The Relationship between Nails and Health.

Health, Lifestyle

fingernails main

Human nails are present on the dorsal aspect of all the fingers and toes. A nail is formed by the living cells presents that are present in the ends of the fingers and toes. It’s structure is shown in Figure 1.

Nail structure

Fig 1: Structure of a nail

  • The nail body or plate: Visible part of the nail that remains attached to the nail bed which represents the skin below the nail. 
  • The cuticle (Eponychium): It is the tissue that forms the rim of the base of the nail and overlaps the nail body. 
  • The nail walls or folds: These are the skin folds that supports the nail from three sides.
  • The lunula: This forms the whitish half-moon part at the base of the nail.
  • The nail root: The nail root forms the matrix which is the underlying structure of the nail found under the cuticle.

Growth rate of the nails

The nails grow from its roots and is made of keratin protein that is also seen in skin and hair. The growing of nails occurs when new cells of the nail matrix are formed pushing the older part of the nail to grow outside the edge of the nail body.  

Due to its biological design, the growth rate of a nail is dependent on the age, gender and environmental conditions. The average growth rate of the nails is approximately 0.1 mm per day that is 1 centimeter in 100 days. 

Why look at the nails?

The main function of the nails is to protect the ends of the fingers and toes from injury. 

Shape, colour and texture can often change with an underlying skin disease or an infection (most often fungal). Although, changes in the nails may not be the first sign of a problem, it can often be accompanied with an underlying health condition which is known or unknown to an individual. Hence, a simple examination of the nails can provide a lot of information about the health and the underlying risk of many conditions.

What should be examined about the nails?

  • Changes in the shape of the nails by comparing with the other hand.
  • Discoloration 
  • Changes around the nail
  • Monitor nail growth

Health problems that are reflected in nails

Abnormal shape and structure of the nail:

Clubbing: This is caused by thickening of the nail plate at the base of the nail due to softening of the nail bed that causes the nail to curve inwards.

It can be found doing a test by keeping the index fingers of both the hands together as shown in Fig 2.

CLUBBING

Fig 2: Test for clubbing

Normally, there should be an angle between the upper skin flesh of the nail and the nail plate forming a diamond shape window. If this window is absent and the angle is lost, it creates the “Schamroth sign” that indicates clubbing.

Clubbing can occur in conditions like:

  • Inflammatory bowel disease – inflammatory conditions of the small intestine and the colon involving ulcers that are formed in the intestine.
  • Lung diseases: Lung cancer, chronic bronchitis, Chronic obstructive lung diseases – asthama.
  • Heart Diseases: Congenital heart disease, heart defects and abnormalities

Koilonychia: This explains wasting of tissue under the nail plate causing the nails to become spoon-shaped as shown in Fig 3.

koilonychia spoon shaped

Fig 3: Spoon shaped nail

 This shape is seen in conditions like:

  • Iron deficiency anaemia – low red blood cells or haemoglobin
  • Diabetes
  • Raynaud’s disease- constriction of blood vessels of fingers and toes due to cold or stress.
  • nail-patella syndrome – genetic disorder affecting the nails and the knee caps.

Ripples on nails: This involves pitting of the nails as shown in Fig 4.

nail pits

Fig 4: Rippled Nail

This can occur as an early sign of,

  • Psoriasis (skin infection with scaly patchy skin problems)
  • Arthritis (painful inflammation of the joints).

Beau’s line: Presence of transverse lines or a line on the nail plate as shown in Fig 5,

Beau's lines

Fig 5: Beau’s Line

It can indicate,

  • Severe infection
  • Heart problem
  • Hypotension (Low blood pressure)
  • shock
  • Hypocalcemia (low calcium in the blood)

Cracked thin and brittle nails: This type of nail is shown in Fig 6.

split nail

Fig 6: Cracked nail

Cracked nails:

  • Thyroid problems
  • Metabolic bone disease like osteopenia (loss of bone mass invovingminerals and bone tissue)
  • Malnutrition

Bitten nails or Gnawed nails: Habitual biting of nails or picking causes damage to the nail plate, nail walls and the skin around the nail. 

Gnawed nails

Fig 7: Gnawed nails

Bitten nails:

  • Chronic anxiety problems
  • Obsessive-compulsive disorder

Nail abnormalities related to Colour

Dark lined nail: Blackish dark discolouration seen beneath the nail as shown in Fig 8.

discoloured nail

Fig 8: Nail with dark lines

 This type of discoloration can be seen among,

  • Dark skinned people with pigmentation problems
  • Melanoma (skin cancer)

Blue coloured nails:

Bluish discoloration of the nails also called as cyanosis is shown in Fig 9, can indicate a problem with the oxygen-carrying capacity in the blood relating to respiratory problems.

Cyanosis

Fig 9: Bluish nails

Conditions related to bluish nails:

  • Lung problems- emphysema (a lung condition that damages the air sacs in the lungs causing breathing difficulty)
  • Heart problems

Yellow coloured nails: Yellowish nails (refer fig 10) can also appear thin and cracked in severe cases.

yellow nails

Fig 10: Yellow discolored nail

Yellowish nails:

  • Fungal infections
  • Severe thyroid disease
  • Lung disease
  • Diabetes 
  • Psoriasis

Whitish nails: White nails with a discolored dark rim as shown in fig 11.

white nails

Fig 11: White nails

  • Liver diseases
  • Hepatitis

Nail Beading: Beads formed on the nails look as if it is like melted wax dripping down a candle ( Refer Figure 11). 

nail beading

Fig 12: Nail Beading

Conditions related to beaded nails:

  • Diabetes mellitus
  • Thyroid disorders
  • Vitamin B deficiency

What can you do if you find changes in your nails?

  • If you see any differences in your nail shape, colour or develop changes in your nails, it could be simply because of any deficiency and not necessarily related to an underlying health condition.
  • It is best to consult with a professional in order to get your finger and toe nails examined. You may be asked to undergo a blood test and/or other tests to correctly determine the cause of your health problem.
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Benefits of Human Milk

Health, Lifestyle, Pregnancy

Baby Milk

Human milk provides optimal nutrition for infants and children for improving their health, growth, and development. It contains many unique properties such as nutrients, growth factors, hormones, enzymes, and anti-microbial factors that provide immunity to many acute and chronic diseases.

Macronutrients of Human milk: These include vitamins A, B1, B2, B6, B12, D, and iodine.

Bioactive components: These are elements that can affect biological processes and play an important a role in healthy body function. 

Bio-active Components What are their functions?
Macrophages and stem cells These cells protect against infection and healing.
Immunoglobulins (IgA/sIgA, IgMIgG) Anti-microbial and anti-inflammatory response to microbes and allergens
Cytokines IL-6, IL-7, IL-8, IL-10, IFNγ,   TGFβ,  TNFα Antibody production, Anti-inflammatory, Stimulates inflammatory immune activation
Chemokines (G-CSF,  MIF) Help the gut against infections, help anti-pathogen activity of macrophages
Cytokine Inhibitors TNFRI and II Anti-inflammatory effect
Growth Factors (EGF,  HB-EGF,  VEGF,  NGF, IGF) Protective against damage from low oxygen. Promotion of healing, nerve growth, Stimulation of growth and development, increased red blood cells and hemoglobin
Hormones (Calcitonin, Somatostatin) Regulation of healthy gut (intestines)
Metabolic hormones (Adiponectin, Leptin,Ghrelin) Reduction of infant BMI and weight, anti-inflammatory, regulation of energy conversion and infant BMI, appetite regulation, Regulation of energy conversion and infant BMI
Oligosaccharides & glycans, HMOS, Gangliosides, Glycosaminoglycans Brain development; anti-infectious
Mucins (MUC1, MUC4) Block infections by viruses and bacteria.

