycle, you have to keep taking the drug. Even worse, if you try to stop taking caffeine, you get very tired and depressed and you get a terrible, splitting headache as blood vessels in the brain dilate. These negative effects force you to run back to caffeine even if you want to stop.

In Case of any queries, contact Dr Anil K Dhull

How do antibiotics work?

Antibiotics work to kill bacteria. Bacteria are single-cell organisms. If bacteria make it past our immune systems and start reproducing inside our bodies, they cause disease. We want to kill the bacteria to eliminate the disease.
An antibiotic is a selective poison. It has been chosen so that it will kill the desired bacteria, but not the cells in your body.
Certain bacteria produce chemicals that damage or disable parts of our bodies. In an ear infection, for example, bacteria have gotten into the inner ear. The body is working to fight the bacteria, but the immune system's natural processes produce inflammation. Inflammation in your ear is painful. So you take an antibiotic to kill the bacteria and eliminate the inflammation.
An antibiotic is a selective poison. It has been chosen so that it will kill the desired bacteria, but not the cells in your body. Each different type of antibiotic affects different bacteria in different ways. For example, an antibiotic might inhibit a bacterium's ability to turn glucose into energy, or its ability to construct its cell wall. When this happens, the bacterium dies instead of reproducing. At the same time, the antibiotic acts only on the bacterium's cell-wall-building mechanism, not on a normal cell's.
Antibiotics do not work on viruses because viruses are not alive. A bacterium is a living, reproducing lifeform. A virus is just a piece of DNA (or RNA). A virus injects its DNA into a living cell and has that cell reproduce more of the viral DNA. With a virus there is nothing to "kill," so antibiotics don't work on it.

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

Weight Control, Diet & Cancer

Stable weight depends on an even balance between energy intake from food and energy expenditure. Energy expenditure occurs during the day in three ways:
· As energy expended during rest (basal metabolism)
· As energy used to metabolize food (thermogenesis)
· As energy expended during physical activity
Basal metabolism accounts for about two-thirds of expended energy, which is generally used to maintain body temperature and muscle contractions in the heart and intestine.
Thermogenesis accounts for about 10% of expended energy.
When a person's consumes more calories than energy that is used, the body stores the extra calories in fat cells. Fat cells function as energy reservoirs. They enlarge or contract depending on how people use energy. If people do not balance energy input and output by eating right and exercising, fat can builds up. This can lead to weight gain.

When energy input is equal to energy output, there is no expansion of fat cells (lipocytes) to accommodate excess. It is only when more calories are taken in than used that the extra fat is stored in the lipocytes and the person begins to accumulate fat.

What is Obesity?
People who are obese have an abnormally high and unhealthy proportion of body fat. To measure obesity, researchers commonly use a formula based on weight and height known as the body mass index (BMI). BMI is the ratio of weight (in kilograms) to height (in meters) squared. BMI provides a more accurate measure of obesity or being overweight than does weight alone.
Measurement of Obesity
Obesity is determined by measuring body fat, not just body weight. People might be over the weight limit for normal standards, but if they are very muscular with low body fat, they are not obese. Others might be normal or underweight, but still have excessive body fat. The following measurements and factors are used to determine whether or not a person is overweight to a degree that threatens their health:
· Body mass index (BMI) (a measure of body fat)
· Waist circumference
· Waist-hip ratio
· Anthropometry (skin fold measurement)
· The presence or absence of other disease risk factors (e.g., smoking, high blood pressure, unhealthy cholesterol levels, diabetes, relatives with heart disease)
A person's disease risk factors plus BMI may be the most important components in determining health risks with weight.

