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2nd September 2001
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Medical

  • Cholesterol: the killing need
  • Don't squint at it
  • Generic prescribing
  • Roaring sleep
  • Hair today and gone tomorrow
  • Cholesterol: the killing need

    Cholesterol is a paradox: Everyone needs it, but for some people it's a potential killer. Cholesterol contributes to such vital bodily functions as building new cells, insulating nerves and producing hormones, vitamin D and bile acids, which aid digestion. Normally, the liver makes all the cholesterol the body needs. 

    But there are many dietary sources of cholesterol, too. Cholesterol is found in foods derived from animal products, although these foods can be processed to remove the waxy substance. Foods derived from plant products- including coconut oil- do not contain cholesterol. A diet high in saturated fats can raise blood cholesterol, too, particularly in people genetically predisposed to high blood cholesterol levels. 

    The amount of cholesterol in your bloodstream would not be of such significance were it not for its association with various cardiovascular diseases. The risk of developing these conditions is complex and depends not only upon how much cholesterol but also what kind of cholesterol you have in your blood. Generally speaking, LDL — the "bad cholesterol" — is associated with increased risk of coronary heart disease; HDL — or "good cholesterol" — is associated with decreased risk. A high level of cholesterol (greater than 200 mg/dl) in the blood does not give rise to obvious symptoms but can be a risk factor leading to other conditions that do have recognizable symptoms, including angina, atherosclerosis, heart disease, high blood pressure, stroke and other circulatory ailments. 

    Soft, yellowish skin growths or lesions called xanthomas may indicate a genetic predisposition to the body's inability to process cholesterol and triglycerides normally. Obesity and diabetes may be associated with high cholesterol levels. In men, impotence may be due to arteries affected by excessive blood cholesterol. Having high cholesterol is determined largely by the luck of the genetic draw. Some families are genetically blessed with low total cholesterol or high levels of HDL or "good" cholesterol regardless of diet or lifestyle. Other families suffer from various hereditary disorders that significantly increase the risk for high cholesterol; the most prevalent of these disorders are also associated with obesity and diabetes. 

    People with such a genetic predisposition who eat a diet high in saturated fats are very likely to have high blood cholesterol. Long-term studies have shown that stress can raise blood cholesterol levels, especially since stress can lead to poor eating habits that may increase cholesterol intake. A blood test to determine your blood cholesterol level is now a routine part of most physical checkups. When you have your blood tested you will typically get three readings expressed in milligrams per decilitre: one for total cholesterol, one for HDL cholesterol and one for triglycerides. Often, a reading for LDL cholesterol will also be included, as well as a figure indicating the ratio of total cholesterol to HDL cholesterol. 

    The first concern is your serum cholesterol level: A total cholesterol below 200 is considered normal and safe. Cholesterol levels between 200 and 240 are considered borderline, and a level of 240 or more is definitely high. HDL cholesterol for a man should be above 35, and for a woman above 45. As for LDL cholesterol — the bad cholesterol — normal is less than 130 for most people and borderline is between 130 and 160 and above 160 is definitely high. However, if you are at risk for heart disease, meaning that either you have other risk factors for heart disease, have or have had heart disease yourself, or have diabetes, then your LDL should be below 100. Your triglycerides-another type of body fat- should be below 200. For the ratio of total cholesterol to HDL cholesterol, the lower the number, the better. 

    For men, 4.2 to 7.3 is average; for women, 3.9 to 5.7 is average. 

    In general, then, any ratio reading below 4 (which means you have more HDL relative to your total cholesterol) is good. Advice from your doctor about cholesterol reduction is likely to echo that of nutritionists and most practitioners of alternative medicine. Adopt a diet low in fat and cholesterol, lose weight, exercise regularly and if you smoke, quit. 

    For people in the high-normal to borderline serum-cholesterol range, diet and lifestyle changes may reduce cholesterol levels or keep them in a desirable range. 

    If your cholesterol level is close to or above 240, adjusting diet and lifestyle may not be enough. Instead, your doctor may prescribe either a natural cholesterol-reduction plan based on a high-fibre dietary supplement, such as bran or a synthetic cholesterol-reducing drug. 

    Of the many cholesterol-reducing drugs available, members of the statin family — lovastatin, simvastatin, fluvastatin, atorvastatin and pravastatin — are among the more widely prescribed. They operate by blocking an enzyme that the liver uses to manufacture cholesterol. They are tolerated well by most patients, although they are expensive and can sometimes produce unwanted side effects. 


    Don't squint at it

    A squint, or strabismus as it is medically termed can have important implications for sight as well as the more obvious effect on appearance. It's a very common problem - as many as one in 25 children has a squint. It is in these early years, while the brain is still learning how to see, that a squint can damage eyesight.

    Normally both eyes look at the same image and the brain fuses these together to form a 3-D picture, with perception of depth. This is an acquired skill - children have to learn how to do this just as they learn to walk or talk, and they have to learn how to control the large muscles before they can learn to control the small muscles of the eye. When someone has a squint, there is a problem with their eyes, which are misaligned and look in different directions. So while one eye seems to look straight ahead, the other will gaze to the left or right, or up or down.

    When there is a squint and the eyes are not looking at the same spot, the brain gets very different pictures from the two eyes. It finds it hard to fuse these images and so doesn't learn binocular vision and instead learns to ignore the image from the weaker or misaligned eye. The brain then uses the image from the stronger or straighter eye, but the image is less sharp than normal (a problem known as amblyopia) and the ability for three dimensional vision and depth perception is lost. 

