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Q : Please tell me what are exact measures for preventing heart attack and strokes?

- N. Narayanaswamy, Purasaiwalkam

A : The best way to prevent heart attacks and stroke is to prevent the atherosclerosis of the arteries. The most important measures to prevent atherosclerosis include .

Stopping smoking cigarettes : the day a person quits cigarette smoking that person decreases his/her chance of dying of a heart attack by 50% that same day! In other words the benefit of stopping cigarettes happens immediately

Lowering blood pressure to below 140 systolic and below 90 diastolic; controlling high blood pressure is especially important to prevent strokes. The brain arteries are more fragile than arteries elsewhere in the body. Untreated high blood pressure significantly increases the risks of stroke.

Lowering total and LDL cholesterol in the blood; cholesterol in proper amounts is needed for making hormones and building cell membranes. But too much cholesterol, especially excess amounts of the bad LDL cholesterol, causes cholesterol to accumulate inside the inner layer of the arteries. Cholesterol accumulation in the inner artery can cause narrowing and blockage of the heart arteries causing a heart attack. Whereas blockage of the arteries to the brain can cause stroke.

Several studies have convincingly shown that lowering the LDL cholesterol reduces the risks of heart attacks and strokes.

On the other hand, HDL is a good cholesterol that protects against atheosclerosis. Therefore, low HDL is a risk factor for heart attack while high HDL cholesterol is desirable.

Physical activity : regular exercise has been shown to decrease the chance of heart attacks.

Regular exercise is important in maintaining proper body weight and maintaining the proper cholesterol metabolism. Regular exercise also helps to lower the LDL and raise the HDL cholesterol.

The other issue is diabetes mellitus. It has been shown that people without diabetes have less chance of developing arteriosclerosis and artery blockages than people with diabetes. And in patients with diabetes, those patients who have better long term control of their blood sugar have less chances of having heart attacks or strokes than those with poor control of their blood sugar levels.

Q : My mother is 45 yrs old. My family doctor has advised her to do oral G.T.T to rule out early diabetes. What does oral G.T.T imply?

Devika Rani, Kilpauk

A : Oral G.T.T is nothing but oral glucose tolerance test. With an oral glucose tolerance test the person fasts overnight ( at least 8 but not more than 16 hours). Then first, the fasting plasma glucose is tested. After this test, the person receives 75 grams, of glucose. Usually, the glucose is in a sweet-tasting liquid that the person drinks. Blood samples are taken up to four times to measure the blood glucose.

For the test to give reliable results, the person must be in good health. Also, the person should be normally active and should not be taking medicines that could affect the blood glucose. For 3 days before the test, the person should have eaten a diet high in carbohydrates. The morning of the test, the person should not smoke or drink coffee.

The classic oral glucose tolerance test measures blood glucose level 5 times over a period of 3 hours. Some physician simply get a baseline blood sample followed by a sample 2 hours after drinking the glucose solution. In a person without diabetes, the glucose levels rise and then fall quickly. In someone with diabetes, glucose levels rise higher than normal and fall to come back down as fast.

Glucose tolerance test may lead to one of the following diagnosis :

Normal response : A person is said to have a normal response when the 2-
hour glucose level is less than 140 mg/gl, and all values between 0 and 2 hours are less than 200 mg/dl.

Impaired glucose tolerance : A person is said to have IGT when the fasting palsma glucose is less than 126 mg/dl and the 2-hour glucose level is between 140 and 199 mg/dl.

Diabetes : A person has diabetes when two diagnostic tests done on different day show that the blood glucose levels is high.

- Kannan. K, Purasaiwalkam

A : Mild to moderate hypertension can be controlled by modifying one's lifestyle.

Following measures help in lowering of blood pressure :
Reduction in salt intake
Epidemiological studies suggest that dietary salt intake is a contributor to hypertension. Reduction in salt intake helps in lowering of blood pressure. Hypertensive patients should avoid added salt & salted food items.

Weight reduction
Excess body weight is the most important factor predisposing to hypertension. Waist circumference >85 cm (34 inches) in women or >98 cm (39 inches) in men, is closely related to the risk of hypertension
Weight reduction of as little as 5 kg reduces blood pressure in majority of individuals. Each kilogram weight loss is expected to lower blood pressure by 1 - 2 mm Hg

Smoking cessation
Smoking cessation is the single most powerful lifestyle measure for prevention & treatment of hypertension. Smoking may decrease the action of certain antihypertensive drugs.

Physical exercise
Sedentary individuals have a 20-23% higher risk of developing hypertension than more active individuals.
Regular physical activity helps in prevention and treatment of hypertension. Brisk walking or a swim for 30 - 45 minutes, 3 to 4 times a week will help in lowering your blood pressure. One should avoid heavy exercises, such as weight lifting, as it may increase blood pressure

Moderate of alcohol consumption
Intake of alcohol is closely related with an increase in blood pressure and it may interfere with effect of antihypertensive drugs. Both binge drinking & sudden withdrawal from heavy alcohol consumption can cause significant increases in blood pressure. Hypertensive patients should restrict their intake of alcohol.

Vegetarian diet
Vegetarians have lower blood pressure than non-vegetarians.
Hypertensive individuals should consume more fruits & vegetables.

Q : I have great inability in getting erection of penis. Can I take Viagra? How does Viagra work?