Exclusive Breast Feeding

Global guidelines recommend exclusive breastfeeding for an infant for a minimum period of the first 6 months. Exclusive breastfeeding is an infant’s consumption of mother’s milk without the use of milk powder supplements. 

Mother’s health Benefits from breastfeeding 

  • Healthy Breast Cells: Breastfeeding also increases differentiation, or maturation, of the ductal cells in the breast that is believed to increase resistance to cancer growth.
  • Cancer prevention: It is reported that it can reduce the number of menstrual cycles lowering the hormonal exposure that can help prevent cancers grow.
  • Prevents stress and depression post-delivery: During feeding, a hormone called oxytocin is released that is found to promote nurturing and feeling of relaxation to the mother thus improving the mother’s mental health.

Milk Banks 

The world health organization (WHO) supports the use of donor human milk in situations where a mother is unable to produce enough or if the mother’s own breast milk is unavailable.  The milk banks are the non-profitable market in human milk that provide services to the community for babies in need. The main priority of milk banks is to provide milk for fragile and sick babies in Neonatal Intensive Care Units of the hospitals for therapeutic purpose for nutrition. 

Human Milk trade 

The informal market in human milk is rising with great demands of human milk even outside hospital community. Now, human milk can be made available by sharing largely through social media and the Internet-based marketing. It is often called “informed sharing” where Mothers feel safe buying human milk from donors that share their health information online.

Personal Consumption of Human Milk

Many human milk traders are increasingly profiting by selling human milk for personal consumption on the internet. Similarly, it has also been reported that a dessert called “Baby Gaga” an ice-cream recipe that used human milk was being served in one of the restaurants in UK for monetary profits. 

Threat of spread of diseases

  • While the milk itself is sterile via breastfeeding, human milk is usually not collected in a controlled or sterile environment. This can cause contamination of the milk. It has been reported that 93% of breast milk sold online are contaminated.
  • Many serious diseases spread through body fluids. Therefore if human milk is infected with viruses, it can spread life-threatening diseases like hepatitis B and C, Human immunodeficiency virus (HIV-aids) and syphilis.
  • Even if the milk is collected by a sterile technique, if it is not stored in proper conditions, there can be a risk of bacterial growth such as staphylococcus, streptococcus and salmonella microbes leading to an infectious spread.

Community Benefit

It is the responsibility of all the parents and consumers to understand the importance of human milk and to support its use for the purpose of nutrition children in need. It is also important to raise awareness on the trade of human milk and the potential health risks involved to maintain a safe and healthy community.

Why do we sleep?

Exercise, Health, Lifestyle

sleeping problems

What is sleep?

Sleep is a state of altered consciousness of the mind and body which typically lasts for several hours every night. It involves the inactivity of the nervous system, relaxation of all the muscle of the body and is considered important for optimal health.

Sleep pattern

The normal sleep pattern involves the alternating REM (rapid eye movement) and NREM (non-rapid eye movement) sleep that occurs in a 90-minute interval cycle in a typical night’s sleep.

There are four phases:

Stage 1: Light sleep – between being awake and sleeping

Stage 2: Initiating sleep, drop in the body temperature, regular heart rate and breathing.

Stage 3 and 4: The deepest form of sleep when the breathing slows down and the blood supply to all the organs increases, the repair process begin, muscles are relaxed, the blood pressure goes down, various hormones like growth hormone are released.

What is the importance of REM and NREM?

REM makes up about 25% of the night’s sleep: It first begins about 90 minutes after falling asleep. Lasts for some time and recurs about every 90 minutes. In the REM stage, the brain is more active, heart rate is raised and intense dreams can occur. At this stage, brain development occurs as the area of learning in the brain is stimulated.

Like deep NREM sleep, REM sleep also helps protein binding for growth.

During the NREM sleep, the body restores its functions of the brain, repairs and regrows tissues, promotes growth, and improves the immune system.

Benefits of sleep 

Normal Brain function and development: Sleep is essential for maintaining the normal levels of cognitive skills. ( This include speech, memory, innovative and focused thinking.)

Emotional well-being: Sleep can give you a feeling a sense of freshness, motivation and relaxation.

Physical health:

  • Sleep will help maintain hormonal balance in the body. For example, the hormones that regulate hunger and insulin regulation for blood sugar levels.
  • It is involved in the healing process of your heart and blood vessels.
  • It can support growth and development in children and teens by releasing hormones that builds muscle mass and helps the body repair.
  • It plays a role in puberty and fertility. 
  • It can improve immunity and help fight infections better.

Good physical performance levels:

  • Sleep can improve concentration, focus, awareness and general activeness of your body. 
  • It improves your ability to perform skillful activities.

How much sleep is recommended?

Age Recommended Amount of Sleep
Newborn babies about 17 to 18 hours per day
Preschool children about 11 to 12 hours per day
School children Minimum 10 hours per day
Teenagers about 9 to 10 hours a day
Adults (including the elders) about 7 to 8 hours a day

Sleep deficit 

Sleep deficiency can increase the risk for some chronic health problems.

  • Heart disease: Lack of sleep will keep the heart rate elevated leading to increased calcification (calcium deposits) in the blood vessels of the heart. There is also an increase in CRP (C-reactive protein), which is released with stress and inflammation that can lead to heart problems.
  • Obesity: Lack of sleep can interfere with appetite regulation due to imbalances in the hormones that regulate hunger. This can lead to eating at night when your body’s metabolism is low causing excessive fat storage leading to obesity.
  • Diabetes: Due to the increase in food intake and lack of rest, hormonal imbalances can affect the insulin response in the body. The metabolism of glucose is affected due to insulin resistant that can lead to type 2 Diabetes.
  • High blood pressure: With insufficient rest, the heart rate remains elevated. This raises the blood pressure which may cause hypertension.
  • Stroke or transient ischemic attack (mini-stroke):  It is related to elevated heart rate and hypertension that can lead to a reduction of blood supply to the brain leading to a stroke or mini-stroke.
  • Depression and attention-deficit hyperactivity disorder (ADHD): Due to lack of rest and interference in the brain function, lack of sleep can cause problems with thinking, mood swings, depression and hormonal imbalances that may lead to ADHD and depression.

Sleep Disorders – There can be about 81 disorders.

  • Insomnias (Sleeplessness): There can be difficulty at the beginning of sleep, maintaining sleep, abrupt waking from sleep, waking too early or poor quality sleep. This sleep difficulty can occur despite all attempts of trying hard to sleep.  This can be related to mental disorder, restless leg syndrome, sleep apnea or due to drug side-effects.
  • Sleep-related breathing disorders: Cheyne-Stokes breathing pattern is characterized by a gradual increase in the breathing followed by a gradual decrease and holding of breath for 5 to 50 seconds. This type of respiratory problem is also typically seen with other medical problems of the heart and kidney.
  • Sleep apnea: Irregular breathing pattern with disruption or episodes of breathlessness. It can be due to lack of sleep causing arterial oxygen desaturation (reduction in oxygen in the blood).
  • Hypersomnias (Narcolepsy): This involves daytime sleepiness and may be related to dysfunction in the brain due to increased lack of sleep at night or misaligned circadian rhythms (body clock).
  • Circadian rhythm sleep disorder: The “body clock” or the circadian rhythm is the 24-hour cycle that tells your body when to sleep and helps to regulate many other physiological processes. Disturbances can occur between the person’s sleep pattern and the pattern that is desired. For example, one cannot sleep when sleep is desired.
  • Parasomnias: The parasomnias consist of abnormal sleep-related movements, behaviors, emotions, perceptions or dreaming. It occurs while falling asleep, sleeping, between sleep stages, or during arousal from sleep. They are disorders that cause sudden waking up or a state of disturbed sleep.
  • Sleep-related movement disorders: Restless legs syndrome, sleep-related rhythmic movement disorder, large movements of the body or legs while sleeping can affect normal sleep pattern.