Body-Mass Index/ BMI
The body-mass index, a measure of adiposity, has been categorized as follows: 18.5 to 24.9, 25.0 to 29.9, 30.0 to 34.9, 35.0 to 39.9, and 40.0 or more. These categories correspond to those proposed by the World Health Organization6 for “normal range,” “grade 1 overweight,” (25.0 to 29.9) “grade 2 overweight” (30.0 to 39.9), and “grade 3 overweight,” (40.0 or more). For many analyses, especially for cancers in specific sites and among participants who had never smoked, the upper categories of body-mass index were combined, because of the small numbers. In oncology, for analyses and discussion, it is customary to we refer to the range of 25.0 to 29.9 as corresponding to “overweight” and to values of 30.0 or more as corresponding to “obesity.”
Waist Circumference and Waist-Hip Ratio
The extent of abdominal fat can also be used in assessing risk of disease. Some studies suggest that:
· Women whose waistlines are over 31.5 inches and men whose waists measure over 37 inches should watch their weight.
· A waist size greater than 35 inches in women and 40 inches in men is associated with a higher risk for heart disease, diabetes, and impaired functioning.
Evidence strongly suggests that more body fat around the abdomen and hips (the apple-shape) is a more consistent predictor of heart problems and health risks than BMI.
The distribution of fat can be evaluated by dividing waist size by hip size. For example, a woman with a 30-inch waist and 40-inch hip circumference would have a ratio of 0.75; one with a 41-inch waist and 39-inch hips would have a ratio of 1.05. The lower the ratio the better. The risk of heart disease rises sharply for women with ratios above 0.8 and for men with ratios above 1.0.

Anthropometry

Anthropometry is the measurement of skin fold thickness in different areas, particularly around the triceps, shoulder blades, and hips. This measurement is useful in determining how much weight is due to muscle or fat.

Obesity and Cancer
Link between cancer and obesity appears paradoxical as cancer is classically seen as illness producing anorexia and massive weight loss. To measure obesity, researchers commonly use a formula based on weight and height known as the body mass index (BMI). According to WHO approximately 1.6 billion of the world’s adult are overweight and over 400 million are obese. Cancers of the endometrium, kidney, gallbladder, breast, colon and adenocarcinoma of the esophagus have been linked to obesity. Obesity and physical inactivity may account for 25 to 30 percent of several major cancers. Those with a body-mass index of at least 40 had death rates from all cancers combined that were 52 percent higher (for men) and 62 percent higher (for women) than the rates in men and women of normal weight. On the basis of associations observed in some studies, it has been estimated that current patterns of overweight and obesity could account for 14 percent of all deaths from cancer in men and 20 percent of those in women. Women with large abdominal fat (apple shaped) have high risk of breast cancer than those having ‘pear’ shaped distribution. Data on link between obesity & cancers of the pancreas, prostate, liver, cervix, ovary and on hematopoietic cancers are scarce or inconsistent. Obesity and physical inactivity may account from 25-30% of several major cancers. For grade-III obesity, relative risk for dying by cancer is 1.70 for breast cancer, 1.63 for esophageal cancer, 1.94 for gastric cancer, 1.84 for colon cancer, 1.70 for renal cancer, 4.52 for liver cancer, 1.76 for gall bladder cancer, 1.49 for pancreatic cancer and 1.34 for prostate cancer.

