Maintaining healthy backs : 

Correct bags/ techniques

by Dr. Ananda Jayasinghe, Senior Lecturer, Peradeniya Medicial Faculty

This is in response to the Health Watch article - Maintaining healthy backs, by Chartered Physiotherapist Mr. B. Samarasinghe, that appeared in Daily News on the 5th of October year 2002.

Usage of heavy backpacks has reached unprecedented proportions not only among schoolchildren but also mature young adults in the universities and other higher educational institutions.

Why essential?

The skeletal system development in adolescence goes on until early twenties.

Therefore, as Mr. Samarasinghe has correctly pointed out, it is essential to select the correct bag and use the right technique in carrying such heavy bags. In most instances these bags are full of textbooks and as a result, are quite heavy causing significant strain to developing backs/spines of children and young adults. Such heavy backpacks carried with wrong techniques, could certainly have long-term adverse effects on their backs/spines.

If these bags are an essential item among our students (although I do not believe so) it is very important to select the most appropriate bag.

Recalling school days 25 to 35 years ago I feel, it is probably appropriate to recall our school days 25 to 35 years ago. Most will agree with me that we took minimum number of books to the school, certainly in the advance classes, perhaps only 2 to 3 monitor's exercise books, the most. We took hardly any textbook to the school, thus enjoying our school days without these "heavy weights" on our backs.

Thereafter at the university, only a file with few half sheets were taken to write down the lecture notes.

No rationale

As a university teacher, now I see almost all the students carry huge backpacks at Peradeniya Medical Faculty. A quite number of textbooks are carried in these bags, daily for no apparent reasons. I see no rationale why such heavy bags with full of textbooks are necessary during daytime at the university level, where active learning is encouraged. They can very well do reference work by using textbooks either at home or halls of residence.

Hunched backs

It is quite common our young children with these "heavyweights" on their backs, acquire some awkward positions e.g. Hunched backs or kyphosis.

They tend to maintain these positions even without heavy backpacks! The spines of young children are not geared or accustomed to bear such heavyweights on their backs.

Increasing spine problems

Having considered the fact that the number of heavy backpacks used by children and young adults, it is perhaps not wrong to expect a definite increase in incidence of back or spine problems of young adults in the future.

Are we going to wait until we face this problem in future? Or, cannot we do anything about it now? Therefore it is important to carry out public awareness programmes especially to educate the parents to select the best bags for the spines.

Setting certain new guidelines for the bag manufacturers with regards to design in order to produce proper bags. Therefore educating the manufacturers of school bags is of vital importance. The pressure from the school to bring textbooks daily should be minimized.

Shouldn't our schools try to promote healthy eating?

A HealthWatch reader Mrs. Prema Fernando from Moratuwa has raised this question, following an article on - Lifestyle changes to battle obesity, which she had read in the November 2000 issue of the American Family Physician's Report.

She writes - "The American Family Physician's article, states that the Physicians had endorsed a 'healthy school nutrition plan, to promote healthy eating for children as part of the educational programme, in combating the growing problem of obesity in America. The percentage increase of the overweights in America has been 60 per cent from 1990 - 99.

The article states that the Family Physicians compare obesity which has an annual death rate of about 300,000 to a communicable disease.

The alarming problem is that one out of every four American children and teens is overweight or obese.

It is to combat this that the school programme has been developed.

In Sri Lanka too, Mrs. Fernando says, that she has observed increasing numbers of overweight children among the urban student population.

She suggests the educational authorities to consider taking an educational approach to tackle this growing problem now itself before it becomes too serious.

She quotes the article where it states

Check junk food sales to students

"We need to remove those vending machines that sell junk food in schools.

"Unfortunately many parents don't do better at home, as they provide junk food themselves to the children. They buy it as part of the daily staple when they go grocery shopping.

"We don't discount the power of advertising. It's hard to combat clever marketing by fast food outlets. "Kids are offered the latest toys to buy a happy meal (junk food) but nobody offers anything to eat a steamed broccoli - and thats a national problem.

Health Watch - Thank you for writing Mrs. Fernando. Yours is a very thought provoking letter. We hope it will catch the eye of the school and educational authorities. The Health Watch Medical Advisory Panel will discuss this issue with the OPA new President Architect V. N. C. Gunasekera who was inducted in office last week. He is very keen to take up these social issues. We offer him our best wishes in carrying out the responsibilities as the head of the OPA in the year ahead.

Oral cancer detection in just - 'two minutes'

A simple oral test kit to detect oral cancers, will be introduced to Sri Lanka shortly.

Dr. Pia demonstrating the kit

Dr. Ms. Pia Trinos, a member of the Philippine Dental Association and a Fellow of the International College of Dentists demonstrated the kit, (ViziLite) at a meeting of the Sri Lanka Dental Association held last week at the SLFI, Colombo.

Demonstrating the new easy oral cancer detection test kit, Dr. Pia said "ViziLite is a simple, easy and non-invasive tool that healthcare professionals can use in conjunction with the conventional visual oral mucosal examination to improve the identification, evaluation and monitoring of oral abnormalities in those with increased risk of cancer. The test is painless and it takes less than two-minutes to perform.