- Babu, Villivakkam

A : Lack of erection is the result of decrease blood flow to male organ. It can be due to the following reasons :

1) Smoking 2) Too much alcohol consumption 3) Stress 4) Diabetes 5) Heart disease and high cholesterol 6) Depression 7) Spinal injury.

Mechanism of Action of Vigra

Upon sexual arousal, the nervous system release nitric oxide which increases the flow of an enzyme called cyclic GMP in the penile tissues. The enzyme relaxes muscles in the penis and allows blood to flow into it. This leads to erection. But almost at the same time, the penile tissues release another enzyme, PDE 5, which breaks down the cyclic GMP and brings down the erection. 'Viagra' - or sildenafil citrate - blocks the effect of PDE5.

The drug is to be taken an hour before sexual activity. Its effect lasts for about 4 hours.

Sildenafil citrate (Viagra) is not compatible with nitrate drugs, which are usually taken to control chest pain. The combination can bring down your blood pressure to dangerous lows, and could be fatal. It should also not be taken if you are under medication for any other heart diseases, high blood pressure and hypersensitivity.

If the above said causative factors and contraindications are not there and if you have a proper sexual desire then Viagra can be consumed.

Question: My father had been consuming ahohol for the past ten years. Presently the gastroenterologist has diagnosed cirrhosis of liver. Please tell me details of this disease?

-Manohar Ram /Purasaiwakkam

Answer: Cirrhosis of the liver is a disease of the liver in which fibrous matter resembling scar tissue is produced as a result of damage and death to the cells. The liver comes yellow-coloured and nodular in appearance, and there is a loss of its normal function that may eventually lead to complete failure. Affects adults of both sexes and all age groups but more common in men.

Liver is involved Symptoms and indication: There are various symptoms, which include loss of appetite and weight, digestive upset, weariness, enlargement of liver, ANAEMIA, dark urine, JAUNDICE, HAEMORRHAGE and blood in the stools. Also, bruising, fine, red spidery veins in skin, fluid retention, bloating (oedema) and red hands. Also, the spleen enlarges and there may be baldness and breast enlargement in men. Eventually there may be collapse, coma and death from liver failure. A person with any symptoms of liver disease should seek medical advice.

Treatment: The progress of the disease can be halted if the cause is known, although nothing can be done to repair the damage to the liver that has already taken place. Excess consumption of alcohol is the most common cause of cirrhosis of the liver. Hence, if this is the cause, no more alcohol should be consumed. The affected person should eat a diet that is high in protein and carbohydrates but low in fat and salt. Iron, vitamins, (B and K) and mineral supplements may also be necessary. Provided that the liver damage is not too great, it should be possible for the person to lead a normal life as long as the progress of the disease is halted.

Causes and risk factors: As stated above, the most common cause of cirrhosis of the liver is excess consumption of alcohol over a long period of time. Other causes are viral HEPATITIS (post necrotic cirrhosis) and cirrhosis of unknown cause (cryptogenic cirrhosis). Exposure to toxic chemicals at the workplace is a further potential risk.

Question : My Sister is suffering from Bronchial Asthma? Please tell me what is the treatment for this condition

-S.Bhairavi Nungambakkam

Bronchial Asthma is a chronic, hypersensitive condition characterised by recurrent bouts of illness or sthma attacks. The affected person has breathing difficulties caused by a narrowing of the airways (the bronchi and bronchioles) leading to the lungs. Affects all age groups except new-born babies, often beginning in early childhood. In childhood, more boys than girls suffer from asthma but in adult life both sexes are affected equally.Organ or part of body involved: airways (bronchi and bronchioles) and lungs.

Symptoms: The main symptoms are breathlessness and a wheezing cough that may be worse at night. The extent to which the bronchi are narrowed varies considerably and governs the severity of the attack. In a severe attack, the breathing rate increases considerably and is rapid and shallow. The pulse rate also increases. In a very severe attack, the person may be so breathless as to make speech impossible and may show signs of cyanosis, i.e. a bluish colour of the skin because of a lack of oxygen in the blood.

A severe asthma attack or one that does not respond to the usual controlling medication taken by the patient is an emergency condition and medical help should be sought immediately. Prolonged and repeated attacks of asthma, with no break in between, are called status asthmaticus. This also is a serious emergency that can cause death due to exhaustion and respiratory failure.

Treatment: The day-to-day treatment of asthma is one of management to avoid the occurrence of an attack. This includes avoidance of the particular substance or allergen that triggers the asthma, if this is known and if it is possible to do so. Drugs used in the treatment of asthma are of two kinds. Bronchodilators are used to dilate the airways, and these include beta-adrenergic agonists such as salbutamol and anticholinergics such as theophyllines. The second group are anti-inflammatory drugs, which are inhaled corticosteroids and sodium cromoglycate. Most of the drugs used in the management of asthma are inhaled. Patients with severe asthma attacks or status asthmaticus require immediate admittance to hospital and treatment in intensive care.

Causes and risk factors: The cause of asthma is swelling and inflammation of the walls of the airways, and ontraction of the muscles, so that the openings are narrowed. This is triggered by a hypersensitive response to a number of different allergens. Common allergens include pollen, dust from mites, domestic pets, birds and farm animals and airborne pollutants from, e.g. car exhaust emissions. An asthma sufferer may have other hypersensitive conditions such as ECZEMA or FEVER, and there may be a genetic element with prevalence within a family. Exercise and stress may also trigger an asthma attack, and the condition is exacerbated by exposure to tobacco smoke.

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