Second Opinion
Let sanity prevail among policy makers
This week, we commemorate Mental Health
Week. To ''celebrate'' this event politicians and medical administrators
would make the usual speeches, appoint the necessary committees and once
again, pledge their commitment to Mental Health.
But, in reality, the country is still lagging way behind in the provision
of mental health services for it's people. Small wonder, then, that Sri
Lanka are world champions not only in one-day cricket, but also in suicide
rates.
The latter was discovered quite some time ago. It disturbed the political
leadership. So, ''Task Forces'' were appointed. Suicide stories were banned
from the state media. But, little else seems to have been done. And, we
remain the world leaders.
Even if there was commitment from the political leadership, it has not
been translated into corrective measures. A look at the services provided
will prove this point.
Specialised care is available only at a few teaching hospitals and General
Hospitals and at the Angoda and Mulleriyawa mental hospitals.
Now, the authorities are toying with the idea of converting the Mulleriyawa
hospital to a school. Where will it's inmates go? They should be sent to
community care centres for rehabilitation. But these don't exist!
Then, even some General Hospitals do not have the services of Consultant
Psychiatrists. At least one Teaching Hospital does not have facilities
for in-patient care of mentally ill patients. Why can't the ''Task Forces''
see such glaring lapses in the system?
Sri Lanka, we must realise, is highly vulnerable to mental ill health.
The high suicide rate has been brought about by a vicious combination of
social factors and lax laws governing the sale of pesticides.
But the country also has other, significant risk factors - a war in
the north and east regularly producing orphaned families, thousands of
refugees, over half a million employed away from their families in the
Middle East and a high proportion of the population being in the elderly
age group.
All these factors will not disappear overnight. They will only continue
to spawn people in need of mental health services, sooner or later. So,
the policy making bodies must realise these ominous signs and make the
necessary changes in a system that seems to resist change at every possible
opportunity.
A step in the right direction was the announcement banning all forms
of liquor and cigarette advertising from 1999. There was some resistance
to this decision too but the President and the Health Minister must be
commended for not wavering in the face of pressure from the business community.
This will go a long way in reducing morbidity for we know alcohol is
at the root of many evils. But, provision of proper mental health care
services to the population still remains a dream. For that dream to be
realised, sanity must prevail among policy makers. Or else, Sri Lanka will
be unbeatable at least in one of their 'World Champion' tags!
Obesity - how to deal with it
The media messages that bombard us regularly
would have us believe the only reason for getting rid of excess weight
would be to look trim and trendy.
That maybe a good reason for motivation, but there is another reason
as well - being obese makes you more liable to suffering a stroke or heart
attack at an earlier age than you should.
Are you overweight?: While the worst vice for your heart's health is
smoking cigarettes, insufficient exercise and excess weight are a close
second.
But how can you tell whether you are overweight? The most common visual
is to step on to the bathroom scales and then scramble to check the results
with a height and weight chart. That is not inappropriate but more accurate
estimations are possible.
A useful method for men is to measure their waist size at the navel.
If it is more than 100 cm, they are overweight. For women, a waist-to-hip
ratio is best. Measure the waist at the navel and then divide it by the
measurement around the hips. Greater than 0.8 is overweight for women.
For even more accuracy, the Body Mass Index (BMI) must be calculated.
Your weight (in kilograms) is divided by your height (in metres) squared.
For example if you are 1.83 metres and 85 kilograms, your BMI = 85/1.832
= 25.3. If your BMI is less then 20, you are underweight. A BMI between
20 to 25 is ideal. A BMI of over 25 is overweight, and an Index over 30
is definite obesity.
Why are you overweight?: The reasons are usually many, but many
people will show either a genetic tendency for excess weight, or eating
habits or more commonly now, insufficient physical activity and exercise.
Most men become overweight between the ages of 25 and 40.
For women, weight gain is marked after childbirth and then, between
45 and 55, following menopause.
Do 'Food Diets'' work?: "Food Diets'' that ''guarantee" a
loss of so many kilograms in so much of time may do more harm than good.
Food diets are usually extremely low-carbohydrate diets that drastically
cutdown on healthy food such as bread, cereals and rice. Therefore, most
of the initial weight loss is water.
The problem with these diets is that they cannot be sustained. Many
dieters are eventually overcome by a craving for carbohydrate-rich food
to which they give in.
And that is when the crash course on dieting crashes!
What are the 'rules' of eating?: For this, you must understand what
happens to the food that you eat. Put simply, if you eat carbohydrate-rich
foods in amounts that exceed your energy needs, the body can only store
them in the muscles and liver. Any ''left overs'' would be burnt off. But
if you eat fat in excess your body stores it away, around the abdomen in
males and on the buttocks and thighs if you are a female. So, when you
are choosing food, you must:
* Eat most: rice, bread, cereals, vegetables, leaves, lentils;
* Eat moderately: fish, beef and poultry, eggs, milk, yoghurt;
* Eat in small amounts: only food, butter, margarine, ''fast'' food, pork.