Other problems: 

Snoring is a sound produced by breathing. Snoring can also lead to impaired health as it can disturb the sleep of the individual and their sleeping partner. 

Sleep talking and sleep walking can be associated with REM sleep behavior disorder or sleep-related eating disorder. Usually, the person can get a sensation of falling, a sensory flash of walking to a place or a sleep-onset dream that can cause talking or walking. 

Who can be at risk of sleep disorders?

  • Working on odd timings/shifts:  Job timings that are against the internal body clock and working long hours.
  • Lifestyle problems: People who take medications to stay awake to complete tasks and studies. Other problems like alcohol or substance abuse.
  • Known or unknown medical condition: People who take medications that have side-effects that interfere with sleep. People with underlying unknown problems like stress and anxiety.

How is sleep problems diagnosed?

  • Blood Tests can be done to help find other underlying medical problems that can cause sleep problems.
  • Sleep studies (polysomnography): The electric activity in the brain (Electroencephalogram studies), behavior and other changes are observed while the person is asleep to study the problems associated.

How to get a good amount of sleep?

  • Sleep schedule should be kept the same every night. Avoid differences that may disturb your body clock.
  • Avoid strenuous exercise or doing work before bed as that will keep your brain active and delay sleep.
  • Avoid cigarettes (nicotine) and caffeine. Nicotine and caffeine are brain stimulants so both substances can interfere with sleep.
  • Getting enough fresh air and sun during the day can also help a good night’s sleep.
  • Learning relaxation techniques like breathing exercises can help.
  • Taking a warm shower before sleep can also relax the body. Keeping the bedroom cool and dark will also help prevent any disturbances.

If you have any type of sleep issues due to a shift-work schedule, it’s best to speak to your employer or consider visiting the experts to better understand your issues and eliminate the worry of any underlying medical condition.

The 5 Types of Hepatitis

Common conditions, Health, Lifestyle

Hepatitis liver

The liver is a vital organ located in the upper right part of your belly under the ribs.

Functions of the liver:

  • Making bile, a yellowish-green liquid that helps with digestion
  • Producing proteins and blood-clotting factors that the body needs
  • Regulating glucose (sugar) in the blood and stores extra sugar
  • Working with the stomach and intestines to digest food
  • Storing vitamins and minerals
  • Removing toxic (poisonous) substances from the blood

“Hepatitis” means inflammation of the liver. Hepatitis is also the name of a family of viral infections that affect the liver.

There are 5 types:

  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E

The most common types of hepatitis disease are Hepatitis A, B and C. 

Causes of infection and types –

Hepatitis A: This is caused by consuming food or drinking water that is contaminated with faecal matter (human waste). As compared to other infections of hepatitis, hepatitis A usually improves without treatment.

Hepatitis B: It can be transmitted through sexual contact with an infected partner, through infected blood transfusions and dirty needles. Hepatitis B may scar the liver (cirrhosis) and lead to liver cancer.

Hepatitis C: This is the most common form of viral hepatitis. The exact cause is unknown, but it can happen through blood transfusion of infected blood and blood products, contaminated injections and through injection drug use.

Hepatitis D: Hepatitis D occurs in people with hepatitis B, increasing the severity of symptoms associated with hepatitis B.

Hepatitis E: Similar to hepatitis A, hepatitis E happens among people in countries with unhygienic living conditions where contaminated water and food consumption often leads to a spread of infection.

Which hepatitis is dangerous?

  • Types B and C have been reported more among people leading to a chronic (long-term) illness of liver disease. It is the most common cause of liver cirrhosis (liver tissue scarring) and cancer.
  • In addition, there are vaccines to prevent Hepatitis A and B. However, there is no known vaccine for Hepatitis C.

Period of illness with different types of hepatitis

Acute Hepatitis viral infection: This is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis virus. Hepatitis A and E may not cause chronic hepatitis but for some with compromised immunity and delayed treatment, it may lead to chronic infection.

Chronic Hepatitis virus infection: Hepatitis viruses B and C can progress from acute to chronic episodes of illness after about 6months. It is long-term as the virus remains in a person’s body and continues to affect liver cells for years to an extent that there can be a complete liver failure.  

Pathophysiology of Hepatitis infection

Acute infection: The course of the virus is not completely understood but once it enters into the body, it multiplies and the infection persists due to weak immune responses which fails to control the viral spread of infection. Symptoms will appear and continue.

Chronic infection is established with the progression of infection. Liver lesions appear due to the immune responses and inflammation of the liver cells. It also triggers fibrogenesis in which the cells of the liver become hard, thickened and fibrous. This leads to scarring of the liver tissue known as cirrhosis. People with cirrhosis are then at high risk of developing end stage liver disease (ESLD) with hepatocellular carcinoma (cancer of the liver cells). 

Chronic hepatitis

Fig 1: Stages of liver infection with Hepatitis C virus(HCV)

Signs and Symptoms with all types of hepatitis

  • Fever due to infection.
  • Fatigue due to loss of appetite, nausea, and vomiting. Also, lead to long-term weight loss.
  • Abdominal pain due to build-up of fluid in the stomach due to inflammation. This occurs when the damaged liver doesn’t produce enough albumin, a substance that regulates the amount of fluid in cells. This may also lead to Pale colored stools, darker urine.
  • Joint pain: Pain and stiffness are early signs of inflammation caused by the body’s autoimmune response to the hepatitis virus.
  • Jaundice: Bilirubin present in the hemoglobin of the red blood cells can build up and cause your skin and the whites of your eyes to turn yellow. 
  • Brain problems: A build-up of toxins in the brain can cause personality changes. Advanced symptoms include abnormal shaking, agitation, disorientation, and slurred speech.
  • Diabetes: Liver is unable to store excess glucose and too much sugar is present in the bloodstream which may lead to insulin resistance or type 2 diabetes.

Who may be at risk of getting Hepatitis?

  • Infants born to infected mothers can get hepatitis B
  • Travelers to regions with high risk of Hepatitis infection most commonly reported in Asia, Africa, South America and the Caribbean.
  • Sexual contact with infected persons that cause viral transmission through body fluids.   
  • Household members, healthcare professionals and caregivers of infected persons through an accidental transmission.
  • Recipients of blood transfusions who may have accidentally received an infected blood.
  • Long-term hemodialysis patients through an accidental infected needle use or blood transmission.

Diagnosis of hepatitis

Blood tests for the antibodies can be helpful in diagnosing both acute and chronic hepatitis. Physical examination of the symptoms along with diagnostic studies such as ultrasound scan of the liver or a liver biopsy is also done to determine the severity of liver damage.

Prevention and Treatment of Hepatitis

Immunization :

  • Hepatitis A immunization of children (1-18 years of age) consists of 2-3 doses of the vaccine. Adults need a booster dose every 6-12 months following the initial dose of vaccine. The vaccine is thought to be effective for 15–20 years or more.
  • Hepatitis B vaccines provide protection against hepatitis B for 15 years and possibly much longer. All newborns and individuals up to 18 years of age and adult should be vaccinated. Three injections over a 6 to 12-month period are provided for full protection.

