Common Pregnancy Issues and Simple Ways to Tackle Them

Nausea (morning sickness), gas, constipation and heartburn can make you feel miserable during your pregnancy. They are caused by normal hormone changes in your body and the baby growing and taking up more room. Here are some things that you can do to help you feel better.

Ways to Tackle Nausea

• Eat before getting out of bed in the morning. Keep crackers, dry cereal or toast by your bed for when you first wake up.

• Get out of bed slowly and avoid sudden movements.

• Eat 5 or 6 small meals during the day to avoid long periods without eating. An empty stomach can make you feel worse.

• Drink liquids between meals. Fruit juice and caffeine free sodas may help settle your stomach

• Avoid odours and tastes that make you queasy. Someone else may need to help with cooking.

• Have fresh air in the room when you cook, eat or sleep. Smelling a fresh cut lemon may also help.

• Take your prenatal vitamins before going to bed.

Ways to tackle Constipation

• Eat a high fibre diet. Include more fruit, vegetables, beans and whole grains. Try whole grain cereals and bread such as oatmeal, whole wheat bread and brown rice.

• Add wheat germ to your cereal or have a bran muffin.

• Have prunes (dried plums) or prune juice.

• Drink more liquids such as water, milk, cocoa, fruit juice and soup. A glass of warm water first thing in the morning may also help.

• Eat meals at regular times.

• Exercise daily, try walking or swimming. Check with your doctor first.

Ways to tackle Acidity

• Avoid foods that can produce gas such as onions, garlic, beans, cabbage, broccoli, Brussels, sprouts and cauliflower.

• Try a mild activity like walking

• Eat and drink slowly

• Avoid chewing gum

• Keep your weight gain gradual and moderate to minimize the amount of pressure on your digestive tract.

• Try to relax. Tension can also cause you to swallow air, both during meals and during the day.

Heart Burn

• Eat five to six  small meals a day

• Eat and chew slowly

• Avoid fatty, greasy or spicy foods.

• Wear clothes that are loose around your waist.

• Avoid lying down right after eating. Wait at least an hour.

• If you must lie down, do so on your left side.

• Drop a few pillows under your head when you sleep or prop the top of the bed up on a few blocks.

• Quit smoking

• Antacids are generally safe to take during pregnancy but ask your doctor first.

These are some of the common pregnancy issues and easy ways to tackle them without the need for medication. Enjoy your 9 months! Have a Safe Delivery!

Accidental Poisoning in Children: Blame it on Medicines

Picture a child fiddling with his granddad’s Diabetes pills. Imagine how dangerous it would be if he were to ingest these. It could cause the child’s blood sugar to plummet to dangerously low levels. This is just one of the many scenarios that the accidental ingestion of drugs could possibly lead to. Incidents like these do actually happen and with alarming regularity.

Nearly 70% cases of poisoning in children are due to accidental ingestion of drugs

Unsupervised ingestion of drugs by children can have serious consequences and may even prove fatal sometimes. Often children have easy access to their medicines. The child may find the packaging attractive and may, out of curiosity ingest a medicine in quantities large enough to cause harm. Of late, we have seen a rise in the number of children reporting to us with an accidental drug overdose. This is a cause for serious concern. The fact that such incidents are completely preventable makes the rising incidence totally unacceptable.

Children less than 5 years of age tend to put everything they find into their mouths. These children may also be attracted to brightly coloured pills and syrups. Therefore if medicines are left lying within their grasp, the chances of accidental ingestion and overdosage increase significantly. An added danger in case of very young children is their tendency to share these medicines with other children, making the situation even more difficult to handle.

In children younger than 5 years, the risk of accidental ingestion of drugs is more given their tendency to explore. This is not to say that accidental ingestion of drugs is something that will not happen to older children. It can and it does. We could practically neutralize the risk if we could somehow prevent access.

Child Resistant Closure (CRC) – An effective solution at hand

Child resistant caps or Child Resistant Closure (CRC) mechanisms make it hard for children to access the contents of a package. In countries like USA child-resistant packaging is mandatory for most drugs. It would be desirable to have similar regulations in place in India. This measure alone would bring down the incidence of accidental ingestion of drugs significantly.

CRC - Current Indian Ratio

In India, some companies are using Child Resistant (CR) packaging for their products but these are mainly meant for export markets. Recently some companies have introduced CRC in the domestic Indian market for its pediatric products.

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The commonest forms of CR packaging currently available in India include ‘push through’ as also blister packs with thicker foil or paper/foil laminates. These require a greater effort to take out the medicine from the blister pack and ensure that the child gives up after a few attempts.  By making CR packaging a must for products that are harmful to children, a large number of incidents of paediatric poisoning due to drug overdose can be avoided.

With the rising incidence of paediatric poisoning due to unsupervised drug ingestion, the need for child-resistant packaging of drugs is being increasingly felt. The introduction of this concept in the domestic Indian market means that a large number of pharmaceutical companies might already be in the process of lapping it up. This might eventually lead to CR packaging being made mandatory in India. On the other hand, it could very well be that CR packaging being made mandatory in India forces these companies to follow suit. Be that as it may, whichever way the tide turns, consumers stand to gain.

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Childhood Overweight and Obesity

What is the prevalence of obesity?

Obesity is rapidly becoming a common problem, especially among urban children. According to the World Health Organization (WHO), there were about 1.6 billion overweight adults aged 15 years and above, and at least 400 million adults are obese worldwide in 2005. It is a serious public health problem that is growing in countries with low or middle income. According to IOTF (International Obesity Task Force), it was estimated that the prevalence rate of obesity could reach 45% to 50% in the USA, 30% to 40% in Australia, England and Mauritius and more than 20% in Brazil by 2025. 