How to start?: It's all very well to say. ''Start eating healthy foods.''
The question is how do you make it happen and then stick to it? And can
a ''crash'' diet help in starting a weight loss programme?
Definitely not. Instead, the key is in identifying your current unhealthy
eating behaviours - not just what you eat, but why, when and where you
eat it. Then you must change these behaviours one by one until they become
new habits which you can comfortably maintain, hopefully for the rest of
your life.
A good way to do this is to first change the foods you eat in one particular
meal-for example, using less butter on sandwiches.
What to expect: The reality is that the human body cannot lose
more than 0.5 to one kilogram of fat per week. But that will be at least
13 kilograms over six months.
So, it is also important to realise that you cannot expect instant results
in this 'game plan'. Patience is as important a weapon as a low-calorie
diet!
Do you need to exercise as well?: Jogging around Independence Square
pleases you, but does that really help? Perhaps it does, but only if you
do it correctly.
What is needed is at least thirty minutes of moderate physical activity
a day. What is moderate, then?
That would be anything that causes you to sweat even slightly vigorous
housework, brisk walking, an outdoor game, swimming and gardening are examples.
So, if you tip the scales a little too much, go ahead and try to take
these hints and remember, don't start today and expect results tomorrow!
Beware of your back
Most backache is postural, provoked and preventable
By Dr.Mark Amerasinghe
If you have never had a backache, you are
indeed lucky. Over 95%, of backaches are due to mechanical causes. Your
spine is like the chassis of a car. It is the main prop of the body, bearing
the body weight during all our activities, whether standing or sitting.
The lower portion of the spine, the portion in relation to the abdomen,
the lumbar spine in particular, is constantly subjected to severe mechanical
stresses. It is in this region, the hollowed out low back, that most people
complain of pain. To avoid backache, you must learn to carry out your daily
activities, handling loads etc., in a way that reduces the stresses to
your low back.
Lifting a heavy load: When you lift a heavy load, stand well
up to it with the feet apart, one foot slightly ahead of the other, and,
if possible, on either side of it. Grip the load firmly, getting down to
it by bending the hips and knees, keeping the back straight. Straighten
up, holding the load as close as possible to your body. The maximum load
is taken on the strong muscular lower limbs. When placing the load down
again, follow, in reverse, the same procedure.
General form of the spine - low back stresses when standing: Let
us consider some simple features of the way our spines are constructed.
The spine forms a strong, flexible column, made up of several segments
of bone - the vertebrae - piled one on top of the other. The vertebrae
are held to each other in front by compressible discs, behind by muscles,
ligaments and small joints. the region of the low back is hollowed out,
because, the lumbar spine, is curved forwards. The weight line falls through
the back parts of the discs, and through the muscles, ligaments and arch
joints. These regions, especially the muscles, ligaments and arch joints,
are thus in danger of being strained. The greater the forward curve of
the spine, the greater the chances of strain. And conversely, the straighter
the lumbar spine, the less the chances of injury.
When standing, the weight line passes vertically though the lumbar spine,
compressing it and increasing the forward curve. Since the chest with the
attached arms is fixed to the upper part of the spine, this part tends
to bend or lever forwards on the lower part. This further increases the
strain on the muscles and ligaments of the low back.
The strain is greater if a load is carried in the hands. Because of
the increased lever effect, the farther away the load is held away from
the body, the greater the strain on the low back. Stooping with a load
imposes the maximum strain. Researches have shown that the pressure in
the region of the lumbar spine increases from 100 units to 150 when stooping.
If a load is held in the hand at the same time, the pressure rises to over
200!
Lifting lighter loads........... pushing and pulling: The correct
technique for lifting heavy loads should not be reserved for heavy loads
alone. We rarely lift heavy loads. But, all the time, we lift relatively
light loads. We repeatedly lift objects like chairs, shopping bags, suitcases,
flower pots etc.
If you do not use your back correctly when carrying out these relatively
light but repeated tasks, you subject it to repeated minor insults, and
at some point it is sure to protest. Even when picking up a light shopping
bag, something we do so often, we should not bend sideways, but go down
for it by bending our hips and knees with our backs straight. When turning,
turn the whole body. Do not twist your back, whether seated or standing.
When taking a spare wheel out of the luggage boot of a car, get down
to the level of the wheel by bending your hips and knees, one foot in front
of the other. Grip the wheel firmly and pull back, getting the force of
the pull from the legs. Similarly, when pushing or pulling anything, get
well down, by bending hips and knees. Have your hands in the optimum position
and then get the main force of the push or pull from the legs. Remember!
The force for lifting, pushing and pulling must come from the legs.
Activities involving stooping: Most people stoop over a wash
basin, their legs straight and the back arched. This is an activity we
do several times a day. To avoid stooping, stand well up to the basin with
one foot in front of the other. Get your hands down to the required level
by bending at the hips and the knees, keeping the back strength.