Safety Measures to Prevent Hepatitis

  • Hygiene: Wash your hands after going to the bathroom and before cooking or eating.
  • Protective sex: This may lower the risk of transmission. It’s always wise to know the history of your sexual partners, especially if they have an infection, you may run the risk of contracting the disease.
  • Drinking clean water: Avoid tap water when traveling to certain countries or regions.
  • Careful handling of drug needles and use of disposable drug needles only.
  • Avoid sharing personal items such as toothbrushes, razors and nail clippers.

Once diagnosed with hepatitis, the treatment will depend on the type and stage of infection. Most adults recover completely from acute hepatitis A and B within six months period. Mild relapses may occur over time during the recovery of the disease. 

Early detection and treatment show excellent recovery from both hepatitis B and C. Further research development continues to provide a vaccine for hepatitis C.

 

Obesity – Adult vs Children

Common conditions, Food, Health, Lifestyle

Obesity

Obesity is the presence of excessive adipose tissue (fat) mass affecting the health status of any individual to an extent that it may lead to the risk of other serious health conditions. It is one of the most common global health problem replacing the more traditional public health issues.

Obesity in adults vs children

In order to classify an adult as obese, the body mass index (BMI) can be calculated that best classifies an individual according to his height and weight. 

BMI: It is the weight of the individuals body divided by the square of the body height ( expressed as kg/m2). The standard classification of an individual is given in table 1.

BMI good one

Note-BMI is not the best indicator for health as your excessive weight can also be due to healthy bulging muscles rather than fat storage. It does not give information on the fat storage distribution in the body especially in the waist region and cannot be used as a predictor for lifestyle changes and benefits.

Obesity in children  

In infants and children within 5 years of age, the obesity is determined according to the World Health Organization (WHO) “Child growth standards” and the WHO reference values for 5-19 years (body mass index-for-age).

WHO classification (birth to age 5)

  • Obese: Body mass index (BMI) > 3 standard deviations* above the WHO growth standard median*. 
  • Overweight: BMI > 2 standard deviations* above the WHO growth standard median*.

WHO classification (ages 5 to 19)

  • Obese: Body mass index (BMI) > 2 standard deviations* above the WHO growth standard median* (equivalent to BMI 30 kg/m2 at 19 years).
  • Overweight: BMI > 1 standard deviation* above the WHO growth standard median* (equivalent to BMI 25 kg/m2 at 19 years). 
*Growth Standard median: This is the standard of weight given for boys and girls by WHO according to the weight-for-length and weight-for-height of the children at a particular age.
*Standard Deviation: The weight difference of a child when compared to the mean (average) weight of the children belonging in the same age group.

Other classification for childhood obesity

  • Child is overweight: if BMI at or above the 85th percentile* and lower than the 95th percentile for children of the same age and sex.
  • Child is Obese: if BMI is at or above the 95th percentile* for children of the same age and sex.
*Percentile: It is a term used in statistics to give a value of a percentage of a child’s weight compared to the weights of the children of the same age group. For example, a test score that is greater than or equal to 75% of the scores of people who took the test is said to be at the 75th percentile rank.

Measuring Body fat in Adults

Waist Circumference: This method measures excessive fat around the waist and can be used as an additional measure in people who are obese or pre-obese according to the BMI.

For men, a waist circumference no more than 94cm and for women no more than 80cm is considered a safe range. Beyond which, one can develop obesity-related health problems.

Factors that lead to obesity

Genetic factors: The risk of obesity can be more if one or both parents are obese. This relationship of genes and obesity due to the environment and eating habits.

Age: With age, there can be a decrease in the metabolism of the body and loss of muscle mass. If physical inactivity ensues, coupled with bad eating habits, this can easily increase their ability to store fat in the body. Sometimes hormonal changescan also play a role leading to obesity. 

Gender differences: Women tend to gain weight during pregnancy due to hormonal changes.  Hormonal changes including estrogen, progesterone hormones can lead to weight gain. Imbalances in these hormones can also trigger insulin resistance, which in turn, leads to fat storage. In Men, imbalances in testosterone hormone can lead to weight gain. In general, it is observed that women are more at risk of weight gain compared to men also due to lifestyle differences.

Lifestyle:

  • Physical activity: With improvements in modern technology and conveniences, there is an increasing lack of physical activity. 
  • Food habits: Consuming foods with excessive fat, sugar and calorific foods. Increased snacking and overeating can lead to excessive fat storage.
  • Stress and lack of sleep: Both stress and lack of sleep can slow the body’s metabolism. Eating late at night can cause indigestion and leads to fat storage. 
  • Socio-Economic Status: Lack of resources, lack of access to healthy foods, unable to afford healthy foods or improper cooking habits, eating out too often can all lead to obesity.  
  • Side effects of medications: Certain pain medication, corticosteroids, antidepressants, thyroid medications taken by people with thyroid problems and other medicines can slow down metabolism and lead to fat storage. 
  • Known Medical Problem: Arthritis in the lower limb causing pain on weight bearing can reduce physical activity that leads to increasing fat storage.

Diseases such as stroke, kidney disease, Prader-Willi syndrome, Cushing’s syndrome and many others can prevent the person from engaging into physical activities due to pain or muscle/joint problems etc.  

Consequences of Obesity

obesity problems

Metabolic problems: 

The major metabolic risk factors resulting from obesity are

  • An increase in the total cholesterol concentrations especially triacylglycerol concentrations, and high-density lipoprotein (HDL) concentrations.
  • High blood pressure
  • Diabetes: Insulin resistance and glucose intolerance.

All this may lead to Metabolic syndrome that describes a group of risk factors that can increase the risk of developing a heart condition. 

Diabetes: Obesity can lead to deficiencies in sex-specific steroid hormones (estrogen, progestin etc) that causes insulin resistance and a decrease in glucose metabolism. 

Coronary Heart Disease (CHD): Metabolic syndrome and diabetes can lead to atherosclerosis and blocking of the major arteries of the heart leading to a heart condition.

Osteoarthritis: Osteoarthritis (OA) is an inflammatory condition that can be caused by obesity. Excessive weight gain can lead to wear-and-tear of the cartilage and bone leading to inflammatory joints. Other reasons underlying the relationship between obesity and osteoarthritis can be metabolic changes associated with increased fat storage. 

Pulmonary disease: Excessive weight gain in the upper body can increases breathlessness that will lead to CO2 retained in the body and a mismatch in the ventilation and blood flow that further worsens the respiratory system.

Hypertension: The exact cause is unknown, however, due to weight gain there is an increase in resistance to blood flow to and from the extremities. Increases in body mass index (BMI) can put an individual at a higher risk of developing hypertension. 

Gallbladder disease: Obesity is associated with increased secretion of cholesterol in the gallbladder that increases the risk of gallstones particularly cholesterol gallstones.

Hormonal disturbances: Increased obesity in women leads to increased male hormone (testosterone) production leading to hormonal imbalances. Upper body obesity is associated with an increase in testosterone that may be a major cause of problems related to menstruation. Obese men can also get hormonal problems that lead to erectile dysfunction. Childhood obesity can cause early puberty and hormonal problems later in adulthood.

Some forms of cancer:  There is an increased risk of growth of cancer cells in various body tissue among obese people. 

Fatty liver: Nonalcoholic fatty liver disease, a condition in which fat storage is excessive in the liver that can cause inflammation of the liver tissue and scarring(Cirrhosis).

Various psychological problems: There has been increased links of obesity with depression and mood problems possibly due to underlying hormonal problems or other conditions.

