Backache - a frequent nagging pain in women

Tips to prevent backache for women

Image courtesy : CartoonStock.com

All of us have either suffered from backache at some point of the time or may know some one in our family who had. The good news is that most lower back pain usually gets better within a few days or weeks. What’s more, simple self-help strategies such as these can be surprisingly effective at preventing back pain and keeping it from returning:

Do’s

1. Get more exercise for your back and stomach. If your back is hurting, you may think the best way to get relief is to limit exercise and to rest. A day or two of rest may help, but more than that may not help the pain. Experts now know that regular physical activity can help ease inflammation and muscle tension.

2. Daily brisk walk for about 1 hour. 

3. Pay attention to your posture. The best chair for preventing back pain is one with a straight back or low-back support. A chair with full arm support and a head support is preferable. Keep your knees a bit higher than your hips while seated. Prop your feet on a stool if you need to. If you must stand for a prolonged period, keep your head up and your stomach pulled in. If possible, rest one foot on a stool -- and switch feet every five to 15 minutes. Make sure your desktop is at eye level and key board is easily accessible.

4. Regular intake of Calcium and Vit D

Don’ts

5. Watch your weight. Extra pounds, especially in your midsection, can make back pain worse by shifting your center of gravity and putting strain on your lower back. Staying within 10 pounds of your ideal weight may help control back pain. 

6. if you smoke, stop. Smoking restricts the flow of nutrient-containing blood to spinal discs, so smokers are especially vulnerable to back pain. 

7. Be careful how you lift. Do not lift away from your body. Don’t bend over from the waist to lift heavy objects. Bend your knees and squat, pulling in your stomach muscles and holding the object close to your body as you stand up. Don't twist your body while lifting. If you can, push rather than pull heavy objects. Pushing is easier on the back.

8. Do not sit continuously for long hours, take a break every hour.

9. Do not carry your laptop on one shoulder, use a roll on bag or a double shoulder bag.

Contributed by:

Dr Saurabh Rawall 

Consultant Spine Surgeon ( Fortis Hospital )

www.spinesuperspecialityclinic.com

WORLD TB DAY - 24 March 2014 : Let's make India TB Free.

Today is a world TB day. 

You may ask why should I care or how does it matter to me. 

Well, I would say that if 40% of Indian population is carrying the Tuberculosis bacteria at any point of time( though most would be harboring a latent infection), and if 25% of the global Tuberculosis patients are in India ( 2.2 million cases out of 8.7 million cases), if despite the initiation of the NTP - National Tuberculosis Program since nineteen sixties we have been unable to eradicate this bacteria from our lives, it matters to all us. 

Though the incidence of tuberculosis has decreased but the overall burden of the disease stays still high. Incidence is 176/ 1 lakh population and prevalence is 5.05/ thousand population with sputum positive prevalence 2.27 / thousand population in India. 

 Dr Robert Koch in 1882 discovered the cause of tuberculosis, the TB bacillus & thus paved the way toward diagnosing and curing tuberculosis. 

But what can I do as an individual or a member of society for the cause. Yes, we all can contribute in our small ways. If there is person in your surrounding who may have these symptoms, please refer or take them to the nearest DOTS center or any government hospital for evaluation. 

1. Look out fever that is 

     unexplained 

     prolonged 

     associated with night sweats & weight loss

     and not responsive to simple antibiotics

2. Prolonged cough > 2 weeks that is not due to any allergy

3. general symptoms such as weight loss, night sweats, 

4. specific symptoms depending on which organ has been - 

Vertebral spine :                                 Back pain, swelling on spine

Bone :                                                 Long-lasting bone infection

Joints :                                                Painful joint swelling, usually affecting    one joint

Kidney and urinary tract:                  Painful urination, blood in urine, frequent urination, lower back pain

Upper respiratory tract (larynx):       Hoarseness of voice, pain on swallowing

Pleural membrane of lungs:              Chest pain, difficulty in breathing, fever

Meninges of the brain (meningitis):  Headache, fever, neck stiffness, vomiting, irritability, convulsions

Lymph node :                                       Swelling of the node, draining pus. Long-lasting ulcer despite antibiotic treatment, draining pus

Also please make sure that person undergoes sputum evaluation for tuberculosis bacteria i.e. AFB, and starts the treatment and adheres to the medical advise. Not completing the treatment is frequent cause of resistant tuberculosis, which has death rate of upto 80%.

Keeping these few things in mind,

LET US PLEDGE TODAY TO MAKE ALL EFFORT TO MAKE INDIA TUBERCULOSIS FREE.

Polycystic Ovarian Syndrome - a frequent cause of irregular periods: What is it? Do I need to treat it?

There are many of us who must have heard that some lady or a girl is having irregular periods or is unable to conceive because she has cystic ovaries or PCOS - Polycystic Ovarian Syndrome. There would be a lot many clinicians who will treat the syndrome with few medications that will normalize periods and cure infertility. But do all patients need treatment and what is the actual meaning of having cysts in the ovaries?  Lets find these answers….