Imagine your are going down to lift a weight. Once you get used to consciously
using the correct technique, it becomes a habit; a habit that can save
you a great deal of trouble. Similarly, when ironing, it is important that
the height of the ironing board be adjusted so that you can again get on
with the job without having to stoop.
If we are standing while doing a job of work, the work table must be
of such a height that the hands could be used in the optimum working range,
arms by the side of the body, elbows bent downwards for about fifteen degrees,
with the back straight. It is important that the feet are placed under
the working area, and not behind it.
A housewife often stands and cuts up food items in a stooping position,
because, below the table top is a cupboard. A pantry or kitchen should
have at least one special ''cutting area", where the table top has
no cupboard below it. You can then stand well up to the working area, with
your feet placed below the area, reducing the need for stooping. There
is a world of difference between bending and stooping!
Sitting: When seated, the region of the low back should be well
supported. Sit upright with the back straight, and your feet firmly planted
on the ground. Do not slouch. In the slouching position, the forward curve
of the lumbar spine is increased, the abdomen is slack - two means by which
pressure on the low back is increased. There should be sufficient space
between the front of the seat and the back of your legs, so that your hips
and knees could be bent to a right angle with your feet firmly planted
on the ground. The height of the seat and the depth of the seating area
should permit this. Push the hollow of your back well up against the back
rest, which should not be inclined backwards more than a few degrees.
Pull your tummy well in and push yourself up to your full sitting height.
Sit tall! If the nature of your work permits you to use a chair with arm
rests, do so. Rest your elbows and forearms on the arm rests and push yourself
up. The hollow of your back tends to straighten out.
When driving, adjust the seat so that you can sit well upright, with
the small of your back pressed well against the back rest, your feet resting
comfortably on the pedals, and your hands comfortably on the steering wheel.
General posture: A few points about your general posture. Wearing
very high heels throws the body forwards compelling you to arch your body
backwards, to keep your balance. This increases the forward lumbar curve,
putting greater strain on your back. At all times, stand as erect as possible.
Pull your tummy in, and stretch yourself to your full height. Stand tall!
This reduces the forward lumbar curve. You can train yourself to tuck
in your tummy by tightening the abdominal muscles. Good for your shape,
good for your spine!
The purpose of this short article is to focus attention on the fact
that low package, which is commonly due to muscular, ligaments, or arch
joint strain, is largely preventable. Most backache occurs because of the
poor posture adopted by us in our daily activities. Most backache is Postural,
Provoked, Preventable.
Heart attack and Viagra
There have been increasing anecdotal reports about heart disorders in
men who have taken Viagra the vitality pill.
Dr.J. Feenstra and colleagues from the Netherlands and Dutch West Indies
report on a patient who had a severe heart attack (acute myocardial infarction)
after taking Viagra. The man was 65 years old and had been prescribed Viagra
by a doctor while in the USA. He obtained the drug from a pharmacy after
a general medical examination.
He had never taken Viagra before. The man had no high blood pressure,
diabetes, or previous heart disease, did not smoke, and drank only about
five alcoholic drinks per week. He took one 50 mg tablet of Viagra, and,
about 30 minutes afterwards, began to experience acute chest pain. On admission
to hospital, an electrocardiogram showed that there was a myocardial infarction.
After treatment, he recovered without complication.
Although Dr. Feenstra & co cannot rule out any pre-existing coronary-artery
disease in the patient, they conclude: "The close temporal relation
between ingesting Sildenafil and the onset of severe chest pain due to
acute myocardial infarction ... suggests that sildenafil was causally related".
Ear problems in children
It's just easy for an adult to describe an earache. But small children
are unable to do so. What then are the signs of a child having an ear problem?
And how do you deal with them? Here are a few useful hints:
* Signs to look for are redness of the earlobe, a high temperature,
rubbing of the ear and irritability.
* Common problems include:
Wax: Wax is produced in the outer ear to help keep it clean and
dry and usually comes out without assistance. Do not try to dislodge the
wax with cotton buds or similar objects. Clean the outer, visible part
of the ear with a face cloth - that's all that should be required. If you
are still worried about a build up of wax, see a doctor.
Swimmers ear: The ear may itch, ache and produce a smelly discharge.
A doctor should be consulted. Ear drops and antibiotics are often prescribed,
and the ears must be kept dry. Swimming is banned until the infection has
cleared.
Objects in the ear: Children's sometimes push small objects such
as beads into the ear canal. Do not try to remove any objects as it may
result in them becoming more deeply lodged. Always seek medical advice.
Middle ear infection: It is common for young children to suffer
from middle ear infections, usually at the same time as they have a cold.
A doctor should be consulted as middle ear infection can spread quickly,
causing serious illness.
Glue ear: This results from blockage of tubes within the ear.
Trapped air in the ear is absorbed and replaced by fluid which thickens,
resulting in hearing impairment.
Inner ear: Inner ear problems are the most serious but fortunately,
the least common. In some cases, viral illness during pregnancy may cause
deafness in the newborn. If you think that your child has a hearing problem,
consult your doctor. A hearing test can be arranged, even for young children.
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