The ViziLite Test Kit includes a handheld disposable chemiluminescent light and 1% acetic acid mouth rinse that work together to help dental professionals detect abnormalities in the oral cavity that might not be visible to the unaided eye.

OraTest, which was launched in Britain last year, is a mouthwash that comes in the form of dye which helps dental professionals to detect mouth cancer in its early stages.

It is used with a soft-tissue examination of the mouth, giving the barely visible lesions and pre-cancerous cells a deep blue stain. Similar to ViziLite, OraTest is safe, painless, two-minute procedure. Both the ViziLite and OraTest are designed to identify and highlight possible cancerous cells in their earliest stage, enhancing the examiners' ability to detect abnormal tissues in patients at risk of oral cancer.

They are targeted at the high-risk group constituting of those who are over age of 40, frequent tobacco and alcohol users, immunocompromised and have a cancer history, she said.

"Oral cancer remains as one of the most debilitating and disfiguring of all malignancies and currently kills about 270,000 people per year worldwide.

If oral cancer is detected in the earliest stage, the survival rate is greater than 90%. However, every year many people still die of orally related cancer because they do not have regular oral cancer examinations or they delay their treatment.

Also, with the increasing trend in smoking, some clinicians believe that such routine oral cancer screening not only serves as a early detection tool, but also as an education tool which might encourage cessation of smoking.

Dr. Graham Mount from Philippine and Mr. Fusun Yu from Sri Lankas Dental equipment trade which has sponsored Dr. Pia's visit associated at the meeting.

Engonona receiving public attention

Sri Lanka's oldest living centenarian O. T. Engonona 114 years from Galle was an honoured invitee last week, at the opening of a Tourist Restaurant 'The Garden' in Mihiripenne, Galle by the Mayor of Galle Lionel Premasiri, Attorney-at-Law.

In the picture Mayor Premasiri offering sweetmeats to Engonona at the occasion. Seated on left is Mrs. M. de Silva a prominent citizen in the area who is helping Engonona and her family. Standing behind are from left Restaurant Partners Sujeevan de Costa, Sucil Chandranath and Keerthi Pathirana.

Since OPA honoured Engonona for her living achievement at its annual sessions held at the BMICH in Colombo last month by inviting her as an honoured guest at the sessions, Engonona has been receiving public attention. Tourists going down South to Matara are often stopping over at Mihiripenne and visiting her in her hut to wish her long life and respect her for her living achievement.

Health Watch Letter box

Exorbitant charges by private labs

K. C. Perera from Ambalangoda has written to us requesting information on fees generally charged by private laboratories for the various medical tests they do at the request of doctors.

He writes: "I am asking for this as some of the laboratories charge exorbitant rates for some of these tests. If you publish a list of charges generally made by the labs for these tests we will have some guide to go by.

Health Watch - In response to your request our Medical Advisory Panel has sent the following list of charges generally made by most of the labs in Colombo.

Depending on the price fluctuation of chemicals used in tests. These rates are subjected to variation. The List:

Charges on lab tests
			Rs.	

AIDS (HIV 1 & 2)	470	
Alkaline phos		150	
Amylase			240	
ANF			250	
ASOT			170	
Bilirubin Total		130	
BT & CT			130	
Calcium			170	
Cholesterol		100	
CPK/CK			200	
C-Reactive Prot		190
Creatinine		130	
Electrolytes		230	
ESR			 80	
FBC			160	
FFAT			130	
Gama GT			160	
Glucose-Blood		100	
Glucose Tolerance	500	
Grouping - Blood	150	
Hb			 80	
HBs Ag			270	
Lipid Profile		380	
Liver Profile		880	
MF			 80	
MP			 90	
Phosphrous		130
Platelet Count		 90	
			Rs.	
         
Protein Total A/G	210	
Protho. Time & INR	270	
Renal Profile		950	
Reticulocytre		90	
RF			150	
SAT			150	
SGOT			150	
SGPT			150	
Triglycerides		140
Urea			130
Uric Acid		150
VDRL			120	
WBC & DC		 90	
Bence Jones		100	
Culture & ABST
(Uri/Pus/Spu/Sto)	280	
FR-Urine		 70
Microalbumin - Urine	210	
Pregnancy/HCG		130	
FR - Stool		 70	
Occult Blood-Stool	140	
Reducing Subst-Stool	 70	
AFB - Sputum		140	
GC			130	
Gram’s Stain		130	
Seminal Fluid		130

Reply to readers querry on Uluhal - its nutritional value Nutritional value of fenugreek : 'Uluhal'

Although classified as a spice fenugreek ("Uluhal") is a legume grain recommended for many disorders in Egyptian Medicine and in Ayurveda. It is one of the 15 pulses listed in the Caraka Samhita. The protein of the seed is rich in essential amino acids isoleucine, lysine and methionine the bitterness of the seed is due to alkaloids. When added to cereal flower at 5 to 10 per cent level, the taste does not affect the acceptability of "roti" made from the mixture. Germination reduces the bitterness and the germinated seed can be used in curries and soups. Germinated fenugreek makes a tasty dish.