Introduction
According to WHO 1.6 billion of the world’s adult were overweight in 2005 and over 400 million were obese. By 2015 the numbers are expected to nearly double.1,2 A recent study from United States reports 14% of deaths from cancer in men and 20% deaths in women were due to overweight and obesity.1 Obesity is not just a problem of west but it is a global phenomenon. According to WHO, figures for obesity in America are 35% for women and 20% for men, in China it is over 20% for both men and women. Even desperately poor countries like Nigeria and Uganda are struggling with the problem of obesity. There is substantial evidence that adipose tissue particularly visceral adipose tissue is a metabolically active endocrine organ. This leads to the release of insulin – like growth factors that are linked to increased cancer risk.3 The mechanism of this link may not be clear at present but there is enough evidence to say that link exists. As the prevalence of obesity is increasing worldwide, we can expect proportional increase in cancer cases. This will not only add to the high cost of cancer treatment but also add to human suffering as well.
Although we have known for some time that excess weight is also an important factor in death from cancer,4 our knowledge of the magnitude of the relation, both for all cancers and for cancers at individual sites, and the public health effect of excess weight in terms of total mortality from cancer is limited. The biological mechanism that explains how obesity worsens risk of cancer may be different for different cancers. The exact mechanisms by which obesity induces or promotes tumor genesis vary by cancer site. However, possible mechanisms include alterations in sex hormones and insulin. Insulin resistance is been associated with cancers of colon and rectum, breast and pancreas. Whatever may be the causes, the obesity still is seen as life style disease and by that definition it is largely preventable. It may be an oversimplified view as many people believe that obesity is genetic (there is evidence for that). It is right time to educate people and emphasize the need for life style changes to keep the weight in check.5 Life style choices that can check weight will not only help in preventing cancer but also help in preventing other diseases such as heart diseases, diabetes and many nervous and mental disorders.
Relationship between Obesity and Cancer?
In 2001, it was concluded that cancers of the colon, breast (postmenopausal), endometrium (the lining of the uterus), kidney, and esophagus are associated with obesity. Some studies have also reported links between obesity and cancers of the gallbladder, ovaries, and pancreas.7 Obesity and physical inactivity may account for 25 to 30 percent of several major cancers—colon, breast (postmenopausal), endometrial, renal and cancer of the esophagus.7
In 2002, about 41,000 new cases of cancer in the United States were estimated to be due to obesity. This means that about 3.2 percent of all new cancers are linked to obesity.1,8,9 The contribution of excess body weight to the total burden of mortality from cancer depends on two factors: the relative risk of death due to cancer among overweight or obese persons as compared with persons of normal weight and the prevalence of overweight and obesity in a given population. The very high prevalence of obesity in the United States explains why small elevations in mortality due to cancer translate into substantial fractions of mortality due to cancer that are related to overweight or obesity. Calle et al. point out how much cancer-related mortality could be reduced among nonsmokers if body weight were adequately controlled. It is intriguing that the positive association between excess body weight and mortality due to cancer is not limited to a few forms of cancer indeed, positive associations represent the rule rather than the exception. The biologic mechanisms that are regularly invoked to explain the association between overweight or obesity and cancer concern steroid hormones, insulin, the insulin-like growth factor system, and mechanical processes such as the contribution of abdominal obesity to gastresophageal reflux and esophageal adenocarcinoma.1, 10
In both men and women, body-mass index was also significantly associated with higher rates of death due to cancer of the esophagus, colon and rectum, liver, gallbladder, pancreas, and kidney; the same was true for death due to non-Hodgkin’s lymphoma and multiple myeloma. Significant trends of increasing risk with higher body-mass-index values were observed for death from cancers of the stomach and prostate in men and for death from cancers of the breast, uterus, cervix, and ovary in women. Previous studies have consistently shown associations between adiposity and increased risk of cancers of the endometrium, kidney, gallbladder (in women), breast (in postmenopausal women), and colon (particularly in men).11-15 Adenocarcinoma of the esophagus has been linked to obesity. 14,16,17 Data on cancers of the pancreas, prostate, liver, cervix, ovary and on hematopoietic cancers are scarce or inconsistent.11-14, 18-21 The lack of consistency may be attributable to the limited number of studies, the limited range and variable categorization of overweight and obesity among studies, bias introduced by reverse causality with respect to smoking related cancers, and possibly real differences between the effects of overweight and obesity on the incidence of cancer and on the rates of death from some cancers.22,23 Experts have concluded that the chief causes of obesity are a sedentary lifestyle and overconsumption of high-calorie food.7,24, 25
In the last 50 years there are marked changes in dietary and work habits. People eat too much and do too little exercise. There is reduction in physical activity and more people have sedentary life styles. Since the beginning of the 20th century, obesity is being linked to diabetes, hypertension and myocardial infarction. In late 1940’s French researcher divided obesity into android type – predominant abdominal obesity particularly seen in males and described it is ‘apple’ shaped whereas gynoid type – with distribution of fat to the hips is characteristic of females and described as ‘pear’ shaped.5 But it took quite some time when in 1980’s abdominal fat was implicated as risk factor for IHD, diabetes and stroke. The distribution of fat is important risk determinant of breast cancer. Women with large abdominal fat (apple shaped) have high risk of breast cancer than those having ‘pear’ shaped distribution.24, 26, 27
Obesity has been studied extensively as risk factor for various cancers. According to American Institute of Cancer Research (AICR), obesity increases likelihood of developing breast, colon, endometrial, esophageal, renal and prostate cancers by 25-33%.
Abdominal fat has a sensitive system for releasing free fatty acids which are transported directly via the portal vein into the liver where it produces 3 important effects as insulin clearance, Glucogenesis and VLDL synthesis which leads to hyperinsulinaemia, hyperglycemia and hyperlipidaemia respectively. Free Fatty Acids (FFA) are synthesized in liver into VLDL predominantly triglycerides. Insulin resistance in liver cells increases glucose products to cause high blood glucose. Hyperinsulinaemia resultant from insulin resistance worsens as insulin level increase further as Liver’s ability to break the hormone decreases.