Prevention and Treatment 

  • Realistic healthy weight loss goal

Comprehensive lifestyle changes: 

  • Dietary changes: Avoid calorific or sugary foods. Developing meal plans to track what you consume. Seeking advice from a specialist to know what nutrients you are lacking or how to go about the changes. 
  • Increasing physical activity
  • Exercise: 3-4 times per week for 30 minutes each. 
  • Group support: Joining a weight loss group can help psychologically and improve motivational level toward achieving your goals.
  • Relaxation and stress management

Adherence to a weight loss program is important to bring about changes and to prevent health problems due to obesity. For further detailed assessment and treatment, it is best to consult an expert for individualized weight loss programs.

The Controversy about Monosodium Glutamate (MSG).

Common conditions, Food, Health, Lifestyle

CRS

In the food industry, great interest has been garnered over the use of a particular ingredient which has caused great controversy overtime. That ingredient is Monosodium Glutamate (MSG). It’s often used as a flavour enhancer. Although additives can improve the taste of many foods, it does carry a threat of causing allergies, food intolerance and even certain conditions among some individuals. 

What exactly is MSG?

MSG is a crystallised water-soluble kind of sodium salt made up of the amino acid “glutamate”.

Glutamate is present in nature both in its free form and usually bound to peptides and proteins. The free form is used as additive and is responsible for the flavour enhancing properties. The bound form does not have any effect on taste and is considered an excitatory neurotransmitter (the ones that keep you alert and awake) as they mediate many signals in the brain and is involved in normal brain function such as cognition, memory and learning. 

Commercially, MSG is made by fermenting molasses, sugarcane, corn sugar or starch. MSG can also be obtained from natural protein-rich foods such as seaweeds. 

How does MSG work?

There are glutamate receptors present in many parts of our body like the brain, tongue and other peripheral tissues.  The MSG used in food stimulates the glutamate receptors of the tongue to give a “meat-like” or “umami” taste to foods. 

MSG – Chinese Restaurant Syndrome (CRS)

MSG consumption has been linked to the term “chinese restaurant syndrome” since 1968. This syndrome is caused due to body’s intolerance to MSG. Although the use of MSG in chinese food is well known, other cuisines, processed foods and many fast foods also contain it. 

It is still considered as a common type of food intolerance that may possibly affect many individuals.  

Who can be more susceptible to MSG Symptom complex?

  • People with Respiratory problems like Asthma.
  • People with known immunity problems with histamine that causes allergies to additives.
  • People with intestinal problems like Coeliac disease.
  • People with a sensitive stomach to additives.

Signs and Symptoms of CRS

The type of allergic reaction, severity and frequency of symptoms can vary from person to person. Sometimes multiple symptoms can occur at the same time.

  • Neurological system:  anxiety or panic attacks, blurred vision, depression, dizziness, excessive sweating, fatigue, hyperactivity, irritable, poor concentration, sleep disturbance, mild to severe headaches, migraines, tiredness and leg cramps, numbness of the upper body, head and neck.
  • Skin problems: eczema, hives (urticaria), tissue swelling, tongue/ throat swelling, atopic dermatitis, facial flushing and burning, and angioedema (quick swelling of tissue under the skin).
  • Gut related problems: bloating(gas trouble), burning mouth or tongue, constipation, diarrhoea, indigestion, mouth ulcers, nausea,  vomiting, abdominal pain, cramping and irritable bowel syndrome.
  •  Respiratory symptoms: wheeze, cough, blocked nose and sinuses, hay fever, sneezing, rhinitis (inflammation of mucosal membrane inside the nose), unstable asthma, and laryngeal oedema.

When should you seek medical care?

Mild symptoms usually subside without treatment, however if symptoms are severe such as excessive swelling of the throat and tongue, difficulty in breathing and raised heart rate. It is best to immediately seek medical care to prevent the complication of allergic shock which is also known as “Anaphylaxis”. It is a potentially life-threatening allergic reaction with excessively severe symptoms associated with the MSG intolerance.

Diagnosis of MSG intolerance?

  • Medical evaluation (clinical assessment) can determine if the symptoms are not due to some other identifiable cause or disease process.
  • Heart rate and ECG-Electrocardiogram may be recorded to check the normal heart rhythm.  
  • Respiratory status will be checked for bronchospasm (narrowing of the airways).
  • Skin prick tests (or RAST) are used as a standard way of detecting allergen-specific IgE (a type of antibody produced in the body).

Prevention and treatment of MSG intolerance

Drinking water: Water can help flush out any allergens from the body especially MSG. It can reduce the impact and delay the occurrence of the allergic reaction. 

Elimination Diet: You can be put on a diet that excludes natural salicylates, amines and glutamate, as well as additives such as preservatives, colourings and MSG. This is to see if your symptoms improve with time.

Medication: Medical care can involve the use of prescribed medications that can help reduce the symptoms of allergic reaction.

Although, a reasonable amounts of such foods can be eaten among mild symptomatic individuals. It is best to avoid it as much as possible to prevent further complications.   

Varicose and Spider Veins – What are they and How to avoid them.

anatomy, Common conditions, Exercise, Health

main pic veins

What are Varicose and Spider veins?

Varicose veins are abnormal, dilated blood vessels (veins) caused by a weakening in the vessel wall. They may appear as swollen, twisted clusters of blue or purple veins.

Varicose veins are sometimes surrounded by thin, red capillaries also known as spider veins.

(group of tiny blood vessels located close to the surface of the skin, also called telangiectasias) – Refer Fig 1.

varicose veins
Fig 1: Varicose vs Spider veins

Role of veins and formation of abnormal veins

Veins carry blood back to the heart and have one-way valves that prevent the blood from back-flowing. The calf muscles act as a pump by which the blood is pumped back from the legs towards the heart as shown in Fig 2.

Deep Leg Veins

Fig 2: Normal blood flow through Veins, Calf muscle pump

If those valves of the veins become weak from extended periods of increased pressure and swelling, the blood can back up and collect within the veins. This causes the vein walls to weaken and bulge with blood, causing the veins to appear swollen and twisted as shown in Fig 3.

deformed valves

Fig 3: Normal vs Abnormal blood flow

Who can get it and where does it happen?

Varicose veins and spider veins can occur both in men and women. However, women are known to be affected more than men due to their hormonal predisposition and changes during pregnancy that affect the veins. 

These abnormal veins can develop anywhere, but most often appear on the legs and in the pelvic area because as compared with other veins in the body. This is because, lower limb veins work harder to carry blood back to the heart with forces from the body weight and gravity acting at the same time. This pressure can be stronger than the one-way valves in the veins.

Most varicose veins are seen on the surface of the skin as the superficial veins get swollen with blood collected in it that get raised on the surface and at times above the surface of the skin.  

Signs and Symptoms

Some may not have any symptoms but may be concerned about the appearance of the veins. Symptoms usually worsen after prolonged standing or sitting as the blood pools or collects in the veins of the lower limbs. 

Print

Fig 4: Swelling, Skin changes and Ulcers due to varicose veins

If symptoms occur, they may include:

  • Tiredness, burning, throbbing, tingling or heaviness in the legs
  • Itching around the vein
  • Swollen legs (Refer Fig 4)
  • Muscle cramps, soreness or aching in the legs
  • Brown discoloration of the skin, especially around the ankles (Refer Fig 4)
  • Leg ulcers (Refer fig 4)
  • Rarely varicose veins can form a painful blood clot, referred to as superficial thrombophlebitis (inflammation of a vein).

Risk factors and causes of abnormal veins

Varicose veins are related to increased pressure in the leg veins or defective valves in the veins.