It is an important ingredient of curry blends, chutneys, stew and soups. Fenugreek is added to "Kiri Hodi" to make the curry tasty. Commercially it is made in the preparation of maple syrup and rum flavours. The seeds have been shown to have anthelminthic properties against common siematodes but much less than the chenopodium oil.

Ayurvedic physicians claim that fenugreek cures anaemia in rats. Blood haemoglobin levels in animals fed with fenugreek as the sole source of iron compared well with values fed with iron salts. Reference: Food and Nutrition (3rd Edition) by Prof. T. W. Wikramanayake.

- Dr. D. P. Atukorale

US study finds offsprings of centenarians healthier

Whether it's the genes or the lifestyle, living to an old age appears to confer benefits to one's children. Researchers said on Monday that the children of people who live to be 100 have strikingly lower problems with heart disease and other health troubles than those whose parents die in their 70s.

"Exceptional longevity runs in families but at this point it's difficult to predict how much of this effect is genetic and how much is related to environment and lifestyle," said Dellara Terry of the Boston University Medical Center.

"Our research suggests that children of centenarians have some cardiovascular health advantages over the rest of us but Americans can still improve their health and age more successfully by not smoking, maintaining a healthy weight and exercising regularly," she said in a report released at the annual scientific meeting of the American Heart Association.

The study was based on a look at 176 offspring of centenarians. They had a 26 percent incidence of high blood pressure and a 13 percent incidence of heart disease compared to 52 percent and and 27 percent respectively for those in the group whose parents did not live as long. Reuters

Health Watch Question Box

Replies to questions in this column are all being answered by Dr. D. P. Atukorale, Consultant Cardiologist and Member Health Watch Medical Advisory Panel. : On Viagra

Q. A reader from Colombo on 'viagra'

I had an ECG done and an echo cardiogram done. The doctor told me everything was OK. I am 58 years old and I take 100 mgms Atenolol, 25 mgms Losartan and a 75 mgm tablet of Asprin daily.

If the need arises is to safe for me to take a viagra tablet and how many mgms is OK?

Atenolol sometimes can cause erectile dysfunction

Reply: Your family physician has prescribed a very good combination of anti-hypertensive drugs for your high blood pressure. As Atenolol sometimes can cause loss of libido and erectile dysfunction, your family physician might substitute Atenolol with another anti hypertensive drug or he might increase the present dose of Losarten to 75 mg or 100 mg per day after omitting Atenolol.

If your erectile dysfunction persists in spite of omitting Atenolol, he might prescribe viagra (sildenafil) for your erectile dysfunction after subjecting you to a good physical examination because deformity of the penis is a contraindication for prescribing sildenafil.

You have mentioned that your ECG and 2D-Echo are normal. Majority of Sri Lankan heart patients have a misconception that a normal resting ECG excludes coronary artery disease (CAD).

It is common knowledge among doctors that resting ECG is normal in majority of heart patients with CAD. Even a normal exercise ECG does not completely exclude CAD as in a significant percentage of CAD patients in whom the diagnosis is proved by coronary angiography exercise ECG can be normal. That is why doctors take a good clinical history before diagnosing CAD. You must discuss your problems with your family physician before taking sildenafil for erectile dysfunction.

***

Varicose veins

Q: Mrs. Colombage from Colombo, writes:

I am 52 years old and married. I have varicose veins in both legs which appeared when my youngest child was born.

Now the veins are popping out and showing like knots. When I stand for very long periods of time, my legs start to ache.

My mother had this same problem which she had operated many years ago, but it has occurred again. She also has the veins knotted and showing. My brother also has the same problem.

Please let me know if anything can be done. I wore elastic stockings but they didn't help. I do not want to undergo an operation. Is there any other way to solve this problem. It makes me very self-conscious.

Reply: As you have been suffering from varicose veins involving both lower limbs from your young days upto the age of 52 years you will need early surgical treatment. My advice for you is to consult a general surgeon or a vascular surgeon and get surgical treatment before you get various complications. Surgery for varicose veins is a very safe procedure.

If you postpone surgery you may develop following complications.

(a) Thrombosis (superficial thrombophlebitis)

which can cause considerable discomfort. Thrombosis can extend into deep venous system and cause deep vein thrombosis (D.V.T.). D.V.T. can rarely lead to pulmonary embolism due to clots getting detected from deep veins and travelling to the pulmonary artery. Pulmonary embolism is a very serious illness and is sometimes fatal.

(b) Haemorrhage

Spectacular haemorrhage can occur if the large superficial veins are damaged. If this occurs you should be lie down, elevating the leg and apply a compression bandage.

(c) Varicose ulcer

The most serious complication is venous ulceration. It is a troublesome and painful condition and requires careful management if the ulcer is to heal.

Therefore please consult a general surgeon or a vascular surgeon at your earliest and get his advice before waiting for above complications to develop.