PCOS (polycystic ovary syndrome), a common problem in teenage girls and women, occurs due to hormonal imbalance.  Causation for most women is probably a combination of factors that includes genetic inheritance among other factors though the exact etiology is still unclear.  

The signs and symptoms include having:

•               Irregular menstrual periods, which means having your period more than once a month or every few months, or never having your period

•               Unwanted hair growth on your face, chest, back, hands, upper arms and legs, or around your nipples and loss of hair from head

•               Acne

•               Patches of dark, thickened skin on your neck, armpits, or between your breasts

•               Weight problems

Testing for PCOS is important as Teens and women with PCOS also are at higher risk for type 2 diabetes, high blood pressure, and/or high cholesterol. Increased risk of infertility and cancer of uterus has been found in patients with PCOS.

Evaluation of PCOS includes detailed history of menstrual cycle and of diabetic background in family.

Few blood tests are required to evaluate hormone levels, blood glucose (sugar), or cholesterol. An ultrasound (imaging) test of the ovaries and uterus may be done to see whether you have ovarian cysts, which are fluid-filled bubbles in or on the ovaries.

Before doctors diagnose PCOS, they must first rule out or exclude other conditions with similar symptoms. This is why they call PCOS “a diagnosis of exclusion.”

Some Conditions That Mimic Polycystic Ovary Syndrome (PCOS)
Condition	What it is	Features similar to PCOS
Thyroid disease	Overactive or underactive thyroid gland	Irregular menstrual cycle
Prolactin excess	The body makes too much of the hormone prolactin	Male-type hair growth in women Irregular periods or lack of periods
Cushing syndrome	The body makes excess cortisol hormone	Weight gain Depression Too much hair in women Abnormal menstrual periods
Congenital adrenal hyperplasia	Inherited disorder that causes the body to make too little cortisol and too much male hormone	Acne that is severe and early (before the teen years) Infertility or decreased fertility Facial hair in women and teen girls Infrequent or absent menstrual periods

Treatment options for PCOS include one or more of the following:

•               Lifestyle Modification to control weight and exercising each day.

•               Medicines to regularize your menses and these medication contain the female hormones estrogen and progesterone (or just progesterone)

•               Medicines like Metformin which help your body use insulin better; but this medication only indicated if you have for pre-diabetes or diabetes

•               Medication for excessive facial hairs, loss of hair from head and/or acne.

•               Cosmetic treatment for unwanted body and facial hair, such as bleach, wax, shaving, electrolysis, or laser treatment

Coping with PCOS is not that difficult if you have enough background knowledge of disease process.

Seeing a doctor who knows about PCOS is the first step. Choose a doctor who specializes in hormone problems (an endocrinologist).

Remember that the sooner you get help for your PCOS, the sooner you could lower your risk for related health problems such as diabetes.

Contributed by:

Dr Rajiv Singla

MD, DM Endocrinology

For any questions please send a mail to : kalpavrikshclinic@gmail.com

So now, your head is aching like anything and you don’t know what to do……

Yes let's talk headache management now.

Pain is a perception and the treatment should be individualized according to the patients' need. Pain is subjective and different people might experience same pain differently. That is why, it is measured most commonly by a visual analogue scale that measures it subjectively on a scale of 0 -10 with 0 meaning no pain and 10 means the most severe pain that the person has experienced in life.

Headache should also be differentiated into mild, moderate and severe. Also whenever possible, a headache diary should be maintained that will help in measuring the severity, intensity, frequency and nature of our headaches, It will also help in noticing headache's trigger factors and will educate patients and doctors more about the illness.

Again, etiology of headache will be the prime factor in determining its treatment.

Tension Type Headache, Migraine, type of migraine, Cluster headache, Trigeminal neuralgia or any other type of headache will have different modes of treatment.

SO THE NATURE OF THE HEADACHE WILL HELP FIND OUR MANAGEMENT STRATEGY. 

But few basic tips might help you in most type of headaches:

Tension Type Headaches and Migraine have their triggers that are individual specific so finding those triggers and avoiding them will help prevent those headaches.

Carry your prescribed analgesics in your bag. And taking the analgesics as soon as possible after the onset of headache episode makes that headache episode easy to handle.

Keeping the painkillers as is needed is important as the overuse of the pain killers may lead to Medication overuse headache, which are kind of rebound headaches that occur as soon as the effect of the painkillers ends in a patient who is addicted to pain killers. May we call it painkiller addiction and headache may be called as pain killer withdrawal headaches….

Instead of going to the highest potency painkillers, patients should start with the simplest painkillers like paracetamol or ibuprufen, which are safer than the other higher level/ potency painkillers.