They can happen due to reasons:

  • Idiopathic: The exact cause of this problem is unknown.
  • Heredity: A family history of varicose veins can put a person at risk of developing abnormal veins.
  • Advancing age: With aging veins can lose elasticity causing them to stretch. The valves in your veins may become weak, allowing blood that should be moving toward your heart to back-flow.
  • Prolonged standing or sitting.
  • Being overweight puts extra pressure on your veins, which means damage to the valves, making them more prone to swell.
  • Pregnancy: Pregnancy increases the volume of blood in your body but decreases the flow of blood from your legs to your pelvis. This circulatory change is designed to support the growing foetus but it can produce an unfortunate side effect — enlarged veins in your legs.
  • Hormonal influences during pregnancy, postmenopausal hormonal replacement therapy and use of birth control pills can cause excessive swelling in the lower limbs that hampers blood flow through veins. 
  • Wearing tight clothes can put pressure on the veins which can cause abnormal blood flow.
  • Injury to the veins due to trauma or accidents.
  • Other health conditions that cause increased pressure in the abdomen including liver disease, fluid in the abdomen, previous groin surgery or heart failure.

How is Varicose and Spider veins diagnosed?

A physical examination of the body especially the legs while the person is standing is done. A Doppler ultrasound scan can also check the blood flow in the veins near the skin’s surface and the deep veins. 

When to seek medical care?

  • Walking or standing becomes painful.
  • Soreness develops on or near a varicose vein
  • Your feet or ankles swell up very frequently.

If immediate care is not taken, symptoms may worsen. Complications may develop if there is an underlying disease in the deep veins or in the perforating veins which connect the deep and superficial veins.

  • Chronic venous insufficiency: Untreated venous problems may progress to a chronic condition of abnormal blood flow through the veins.
  • Venous stasis ulcers that result when the enlarged vein does not provide enough drainage of fluid from the skin. As a result, an ulcer (open sore) may form.
  • Fungal and bacterial infections may occur as the result of skin problems caused by the fluid buildup (edema) in the leg. These infections also increase the risk of tissue infection (cellulitis).
  • Thrombophlebitis: Inflammation of the vein due to blood clot formation.
  • Venous hemorrhage: Bleeding through the veins due to micro-tears and ruptures.

How to prevent varicose veins and its complications?

Lifestyle modifications:

  • Losing weight if you are overweight
  • Exercising regularly (especially walking)
  • Avoiding prolonged periods of sitting or standing
  • Avoid wearing tight-fitting undergarments and clothing that constricts the waist, groin or legs.
  • Avoid crossing your legs while seated.
  • Elevating your legs while sitting and sleeping will help.
  • When you need to stand for long periods, take frequent breaks – sit down and elevate your feet.
  • Do ankle pump exercises as shown in Fig 5.

ankle pumps

If you still develop varicose or spider veins, it is best to seek medical attention to know more in details on exercises and lifestyle changes that can be personalized to your needs.  

Why is Deep Vein Thrombosis Dangerous?

Common conditions, Exercise, Health, Lifestyle

DVT What is thrombosis?

Thrombosis is a process by which there is clotting of the blood in a part of the circulatory system. This causes a partial or total obstruction thus preventing blood from flowing normally through the circulatory system. This clot is known as a thrombus. 

What is Deep Vein Thrombosis(DVT)? 

A blood clot (thrombus) in the deep venous system is known as DVT. These clots are formed in the deep veins which are a part of the circulatory system that helps bring deoxygenated blood back to the heart. These veins have one-way valves that function to transport blood from various parts of the body to the heart as shown in Fig 1.

veins of our body

Fig 1: Deep veins of the body

Which body part can be affected with DVT?

There is a greater risk of developing DVT in your lower limbs than upper body as the deep lower limb veins work harder to carry blood back to the heart with forces from the body weight and gravity acting on them at the same time. In addition, if there are other factors that increases the pressure exerted on the valves in the deep lower limb veins, there are more chances of blood collecting within the veins thus making the lower limbs deep veins more susceptible to DVT.

Why is DVT dangerous?

There is a risk of a partial or complete detachment of this thrombus formed in the deep veins. This allows the thrombus to move with the blood flow and block other blood vessels. This process is called as venous thromboembolism.

pulmonary embolism

Fig 1: Thromboembolism

As shown in Fig 1, the thrombus blocks the blood vessel and cuts off the circulation to a particular body part or organ. This will lead to a lack of oxygen to the tissue (ischemia) and a loss of tissue function. The clot can also reach other blood vessels that supply the vital organs of the body, putting the body at a dangerous risk of stroke, lung, heart problems and post-thrombotic syndrome (PTS).

Post-thrombotic syndrome is a chronic(long-term) problem that occurs with DVT and involves chronic leg pain, swelling, redness, and ulcers (sores).

How does a thrombus form in the deep veins?

Blood clotting is the transformation of liquid blood into a semi-solid gel. The blood has a protein called fibrin. Fibrin is usually in its inactive state but when tissues or blood vessels are damaged, it becomes active. This process is called coagulation. The main reason of thrombus formation can be explained by the Virchow’s triad as shown in fig 2.

cause of thrombus

Fig 2: Main causes of thrombus formation

Conditions of prolonged bed rest or immobility which could be lifestyle-related or due to other reasons may cause stasis of blood within the veins that may lead to clot formation. Also, if there is an imbalance of the coagulation and anti-coagulation factors in the blood which may be caused by an injury or acute/chronic inflammation to the blood vessel walls may cause blood clot formation.

Who is at risk of developing DVT?

  • Anyone with vein trauma due to broken hip or leg fractures during accidents.
  • Long periods of air travel coupled with lack of movement in sitting position can cause excessive swelling in the legs and stagnation of blood flow leading to clot formation.
  • Bed bound individuals post-surgery, muscular paralysis from a spinal cord injury, pregnancy or having recently given birth, especially by C-section, causing swelling and lack of calf muscle strength that impair blood circulation in the legs.
  • People with inherited blood clotting disorder.
  • People who have cancer as tumors shed particles that contain procoagulant activity.
  • Smoking affects blood circulation and stiffens the blood vessel wall making a smoker at higher risk of DVT.
  • Side-effects with the use of hormone therapy, including that used for postmenopausal symptoms among women.
  • Individuals with varicose veins, which are swollen, twisted and painful may develop clots.
  • People with a history of heart attack, stroke or congestive heart failure have high levels of cholesterol in the blood that lead to inflammation and possibly clot formation.

Signs and Symptoms of DVT

  • Pain, swelling and tenderness in one of your legs (usually your calf)
  • Affected area can be very painful and heavy.
  • Warm skin in the area of the clot.
  • Redness of the skin, particularly at the back of your leg below the knee.

How is DVT diagnosed?

A physical examination may not be enough as there may be individuals with no possible signs of DVT. Diagnostic tests will be necessary to confirm the condition.

  • Doppler ultrasound scan:  A clot may be visible in the image. Sometimes a series of ultrasounds are done over several days to determine whether a blood clot is growing or to detect any formation or movement of a clot.
  • Blood test: An elevated level of a clot-dissolving substance called D dimer will be found in the blood.
  • Venography. A dye (contrast agent) is injected into a large vein in your foot or ankle. An X-ray procedure is then undertaken that creates an image of the veins in your legs and feet, to look for clots. 
  • CT or MRI scans. Both computerized tomography (CT) scan and magnetic resonance imaging (MRI) can provide visual images of your veins and may detect any clot formed. 

When to seek medical care?