    This happens in about half of those children who have a squint. It's unusual to develop a squint as an adult but if you do, it may result in double vision because, having been trained to collect images from both eyes, the adult brain is much less able to suppress the image from the weaker eye. New squints in adults always need thorough investigation of the cause. If squints are treated while the child is still young (ideally before school age) the brain is able to learn to see using both eyes and these problems can be prevented. So time is critical. 

    The goals are to preserve vision, straighten the eyes and restore binocular vision.

    Simple steps are tried first. Glasses may be necessary to overcome sight problems contributing to the squint. Amblyopia can be treated by putting a patch on the good eye, in order to strengthen and improve sight in the weak eye. Although the cause of squints is not known, the complicated system of muscles that acts like pulleys to move the eye in different directions may be at fault. Surgery may be needed to tighten these muscles in certain places. 

    During surgery the eye muscles are repositioned, shortened or occasionally injected with a nerve toxin to temporarily paralyse the muscle and allow other muscles to strengthen. So, don't let a squint hold you back. Seek medical advice; in many cases intervention yields successful results.


    Generic prescribing

    Recently, there has been some controversy regarding the practice of prescribing drugs by their trade names, with even allegations of profiteering made against doctors. 

    Now, the Sri Lanka Medical Association, the country's oldest medical professional body has recommended the following with regard to drug prescription by doctors:

    1. Doctors should retain the right to prescribe drugs which are most appropriate to patients.

    2. Doctors should use only generic names when prescribing in state hospitals.

    3. In the private sector, a doctor should use ganeric names of drugs and add the relevant trade name if he or she wishes to do so.

    4. Doctors should be mindful of the cost of drugs when prescribing.


    Roaring sleep

    Snoring is not consid ered a major medical problem but for some people- or rather, their partners- it is. Why do people snore and can something be done about it?

    To begin with, most people deny that they snore in their sleep - but about three out of ten people do. It becomes a problem either when it poses a health risk to the snorer or when it is severe enough to disturb his spouse. Indeed, there have been divorces asked for - and granted - because of snoring!

    The noise of snoring is caused by parts of the nose and throat, in particular the soft palate, vibrating as someone breathes in and out. At night muscles that help keep the airways open, relax and become floppy, the airways narrow and vibrate more, so snoring is more likely.

    Alcohol and sleeping tablets relax these muscles more and being overweight puts more pressure on the airways. A nose blocked by a cold, allergy or a nasal polyp means a person is likely to breathe through his mouth and then too make snoring more likely. Smokers are twice as likely as non-smokers to snore because their airways get inflamed and blocked.

    If the intensity of snoring is very severe, it may be an indication of a condition called obstructive sleep apnoea (OSA). In this condition the relaxed throat muscles block the airway briefly hundreds of times each night stopping a person from breathing and depriving his body of oxygen. This can cause day-time tiredness, irritability, restlessness, and increase the risk of accidents when driving. Treatment involves wearing a dental splint and in more severe cases, surgery to relieve any obstructions in the airway that maybe the cause of the snoring.

    These are of course last resorts in treatment and the vast majority of troublesome snorers can alleviate their distress by using simpler methods to minimize snoring: refraining from late night alcohol, maintaining an ideal weight, raising the head end of the bed, steam inhalation before bedtime and sleeping in a sideways posture instead of the prone or supine positions. If these strategies are not helpful, then it is probably wise to seek medical advice.


    Hair today and gone tomorrow

    Hair loss is very common among women as they age. And as almost all women know a substantial amount is often lost. So, what can be done about it? The most common type of hair loss in women, accounting for over 95% of cases, is Androgenetic Alopecia or female pattern baldness. 

    There is a large genetic predisposition which may be inherited from the woman's father or mother.What causes the hair loss in this condition is dihydrotestosterone, or DHT, which is made from androgens- male hormones that all men and women produce. 

    The pattern of hair loss is different to the typical receding hairline and crown loss in men. Instead there is usually general thinning of the hair with loss predominantly over the top and sides of the head. It usually gets worse with menopause. Another common cause of hair loss in women is a condition called Alopecia areata, a disease which affects about one per cent of women. The hair follicles are attacked by the white blood cells and hair production slows down dramatically, so that there may be no visible hair growth for months and years. After some time hair may regrow as before or come back in patchy areas, or not at all. 

    The good news is that in every case the hair follicles remain alive and can be switched back on again - the bad news is that we don't yet know how to switch them on. 

    Since hair loss is a cause for so much concern, there are also myths about hair loss in women: that it's caused by washing, brushing or combing hair too often, that hair dyes and perms can cause permanent loss, that shaving your head will make it re-grow thicker and the commonest of them all: that there is a miracle cure out there waiting for you!

    Nevertheless there are a few rational options available: cosmetic treatments such as wigs, medical therapies and hair-replacement surgery as a last resort. 

    But before resorting to solving the problem by yourself, it is advisable to see a doctor who will check if the hair loss is due to some other illness-more so, if it is of recent onset.

    Minoxidil is a drug first developed for treating high blood pressure and found to have the side effect of thickening hair growth in some people. 

    It is now available as a lotion to apply directly to the scalp but it doesn't work for everyone. It works best on younger people, with early hair loss. A big disadvantage is that you have to carry on using Minoxidil indefinitely or the new hair will fall out again.

    Surgical techniques for restoring hair have improved greatly in the past couple of decades but this is still a choice. Hair transplantation and scalp reduction are the methods used but these surgeries are not routinely performed in Sri Lanka.

    Therefore, it is always worthwhile reassuring yourself that many causes of hair loss are temporary; so, check your general health and be patient. 

    Then, don't be taken in by claims of miracle cures overnight. And even if all seems lost remember that many women cope well by using cosmetic products- hats and wigs. persevere until you find your own style.

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