The current burst of articles on metabolic syndrome shows the relevance of obesity in the contemporary society. It is the gift of modern western life style with its negative features of physical inactivity, excessive intake of energy and stress.
The International Agency for Research on Cancer (IARC) has concluded that there is sufficient evidence of a cancer-preventive effect of avoidance of weight gain for cancers of the colon, breast (in post menopausal women), endometrium, kidney (renal cell carcinoma), and esophagus (adenocarcinoma).14 Potential biologic mechanisms include increased levels of endogenous hormones (sex steroids, insulin, and insulin-like growth factor I) associated with overweight and obesity and the contribution of abdominal obesity to gastresophageal reflux and esophageal adenocarcinoma.14 Moderate relative risks (less than 2.0) associated with overweight and obesity both for colon cancer and for breast cancer in postmenopausal women have been documented consistently.11 Much higher relative risks have been observed for uterine cancer (2 to 10) and kidney cancer (1.5 to 4), and the increased risk of kidney cancer associated with excess weight is higher in women than in men in majority studies.11, 28, 29 Increases by a factor of two to three in the risk of adenocarcinoma of the esophagus in association with high body-mass index have been reported16, 17, and the magnitude of this association has been found by other investigators to be greater in nonsmokers.16
Conclusion
International experts in the field of nutrition, cancer biology and public health are working on this link between life style and cancer and have come out with health recommendations for prevention of cancer. Their recommendations need to be incorporated in management plans and advising people how they can reduce their own cancer risk.91 It may take time to establish the exact link between obesity and cancer but the time has come to start talking to patients about the link between life style and cancer prevention through healthy weight, healthy eating habits and increasing physical activity.
An apple a day keeps the doctor away, but if you remain in a pear, you can avoid either of them.