  • If you get swelling, redness, and pain in your leg, it may indicate a blood clot and immediate medical attention should be given. Sometimes there may not be any signs or symptoms or these symptoms could be due to other inflammatory condition or infection, therefore, it is difficult to make the diagnosis without seeking medical advice.
  • If there is associated pain in the chest or breathlessness further concern exists that you may be at risk of a pulmonary embolus. This could be a potential danger hence if you are at risk its best to discuss with your doctor about taking medications for preventing clot formation.

How to prevent DVT?

  • Compression stockings for bed bound individuals.
  • Early ambulation Post-surgery – getting the individual out of bed walking to allow good circulation of blood. If not possible, use a continuous passive motion (CPM).
  • Low dose of anti-coagulants can also be prescribed by the doctor.
  • During long flights, it is recommended to move frequently and/or use compression stockings.
  • Ankle exercises can help pump the blood from the legs upwards to the heart.
  • Lifestyle modifications –  smoking cessation and increased exercise.

If in doubt or experiencing any of the symptoms, always seek medical advice immediately. When detected early, it’s much easier to deal with.

What is Torticollis – Congenital and Acquired

Common conditions, Health, Injury, Pain

MAIN WRY NECK

What is Torticollis?

Torticollis is derived from the Latin word tortus, meaning “twisted” and collum, meaning “neck”.  It is an abnormality, where the muscles in the neck that control the position of the head are affected causing the head to tilt and/or rotate to one side or be pulled forward or backward. This condition is also known as “Wry neck” or “Cervical dystonia”.

What happens in torticollis?

Acute injury to the soft tissue structures of the neck is the most common presentation that causes inflammation, spasm and shortening of the muscles of the neck. Characteristic head tilt with the ear moved toward the shoulder happens from an increased tone in the neck muscles. 

Most commonly, the trauma is to one of the neck muscles called sternocleidomastoid (SCM). This muscle is present in front of the neck on each side and runs diagonally from the collar (clavicle) and breastbone to the mastoid process and the base of the skull bone as shown in Fig 1.

sternocleidomastoid FRONT VIEW

In torticollis, there is shortening or excessive contraction of the SCM on one side of the neck. The head is typically tilted sideways towards the affected SCM and rotated with the chin facing to the opposite side as shown in Fig 2. 

CT

Pathophysiology of torticollis

As shown in Fig 2, Torticollis can be of two types.

  • Congenital
  • Acquired

Congenital Torticollis

“Congenital” means a physical abnormality present from birth. Congenital torticollis is an abnormal positioning of the neck caused due to the damage of the nerves or the blood supply of the neck. This occurs due to various reasons such as, 

  • Intrauterine (inside uterus) malposition of the baby 
  • Trauma while undergoing breech or difficult forceps delivery, fracture to the collar bone (clavicle) of the child during birth. 
  • Genetic birth defects: For example, webbing of the neck deformity seen in various syndromes, including Turner’s, Klippel-Feil, or Escobar-Syndrome. Brachial cleft cysts, vertebral bone problems, odontoid hyperplasia, spina bifida, hypertrophy or absence of neck muscles, and Arnold-Chiari syndrome.

Acquired Torticollis

This condition clinically presents because of other problems that affect the musculoskeletal structures of the neck. It typically occurs in the first 4 to 6 months of childhood or later affecting both children and adults. 

Reasons for Acquired Torticollis

  • Idiopathic or Unknown cause: Also classified as “Dystonia” which is a disorder characterized by involuntary muscle contractions that cause slow repetitive movements or abnormal postures. It is unclear but believed to occur due to lesions in an area of the brain (thalamic lesion). 
  • Postural problem: The problem with neck muscles can arise from a prolonged incorrect posture of the neck. It may appear overnight when, for example, a person has slept with his/her neck in an awkward position. Other activities like holding the telephone between the head and shoulder, or playing an instrument, such as the violin, for long periods.
  • Vision problem: Problem with vision in one eye can cause the individual to tilt his or her head to see better affecting the neck muscles on one side.
  • Trauma: Sudden accidental bend or twisting of the neck too far. Whiplash injury of the neck.
  • Infection: Inflection of upper respiratory, ear, or sinus lead to inflammation of the cervical lymph nodes that can irritate the nerves supplying the neck muscles causing torticollis. It can also damage the soft tissues and cause improper alignment of the neck bones.
  • Arthritis of the neck joints: Inflammatory joint conditions like cervical spondylitis, intervertebral disc problems of the neck can also cause torticollis.
  • Side effects of certain medications: Inflammation caused by many antipsychotic and antiemetic medications can cause Spasm or dystonia of the neck muscles.  
  • Neurogenic abnormalities: Spinal cord tumor or progressive spinal cord diseases can cause problems in the neck region. 

Signs and Symptoms of Torticollis

  • Inability to move the neck with limited range of motion
  • Chin tilted to one side
  • Headaches
  • Head tremor
  • Neck muscle spasm and pain
  • One shoulder is higher than the other
  • Spasms in other areas of their head such as their eyelids, face, or jaw, as well as in their hands
  • Stiffness of the neck muscles
  • Swelling of the neck muscles (possibly present at birth)
  • Other neurological signs: Difficulty in speaking, drooling, respiratory problems, swallowing difficulty (trouble initiating), tingling sensation in the neck, upper back and arm due to nerve problems, depression, self-consciousness.

When to seek medical care?

Congenital torticollis can be easily identified after childbirth and determine  the severity of the condition related to its neurological involvement. If a child or an adult suffers from neck problems, it is best advised to seek treatment immediately to prevent worsening of the pain and to prevent the development of torticollis.  

How is torticollis diagnosed?

A thorough assessment of the condition related to the history of the individual will be taken. Any injuries to the neck can be detected by certain diagnostic tests like an X-ray, computed tomography (CT) scans, and magnetic resonance imaging (MRI).  However, it’s unlikely that the exact cause of the muscle spasm can be isolated.

In children and infants, experts can detect neck muscle damage that may cause torticollis through routine physical examination. Newborns will be assessed for the presence of neck and/or facial or cranial asymmetry within the first 2 days of birth through visual observations.

How can torticollis be treated?

Treatment should begin immediately for infants with torticollis. At this stage, it is most successful in reversing the deformities caused by torticollis. For example, as the child grows with torticollis, the face on the tilted side may become flattened. This flattening can be reversed while the bones are young and soft but after one year of age it is most likely that the bones get fused and the deformity may become permanent. 

Other problems with delayed treatment 

  • Difficulty learning to walk and frequent falls seen because the head tilt causes unequal weight bearing and loss of balance.
  • Open mouth posture with the tongue pulled to one side or the other.
  • Suck/swallow may be affected leading to feeding issues.
  • A permanent trunk and facial asymmetry can occur.

 Chances of torticollis relapse

Most cases of muscular torticollis have good outcomes, however, there is a chance of relapse with both non-surgical and surgical treatments. Sometimes even if the recovery is spontaneous with continued treatment, there may still be a possible head tilt of small degree.

The outcome will also differ depending on the severity of the injury to the soft tissue and joint structures of the neck.

General goals for treatment,

  • Reducing pain, spasm and muscle strains of the neck.
  • Improving mobility and flexibility of the soft tissue structures affected.
  • Reducing stiffness in the neck and mobilizing the joints of the neck.
  • Postural correction and awareness by changing or selecting positions that will be beneficial for the neck.
  • Functional exercises to the neck muscles to restore stability, strength, and mobility of the neck.
  • Reassurance and education to prevent emotional stress, providing support to cope with social embarrassment.

There is no sure way to prevent wryneck and congenital torticollis; however, utmost care should be taken to avoid trauma to the child as much as possible during delivery. 