Eating regular meals, taking a good night sleep and keeping the stress at bay either psychological or physical is another mantra that will decrease patient’s headaches. There are other non- pharmacological methods that may help in alleviating the headaches if done regularly. These are:

• Breathing exercises
• Progressive muscle relaxation
• Mental imagery relaxation (also called guided imagery
• Biofeedback
• Relaxation to music
• Counseling/cognitive therapy (to help patients recognize and relieve stress)
• Alternative therapies, including physical therapy, massage, hypnosis, chiropractic manipulation, acupuncture/acupressure, aromatherapy, and herbal therapy

Though this is just a gist of how the headache should be managed, these simple tips can decrease the headache intensity and frequency, making the problem more manageable.

Contributed by : 

Dr Sweta Singla 

MD, DM Neurology

Headache – a frequent troublemaker - Its various causes

Headache – a frequent troublemaker

Headache is one of the commonest disorder that can contribute to poor quality of life in women. Headache might lead to irritability, depression and insomnia if present on a chronic basis. And these consequences may further aggravate the headache problem leading to a vicious cycle. At that time what should one do is one question that might come into everyone’s mind. But before we talk about management we should know the common causes of headaches that might afflict women frequently. 

1.     Migraine – one of the commonest headache syndromes that affects a woman. It is usually one sided but may change the side of the head, throbbing, may be associated with nausea and vomiting, may or may not lacrimation or nasal congestion. Many patients with migraine have prodromal symptoms that are called aura – that precede headaches and may be in the form of scintillating lights in the visual field, some vague sensory symptoms etc. Migraine episodes may last from few hours to up to 72 hours and may be relieved by sleep. Most of the patients might have sensitivity to lights and sounds and may have particular trigger factors like sleep deprivation, excessive physical stress, hormonal changes (during a woman's menstrual cycle), certain foods (e.g., chocolate, aged cheeses), beverages (e.g., red wine), strong odours etc. It is not uncommon to experience mixed tension-migraine headaches.

Migraine is more common in females may be familial and many patients report more episodes during the time they have their periods. Few patients of migraine may turn chronic and convert into chronic daily headache and these are the patients who might need aggressive management.

2.     Tension type Headache – TTH: It is again an episodic headache that is usually affects the whole of the head and is associated with stretching sensation or band like sensation inside the head, which is most of the times associated with scalp muscle contraction. It is not related with sleep but a lot many times may be associated with psychological and physical stress. Patients might report associated insomnia and depression along with it.

3.     Cluster Headache - : It is again a common type of headache in young populations though have slightly more predisposition for males. It occurs on one side often head, would occur in clusters and these episodes are usually associated with tearing, eyelid drooping and nasal congestion on the side where the headache is prominent. Pain may last about 20 to 90 minutes at a time. They typically start during sleep. Alcohol and seasonal change might trigger the bouts of these types of headaches.

4.     Trigeminal Neuralgia – Sharp shooting electric current like pain on one side of the head that may last for few seconds but may be the most severe pain that patient might have experienced in life. It is a neuralgic pain and is because of involvement of the trigeminal nerve that supplies the sensations on the face.

5.    TM Joint dysfunction - It occurs in the pre-auricular region i.e just in front of the ear and is increased by movement of the jaws.

6.    Hypertension – Increased blood pressure is yet another cause of acute headache.

7.    Medication abuse headache – Many times overuse of painkillers taken for chronic headache also may lead to Medication abuse headaches.

8.    Sinusitis:  The patient with sinusitis will have bi-frontal headache that is associated with running or stuffy nose and heaviness on the forehead. They may follow upper respiratory tract infection such as cold and coryza. For sinusitis ENT specialist might order few specific tests and may prescribe oral tablets and nasal spray.

9.     There are many other cause of headache but one should know what one can do at the time of an acute headache and when to consult a neurologist for further evaluation.

There are some red flags signs that signal that headache might be potentially serious and may need urgent medical attention –

•       Headache getting worse over days or weeks

•       Headache accompanied by impaired neurological function (e.g., loss of balance, weakness, numbness, or speech disturbance) and double vision

•       If there is associated nausea and vomiting

•       If it are associated seizures, mental disturbances, and loss of consciousness

•       If headache is associated with a fever or stiff neck (could signal meningitis)

•       If headache is different than the usual pattern of headaches you have experienced

•       If it is the most severe headache that you have experienced in your life. intensity

•       If the headache wakes you from sleep or is worse when you lie down

Will discuss the management in the next article....please look out for it...

Till then enjoy reading and enjoy good health.... 

If there is particular topic in your mind that you would like to discuss please feel free to write to us on kalpavrikshclinic@gmail.com

Visit our website: www.kvsc.in

March 8 – International Women’s Day - Let's focus on women - the better halves of the world....

Women the better halves of the society, the atlas of any house hold, the pillar of strength for other family members when the going gets stuff. For this pillar to remain strong women need to take good care of their health but unfortunately women health is often ignored in any household. She would put aside any of her problem if that is interfering with the comfort of any family member. And finally when that pillar breaks the whole family crumbles beneath it. Hence, the need for any woman and her family to give prime importance to health of the women in their home. So in the next few articles in the month of march, let us re-emphasize the need for healthy women in our society and look closely at the common health related issues that she suffers and how we can be instrumental in alleviating that suffering and making her life more beautiful.