References
1. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. New England Journal of Medicine. 2003; 348(17):1625–38.
2. The Tribune, Thursday 4th October 2007.
3. Martin G Healthy eating V Cancer GMC Today. 2007, 6, 6-7.
4. Lew EA, Garfinkel L. Variations in mortality by weight among 750,000 men and women. J Chronic Dis 1979; 32 : 563-76.
5. Berne C, Bjorntrop P. The Metabolic Syndrome. In: ArnetzBB, Ekman R,editors. Stress in health and disease. Weinheim:WILEY-VCH Verlag GmbH&Co.KGaA;2006.p317-332.
6. Thun MJ, Calle EE, Namboodiri MM. Risk factors for fatal colon cancer in a large prospective study. J Natl Cancer Inst.
7. Vainio H, Bianchini F. IARC handbooks of cancer prevention. Volume 6: Weight control and physical activity. Lyon, France: IARC Press, 2002.
8. Polednak AP. Trends in incidence rates for obesity-associated cancers in the U.S. Cancer Detection and Prevention 2003; 27(6):415–421.
9. McLaughlin JK, Blot WJ, Devesa SS, Fraumeni JF Jr. Renal cancer. In: Schottenfeld D, Fraumeni JF. Cancer epidemiology and prevention. 2nd ed. New York: Oxford University Press. 1996: 1142-55.
10. Obesity and Mortality from Cancer N Engl J Med.2008; 348; 17.
11. World Cancer Research Fund. Food, nutrition and the prevention of cancer: a global perspective. Washington, D.C.: American Institute for Cancer Research. 1997:371-3.
12. Carroll K. Obesity as a risk factor for certain types of cancer. Lipids 1998; 33:1055-9.
13. Bergstrom A, Pisani P, Tenet V, Wolk A, Adami H-O. Overweight as an avoidable cause of cancer in Europe. Int J Cancer. 2001; 91:421-30.
14. IARC handbooks of cancer prevention. Vol. 6. Weight control and physical activity. Lyons, France: International Agency for Research on Cancer, 2002.
15. Peto J. Cancer epidemiology in the last century and the next decade. Nature. 2001; 411: 390-5.
16. Chow W-H, Blot WJ, Vaughan TL. Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst. 1998; 90: 150-5.
17. Vaughan TL, Davis S, Kristal A, Thomas DB. Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev. 1995; 4: 85-92.
18. Lew EA, Garfinkel L. Variations in mortality by weight among 750,000 men and women. J Chronic Dis. 1979; 32: 563-76.
19. Michaud DS, Giovannucci E, Willett WC, Colditz G, Stampfer M, Fuchs C. Physical activity, obesity, height, and the risk of pancreatic cancer. JAMA. 2001; 286: 921-9.
20. Wolk A, Gridley G, Svensson M. A prospective study of obesity and cancer risk (Sweden). Cancer Causes Control. 2001; 12: 13-21.
21. Moller H, Mellemgaard A, Lindvig K, Olsen J. Obesity and cancer risk: a Danish record-linkage study. Eur J Cancer. 1994; 30: 344-50.
22. Calle EE, Terrell DD. Utility of the National Death Index for ascertainment of mortality among Cancer Prevention Study II participants. Am J Epidemiol. 1993; 137: 235-41.
23. Physical status: the use and interpretation of anthropometry: report of a WHO Expert Committee. World Health Organ. 1995; 854:1-452.
24. Friedenreich CM. Physical activity and cancer prevention: From observational to intervention research. Cancer Epidemiology, Biomarkers and Prevention.2001; 10(4): 287–301.
25. Kritchevsky D. Diet and cancer: What’s next? Journal of Nutrition. 2003; 133(11):3827–29.
26. Kaaks R, Van Noord PAH, Den Tonkelaar I. Breast cancer incidence in relation to height, weight and body-fat distribution in the Dutch “DOM” cohort. International Journal of Cancer. 1998; 76(5): 647–51.
27. Männistö S, Pietinen P, Pyy M. Body-size indicators and risk of breast cancer according to menopause and estrogen-receptor status. International Journal of Cancer. 1996; 68(1): 8–13.
28. Hill HA, Austin H. Nutrition and endometrial cancer. Cancer Causes Control. 1996; 7: 19-32.
29. Wolk A, Lindblad P, Adami H-O. Nutrition and renal cell cancer. Cancer Causes Control. 1996; 7: 5-18.

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.