Pregnancy – Things to note

Exercise, Health, Lifestyle, Pregnancy

preg main

Pregnancy is a time when the mother undergoes many physical and physiological changes. These changes happen so that the mother’s womb can nurture and host the growing baby. However, there are other possible effects of these changes on the musculoskeletal, cardiovascular and respiratory system of the expectant mother. Therefore, it is important to be aware of these effects in order to help the expectant mother to cope with the challenges of pregnancy.

What are the effects of the hormonal and Physiological changes during pregnancy?

Hormonal changes: Progesterone and Relaxin are two hormones whose levels are extraordinarily high during pregnancy. 

  • They cause changes in the collagen fibres of the connective tissues of the joints and soft tissue structures.
  • Loosening of ligaments decreases the stability of the joints.

Weight gain: Excessive weight and gravity can slow down the circulation of blood and body fluids mainly in the lower limbs. 

  • This can cause excessive workload on the body with physical activity
  • Excessive fluid retention
  • Swelling in the limbs and even face.

Postural change: 

PregnancyPosturePositions
Fig 1: Improper postures and good posture

Improper postures as shown in Fig 1, due to increased weight gain and forward shift of the centre of gravity. It can also affect balance and gait.

Improper postures:

  • increased lower back curvature – lumbar lordosis,
  • compensatory curving of the upper back – kyphosis or scoliosis,
  • rounding of shoulders 
  • forward chin position

Muscular changes:  As the baby grows the mother’s abdominal muscles and ligaments get stretched.

  • Weakness of the abdominal muscle 
  • Less support or bracing to the spine

Due to weight gain, improper posture and possibly lack of gait control, there will be an excessive strain to the muscles of the hips, knees and ankles.

Blood Pressure changes: Pregnancy hormones can suddenly affect the blood vessels by narrowing or expanding them, causing a drop or sudden increase in blood pressure. This if may affect the blood supply to the vital organs like the brain and in severe cases may also affect the growing baby. 

Low blood pressure may cause:

  • Dizziness 
  • Brief loss of consciousness (passing out)

High blood pressure in pregnancy is also known as pre-eclampsia which may worsen to a condition called eclampsia.

Symptoms of Eclampsia:

  • Severe headaches and convulsions.
  • Problems with your vision, such as blurred vision, flashing lights or spots in front of your eyes.
  • Tummy (abdominal) pain, vomiting later in your pregnancy (not the morning sickness of early pregnancy).
  • Sudden swelling or puffiness of your hands, face or feet.

Changes in the Respiratory system: As the uterus enlarges, the movement of the diaphragm (main breathing muscle) may be limited. The uterus moves upwards, it progressively obstructs the downward movement of the diaphragm as shown in fig 2.

diaphragm pushed up
Fig 2: Uterus and abdominal contents pushing the diaphragm

It can force the diaphragm upwards mostly towards the end stage of pregnancy causing:

  • Breathlessness: difficulting in breathing normally.
  • Painful ribs: Rising pressure pushes the rib cage out sideways and forwards, resulting in pain in the front of the lower ribs, also known as rib flare.

Increased Metabolic Rate: Basal or resting metabolic rate (RMR) is the amount of energy the body uses while at rest. Due to hormonal changes, this RMR increases significantly during pregnancy that may put the pregnant women at a higher risk of developing hypoglycemia or low blood sugar leading to light-headedness and fainting.

Risk of health conditions during Pregnancy 

  • Ligament and joint sprain: As the ligaments are lax due to hormonal changes, there is more risk of ligament and joint sprains especially in the ankle joint during pregnancy. Ligaments of the feet become lax and with the additional weight of pregnancy, results in flat feet and development of painful conditions like plantar fasciitis, Achilles tendonitis etc.
  • Supine hypotensive syndrome (Restriction of blood flow): The enlarging fetus compressing the aorta and inferior vena cava against the lumbar spine, restricting blood flow.
  • Painful joints: Incorrect posture causes abnormal curves like kyphoscoliosis and scoliosis which may cause issues for anesthesia during pregnancy and delivery. They also exert excessive strain and fatigue on the body, particularly in the spine, pelvis and other weight-bearing joints (i.e. knees). This results in aches and pains, such as lower back, with the pain spreading to the buttocks, thighs and down the legs.
  • Low back Pain: The extra weight of the baby coupled with the shift in weight distribution may strain the back muscles and can cause muscular spasms. Excessive pressure placed on the back may also cause low back disc herniation that may affect the spinal nerves.
  • Posterior pelvic pain (PPP): Lax ligaments of the body allows the pelvis to enlarge, in preparation for childbirth. Also, due to the growing uterus, some of the core muscles around the pelvis get ‘stretched’ and weakened. This affects the stability of the sacroiliac (SI) joints – the joints between the tail bone and the pelvic bones on either side at the lower back region as shown in Fig 2.
SI Joint
Fig 2: Sacroiliac joint
  • Diastasis recti: “Diastasis” means separation. “Recti” refers to your abdominal muscle called the “rectus abdominis.” The rectus abdominis muscle runs in the front of the stomach and is excessively stretched during pregnancy. Sometimes the pressure increase due to baby growth may be too much causing the muscle to separate as shown in Fig 3. 
Diastasis recti
Fig 3: Separation of Rectus abdominis muscle.

This separation in the abdominal muscles may lead to:

  • Low back pain: due to lack of bracing to the spine.
  • Hernia: a condition when the abdominal contents can protrude out due to increasing pressure from growing baby and lack of support by the abdominal muscles. Umbilical hernia as shown in Fig 3.
umblical hernia

Fig 3: Umbilical hernia

  • Pubic symphysis pain: The weight-bearing joints, such as the pelvis, is increasingly stressed and loaded during pregnancy. Coupled with the instability that relaxin causes, the pelvis is susceptible to pain and injury. Sometimes due to stress, the pubic symphysis may be separated causing a condition known as symphysis pubis diastasis as shown in Fig 4. This commonly occurs during delivery.
Pubic symphysis
Fig 4: Symphysis Pubis Diastasis
  • Transient osteoporosis: This is a bone condition that happens during pregnancy and symptoms disappear within weeks of labour. It has no known cause, although hormones, nutrient deficiency, and other causes have been proposed. There is a sudden drastic loss of bone mass and swelling in the affected portion during pregnancy. This causes weakness of the bones which may lead to fractures during delivery and other complications for the mother.
  • Gestational Diabetes: Due to hormonal changes in your body, your cells can become less responsive to insulin. When the body needs additional insulin, the pancreas dutifully secretes more of it. However as the cells are unable to respond to it, your blood glucose levels rises too high resulting in gestational diabetes. This may lead to excessive weight gain and development of diabetes post pregnancy.
  • Carpal tunnel syndrome: “Water retention” or swelling in ankles, feet and hands in late pregnancy may lead to joint stiffness and nerve compression syndromes, such as carpal tunnel syndrome.
  • Varicose veins: Varicose veins of the legs may occur during pregnancy or worsen during this period. This is due to a reduction in the vascular tone and changes in the collagen structure in the body (due to progesterone and relaxin) that affect the veins. 

How to prevent health conditions during pregnancy?

Always monitor your health status and evaluate the presence of any specific health condition at an initial stage.

It is important to understand your body in order to avoid conditions and the potential complications it may cause. Proper treatment planning is undertaken at an early stage to ensure the safety and health of both the expectant mother and the baby. 

 As most of these conditions can be prevented with lifestyle and dietary changes, it is best to consult with the experts to know more in details about how to manage and prevent them.