Of note, many developing countries like India, face the double burden of obesity and undernutrition. The worldwide prevalence of childhood overweight and obesity increased from 4.2% in 1990 to 6.7% in 2010 and is expected to reach 9.1% or 60 million, in 2020. Data on the prevalence of overweight and obesity in children & adolescent age group in India is limited.  Several cross-sectional surveys have shown a high urban prevalence of childhood obesity in India and studies done in AIIMS has shown such prevalence to be around 20 per cent among school going children of Delhi.

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Why is it increasing?

The common factors attributed for increasing prevalence of obesity is increased and easy availability of junk food, provision of such food in the school canteen, decreased physical activity, unrestricted TV watching and indoor games, lack of space for outdoor games.

Is there any other cause?

Yes. Other than the common factor of decreased physical activity, there are various endocrinological disorders which can lead to obesity. Usually, these disorders are associated with compromised height, so if any child is not growing in height but have excessive weight, their parents should always meet their endocrinologist as early as possible to prevent from the child from short stature and also to rule out various endocrinological etilogy. There are some genetic disorders of obesity which run in family and early recognition of these can be of help the future progeny.

What if my child is obese?

Obesity could be the root cause of various disorders. Early onset of obesity leads to increased chances of Diabetes among children as early as by 10 years of age. It also increases the chances of hypertension, heart disease, breathing difficulty and poor school performance due to its complication. 

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What can I do if my child is obese?

From the beginning, you should always watch your child`s height and weight and follow the growth chart as suggested by the paediatrician. If you observe that your child is deviating from the growth chart, become alert as there is a good probability that the diet of a child is inappropriate or physical activity is minimal or non-existent. Do not allow your child to watch TV or sit near the desktop screen for more than 2 hours in a stretch and help them indulge in physical activities such as swimming, dancing and many more. Consult your endocrinologist for ruling out endocrinological disorders.

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Cancer Screening - Early Detection is the Best Protection

INTRODUCTION

All of us know that prevention is better than cure and its importance cannot be overemphasized. However, not every disease is preventable and screening provides us with the second best option by catching them early. Although there are various definitions for screening, it can simply be summed up as detecting the disease early in asymptomatic (those without any symptoms) individuals.

SCREENING – WHY AND WHEN?

It is estimated that screening results in mortality reduction ranging from 3 to 35% depending on various factors. Cervical cancer is an excellent example of mortality reduction as a result of screening. Apart from a reduction in deaths from cancer, screening also gives us an opportunity to detect cancer at a stage where minimal treatment is required. For example, very early breast cancer may just require a small surgery and the patient may be able to avoid chemotherapy and radiation therapy completely. Also, most of the screen-detected cancers would require less mutilating operations with much lesser hospital stay and the cost of treatment. However, you must discuss the pros and cons of any screening investigations with your oncologist before having it done.

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SCREENING – HOW?

Screening can be broadly divided into having the following components:

1. Self-examination (wherever feasible)
2. Examination by trained health personnel (clinician or a paramedical staff specifically trained for screening)
3. Appropriate investigations

GENERAL GUIDELINES (for normal risk general population)

High-risk individuals by virtue of their family history, habits or any other risk factor need to be counselled separately and usually require more intense screening methods.

Breast Cancer Screening:

1. Self-examination periodically starting at the age of 20 years
2. Clinical examination 1-3 yearly between 20-40 years and yearly after 40
3. Mammogram every 1-2 years after 40-50 years of age.

Cervical Cancer Screening:

Should begin approximately 3 years after the beginning of vaginal intercourse. It includes pelvic examination every 3 years and Pap smear yearly for three years and, if found normal for three consecutive years, thereafter the frequency can be decreased. If pap smear is combined with HPV DNA testing the frequency of screening can be decreased and it can safely be done every three years

Colon Cancer Screening:

One of the following is recommended for a normal risk individual above 50 years of age:

1.  Colonoscopy (endoscopy of the large intestine) every 10 years
2.  Stool test of occult blood yearly and 5 yearly sigmoidoscopies (only partial endoscopy of the large intestine)
3.  Double contrast barium enema every 5 years

Individuals with family history of colon cancer or personal history of precancerous lesions like polyps (small benign growths in colon/rectum) require the screening to begin at a younger age and done more frequently depending on the level of risk.

Prostate Cancer:

A combination of clinical examination and a serum PSA test (blood test) may be beneficial in reducing deaths for individuals between the age of 55 and 69 years.

Oral Cancer:

Although there are no guidelines for oral cancer screening (largely due to the fact that it is a unique problem of our country and is seen much less in developed), it is a good idea to keep doing monthly self-examination of inside of the mouth for any ulcer, white or red patches and neck for any lump.

CONCLUSION

Screening is an effective tool to diagnose cancers at a pre-clinical stage thereby providing an opportunity to attain high cure rates by using less aggressive treatment options thus improving the quality of life as well.

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KEY POINTS

1. Screening is a strong tool to detect cancer at an early stage
2. Screening has been found to reduce death due to cancer significantly in some cancers
3. It is not cost effective for all cancers and must be done under specialist guidance
4. Individuals at higher than normal risk of particular cancer by virtue of family or personal history require more intense screening
5. Be alert towards warning symptoms/signs (see box) and get an expert opinion on it.

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