Authors: Dhull AK, Gupta R, Gupta A, Kaushal V

Basics of Anaesthesia

INTRODUCTION
Many patients, and even some physicians, automatically assume that surgery requires general anaesthesia, and that the patient should be asleep during surgery. This is not true. Many procedures can be performed on awake patients, using local or regional anaesthesia. This not only avoids the risks and unpleasantness sometimes associated with general anaesthesia, but may also provide specific benefits such as reduced blood loss and better postoperative analgesia.
Patients are often concerned about having surgery under a local or regional anaesthetic. These concerns are not usually justified by the facts. The more patients understand the reasons for, and the benefits of, local or regional anaesthesia, the more likely they are to choose this type of anaesthetic. Unfortunately, in these days of cost-cutting and same day surgery, patients may never get the opportunity to discuss their anaesthetic options with an anaesthetist in detail prior to surgery. In the rush to get through a busy operating list the anaesthetist may, unfortunately, decide that it is quicker and simpler just to put the patient to sleep, rather than enter into the discussion and education necessary to allow the patient to make an informed choice about the most appropriate type of anaesthesia.
Patients are becoming more involved as consumers of health care. They are actively seeking out information about treatment choices, and some are turning to the Internet as a source of medical information. This site is dedicated to patients who want to learn more about local and regional anaesthesia. However, they must understand that this article provides background information only. The final decision about the best type of anaesthetic depends on the specific operation, patient, surgeon, and anaesthetist involved.
If you are faced with the possibility of needing surgery in the future, chances are you will need some type of anaesthesia to go along with it. There are many different types of anaesthesia. Which one you will need depends on a variety of factors such as the type of surgery you are having and your state of health. Some surgical procedures require only an injection of local anaesthesia into the incision area. Other procedures cannot be performed unless you are completely anesthetized -- unconscious and unaware of pain.

The Basics
Anaesthesia is divided into four basic categories:
· general anaesthesia
· regional anaesthesia
· local anaesthesia
· sedation
Each type of anaesthesia has an effect on a part of the nervous system, which results in a depression or numbing of nerve pathways. General anaesthesia affects the brain cells, which causes you to lose consciousness. Regional anaesthesia has an effect on a large bundle of nerves to a particular area of the body, which results in losing sensation to that area without affecting your level of consciousness. Local anaesthesia causes you to lose sensation in a very specific area.
Some of the drugs that produce general anaesthesia in large doses can be used to produce sedation, or "twilight sleep" in lower doses. Sedation can be given in many ways. A common example of an anesthetic gas that is used for sedation is nitrous oxide or laughing gas.
If you are scheduled to have surgery, you may be told not to eat anything for eight hours. It is very important that you follow whatever instructions you are given for not eating or drinking anything prior to surgery. Why? Because when you are given anaesthesia, you lose the ability to protect your lungs from inhaling something you're not supposed to inhale. When you are awake, you can usually swallow saliva and food without choking because part of the swallowing mechanism involves a reflex that results in covering the opening into the lungs. When you are anesthetized, you lose that reflex. So, if you have any solids or liquids in your stomach, they could come up into your mouth and be inhaled into your lungs. The result could be very serious lung damage.
Sleep is a state of reduced consciousness, depressed metabolism, and little activity of the skeletal muscles. Strong stimuli such as loud noise, bright light or shaking can arouse the sleeper. Consciousness is being clearly aware of yourself and your environment.
Unconsciousness is when you are completely or partially unaware of yourself and your environment, or you don't respond to sensory stimuli.
Conscious sedation is caused when an anesthesiologist administers depressant drugs and/or analgesics in addition to anaesthesia during surgery. Consciousness is depressed and you may fall asleep, but are not unconscious.

General Anaesthesia
General anesthetics produce an unconscious state. In this state a person is:
· unaware of what is happening
· pain-free
· immobile
· free from any memory of the period of time during which he or she is anesthetized
It is not completely clear exactly how general anesthetics work at a cellular level, but it is speculated that general anesthetics affect the spinal cord (resulting in immobility), the brain-stem reticular activating system (resulting in unconsciousness) and the cerebral cortex (seen as changes in electrical activity on an electroencephalogram).

General anaesthesia can be administered as an inhaled gas or as an injected liquid. There are several drugs and gases that can be combined or used alone to produce general anaesthesia. The potency of a given anesthetic is measured as minimum alveolar concentration (MAC). This term describes the potency of anesthetic gases. (Aveolar is the area in the lung where gases enter and exit the bloodstream via the capillary system). Technically, MAC is the alveolar partial pressure of a gas at which 50 percent of humans will not move to a painful stimulus (e.g. skin incision). Injected liquid anesthetics have a "MAC equivalent" which is the blood concentration of the liquid anesthetic that provides the same effect. Using MAC as a guideline, the amount of anesthetic given to a patient depends on that particular patient's needs.
When anesthetics reach the bloodstream, the drugs that affect the brain pass through other blood vessels and organs so they are often affected too. Therefore, patients must be carefully monitored. The anesthesiologist continuously monitors the patient's heart rate, heart rhythm, blood pressure, respiratory rate, and oxygen saturation. Some patients may have even more extensive monitoring depending on their health and which type of procedure or surgery they are having.

Most adults are first anesthetized with liquid intravenous anesthetics followed by anesthetic gases after they are asleep. Children, however, may not like having an injection or intravenous catheter placed in them while they are awake. Therefore, they often breathe themselves to sleep with anesthetic gases given through a mask.
What is local or regional anaesthesia?
Anaesthesia means the absence of sensation. Regional anaesthesia means blocking the nerve supply to part of the body, such as an arm, so the patient cannot feel pain in that area. Local anaesthesia, strictly speaking, means putting local anaesthetic ("freezing") around the affected area to make it pain free. However, many people use the phrase loosely to include regional anaesthesia.
Local Anaesthesia
Local anaesthesia involves numbing a small area by injecting a local anesthetic under the skin just where an incision is to be made. When used alone, this type of anaesthesia has the least number of risks. Local anesthetics are thought to block nerve impulses by decreasing the permeability of nerve membranes to sodium ions. There are many different local anesthetics that differ in absorption, toxicity, and duration of action.
One of the most commonly used local anesthetics is lidocaine (Xylocaine). Lidocaine can be administered as an injection or placed topically on mucous membranes. Another topical anesthetic is cocaine. Cocaine is primarily used to anesthetize the nasal passages for surgical procedures. A topical anesthetic that is gaining popularity for anesthetizing the skin prior to painful procedures, such as injections, is known as eutectic mixture of local anesthetics (EMLA) cream which contains lidocaine and prilocaine. This white cream is placed on the skin and then covered with an occlusive dressing for approximately one hour to obtain a good numbing effect. In addition, EMLA can be used to numb the skin prior to giving injections or pulling superficial splinters.

Regional Anaesthesia
Regional anaesthesia is so named because a "region" of the body is anesthetized without making the person unconscious. One example of this is spinal anaesthesia, which is often used on women during childbirth. A local anesthetic is injected into the spinal fluid and causes a loss of sensation of the lower body. Spinal anaesthesia can be used for surgery on the legs or lower abdomen (below the bellybutton).
Epidural anaesthesia is similar to spinal anaesthesia in that a patient loses sensation in the legs and lower abdomen, but instead of injecting the local anesthetic into the spinal fluid, the anesthetic is injected into a space outside the spinal canal called the epidural space. A small tube or catheter can be placed into this space and a local anesthetic can be infused (fed) through the tube for hours, days, or even weeks. This type of anaesthesia can be used for surgery with larger doses of anesthetic, or for chronic pain relief with lower doses of anesthetic. Regional anaesthesia techniques can be used to block very specific areas such as one foot, one leg, one arm, or one side of the neck. In these cases, a smaller group of nerves is blocked by injection of the local anesthetic into a specific area. For spinals and epidurals, narcotic painkillers such as morphine and fentanyl can be used in addition to a local anesthetic.

Sedation
Some of the drugs that produce general anaesthesia in large doses can be used to produce sedation or "twilight sleep" in lower doses. Sedation can be given in many ways. A common example of an anesthetic gas that is used for sedation is nitrous oxide or laughing gas. Liquid sedating drugs are usually given by injection but some can also be given by mouth. Ketamine and Versed are examples of sedating drugs that can be given by injection or by mouth. The oral route is particularly useful for sedating children who do not like injections.
Children who refuse to drink medications may also receive sedation through the rectum via a small, lubricated tube or via the nasal route by spraying it into the nose. Regional and local anaesthesia can be combined with sedation to make patients more comfortable during a procedure in which general anaesthesia is not necessary, or when general anaesthesia may be too large a risk for the patient.

How is it used?
Local or regional anaesthesia can often be used to prevent pain during surgery. Sometimes it is used by itself, with no other medications, so that the patient remains wide awake during surgery. It can also be combined with sedative drugs to make the patient relaxed or sleepy during surgery.
Sometimes local or regional anaesthesia is used in addition to a general anaesthetic (i.e., in patients who are asleep during surgery). This is done to reduce the stress associated with surgery, to allow a lighter level of anaesthetic during surgery, and to provide pain relief after surgery.
Inhaled Anesthetics
Many adults may remember having ether for their anesthetic when they were young. Ether is an inflammable anesthetic that is no longer used in the United States. Today, the commonly used inhaled anesthetics are nitrous oxide (also known as laughing gas), sevoflurane, desflurane, isoflurane and halothane.
Why do we have so many different kinds of gases? Because each gas has its own special properties. For example, sevoflurane and halothane are easy to inhale while desflurane is very irritating to inhale and has a shorter duration of action. If you need to breathe yourself to sleep, halothane or sevoflurane would be easiest to inhale. If a very short-acting anesthetic is needed, the anesthesiologist can switch to desflurane after you fall asleep. Nitrous oxide is easy to inhale, but when used alone is not potent enough to be a complete general anesthetic. However, it can be used alone for sedation, or combined with one of the other inhaled anesthetics or injected liquid anesthetics for general anaesthesia.
These gases have different effects on other organs as well. For example, halothane may cause the heart rate to slow down and the blood pressure to decrease while desflurane may cause the heart rate to speed up and the blood pressure to increase. How do these inhaled anesthetics reach the brain? When an anesthetic gas is inhaled into the lungs, the blood that travels through the lungs carries the anesthetic gas to central nervous system cells. The rate at which the bloodstream takes up the anesthetic is dependent on many factors including the concentration of the inspired gas, the rate of flow of the gas from the anaesthesia machine, the solubility of the gas in blood, the rate and depth of breathing, and the amount of blood the heart pumps each minute in the person breathing the gas.
An important property of anesthetics is reversibility. When the surgery is over, the anesthesiologist wants to shut off the anesthetic and have the patient wake up from the anesthetic-induced sleep. Once the anesthetic gas is turned off, the blood stream brings the gas back to the lungs where it is eliminated. The more soluble the gas is in blood, the longer it takes to eliminate. Nitrous oxide and desflurane are the shortest-acting anesthetic gases because they are the least soluble in blood.

Injected Anesthetics
A liquid anesthetic drug is delivered to the brain by injecting it directly into the bloodstream, usually through an intravenous catheter. Examples of injected drugs are barbiturates, propofol, ketamine, and etomidate, as well as larger doses of narcotics (such as morphine) and benzodiazepines (Valium-like drugs). These drugs quickly reach the brain and their effect is dependent on several factors including the volume in which the drug is distributed in the body, the fat-solubility of the drug, and how quickly the body eliminates the drug.
A commonly used injected barbiturate anesthetic is sodium thiopental, also known as Pentothal. This drug is fat-soluble and acts very quickly. If you receive sodium thiopental and then you are asked to count backward from 100 after the drug is injected, you probably won't remember counting past 95. Some injected anesthetics are used in low doses for sedation. A small dose of a narcotic or a benzodiazepine like Valium or Versed can significantly decrease anxiety. These drugs are used in these doses either as a premedication prior to general anaesthesia or as "twilight sleep" or sedation when used in conjunction with local or regional anaesthesia.

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