Caring for Your Health

Basic Facts


Preventive Health
Eye Care
Dental Health
Maternal and Child Health
Health and Hygiene
Getting Well Without Antibiotics
Early Detection of Cancer
Health Care for Women
Colorectal (Bowel) Cancer
Healthcare for Men: Prostate Cancer

Some Common Diseases
Heart Disease
Diabetes
HIV and AIDS

Donation
Blood Donation: A Great Humanitarian Act
Eye Donation
Organ Donation: A Gift of Life


First published in 2001 by Maharaj Jagat Singh Medical Relief Society

Second edition published in 2006 by Radha Soami Satsang Beas

Third edition published by:
G.P.S. Bhalla, Secretary
Science of the Soul Research Centre
c/o Radha Soami Satsang Beas
5 Guru Ravi Dass Marg, Pusa Road
New Delhi 110 005, India

© 2012 Maharaj Jagat Singh Medical Relief Society
All rights reserved

Third Edition 2012

Any part of this booklet may be copied, reproduced or adapted to meet local needs, without permission from the publisher, provided the parts reproduced are distributed free or at cost – not for profit.

For any reproduction with commercial ends, permission must first be obtained from the publisher. The publisher would appreciate being sent a copy of any material in which text from this booklet has been used.

This booklet is intended for your information only, not as a substitute for medical advice. Always be sure to seek medical advice when you need it.

Eye Care

Eyes are the windows to the outside world. They are nature’s priceless gift. We can realize just a bit of the plight of a blind person if we close our eyes and try to move around.

Our eyes take care of us throughout our life. Likewise, we must take care of them. Eye problems can occur at any stage of human life. Certain eye diseases occur while the baby is still in the mother’s womb. Others present themselves when the child is born. There are eye conditions that are predominantly encountered during a child’s growing years (pre-school and school-going age). People are faced with a variety of eye problems during young adulthood, middle age, elderly years and extreme old age.

One important fact to be remembered is that many eye problems, if not recognized and treated in time, can lead to blindness. A second important fact is that many of these blinding conditions are preventable. Preventing a disease is more effective, convenient, cheaper and much easier than getting a disease and having to treat it.

Now let us see how care of the eyes is required right from the beginning of life in the mother’s womb, and should be continued till the end of your life and even thereafter (for eye donation).

Care of the baby’s eyes in the mother’s womb

During pregnancy (the antenatal period) poor nutrition, anaemia, medications containing steroids, x-ray examination of the abdomen and rubella (German Measles) infection can harm the eyes of an unborn baby by causing blindness due to conditions such as congenital cataract, glaucoma and retinopathy. To prevent such complications, you should:

Care of the newborn’s eyes

A baby’s face, especially the area around the eyes, should be cleaned with a sterile lint before opening them. Thereafter antibiotic drops need to be instilled into the eyes of the baby. If there is any watering or discharge from the baby’s eyes during the first month of life, you must consult your eye doctor without delay. Such a condition may be simple conjunctivitis (eye flu), but it may be one of the following serious conditions:

In such conditions, follow the treatment advised, and you will save the child from vision loss and other eye complications. If the pupil of the baby’s eye has a white discoloration, it may be due to a congenital cataract or cancer of the eye (retinoblastoma) or another serious eye condition. Consult your eye doctor.

Eye problems in growing children

As the baby grows, the following eye problems may be encountered:

Nutritional blindness

Vitamin A deficiency in children can cause night blindness, dryness of the eye (xerosis), keratomalacia (ulcerations and dissolution of cornea, which is the front transparent covering of eye) leading to total blindness and even loss of an eye. This condition is known as nutritional blindness. It commonly affects children below five years of age especially if they suffer from protein-calorie-malnutrition. Additional factors include URI (upper respiratory tract infection), measles, diarrhoea and worm infestation.

Prevent nutritional blindness by eating
carrots, mangoes, papayas, dark green leafy vegetables
(like palak and bathua), and milk-based foods.
Give breast milk to newborns and infants.

If you cannot get these foods, then give children (between the age of six months and six years) doses of vitamin A every six months.

Eye problems in school-going children from 6 to 14 years

There should be a check-up for refractive errors (near-sightedness, far-sightedness, and astigmatism), amblyopia (lazy eye), squint and colour vision defects.

Refractive errors (problems needing spectacles)

In this group there are three main conditions that cause poor vision and sometimes blindness. These are:

All the three problems happen to people of all ages and they can usually be helped by wearing spectacles. Short- and far-sightedness are caused by a change in the shape of the eyeball. In children, these problems are congenital. If children have one of these problems, they will:

Children usually don’t say they have poor vision. They may not even notice their problem and may adjust to their poor eyesight by sitting near the television or blackboard or by squeezing their eyes.

Check your children’s eyesight before
they start school and later also at least once or twice
during their school years (between 6-14 years)
for early diagnosis and treatment of problems.

Squint (deviated eye or lazy eye)

Deviated eye (squint) is not only a cosmetic problem but it can also cause blindness (amblyopia). Get it corrected as soon as possible.

Colour vision defects

These defects are often detected at the time of selection of a child for a particular career. At this stage, the child may be rejected because of defective colour vision and feels very much disheartened. If the colour vision defect is detected early, this may help the child and the parent to make up their mind for a career where colour vision is not really important.

Injuries

Injuries to the eyes may cause blindness. Children are prone to injuries. Eye injuries are commonly caused by:

To prevent eye injuries:

Trachoma (kukre or rohe)
Trachoma is an infection of the eye caused by a germ called Chlamydia trachomatis. Left untreated, it can lead to blindness. It is common in India, especially in villages among people living in unhygienic conditions. Trachoma occurs when: Blindness in trachoma

Trachoma infection by itself (“pure” trachoma) is a relatively mild condition, so mild and symptomless indeed as to excite little or no attention. However, in the absence of treatment, the disease runs a persistent course (subacute trachoma) and ultimately leads to opacity of the transparent covering of the eye (cornea) leading to blindness. The cornea becomes opaque in the following ways:

  1. There is roughening and scarring of the undersurfaces of the eyelids (hallmark of trachoma) with inturning of eyelashes (trichiasis). The uneven undersurface of the eyelids and misdirected eyelashes rub the cornea with every blink and damage it, finally making it opaque due to scarring.
  2. Trachoma germs can cause an ulcer on the cornea directly which, when healed, leads to opacity.
  3. Eyes with trachoma are vulnerable to secondary infection with other types of germs (previously known as “acute” trachoma) resulting in an acute and severe ulcerative condition of the cornea. These are liable to relapse and lead to more scarring, more opacity and blindness.

TO PREVENT TRACHOMA:
Wash your eyes with clean water.
Keep yourself and your surroundings clean.
IF YOU HAVE AN EYE INFECTION:
Show it to a qualified doctor.
Use the right medicines (antibiotics) early.

Follow the SAFE strategy as recommended by WHO (the World Health Organization). The components of the SAFE strategy are:

S –
Surgery to correct trichiasis (inturned eye lashes),the immediate precursor to blindness
A –
Antibiotics to treat an active disease (as advised by an eye specialist)
F –
Facial cleanliness to reduce transmission of infection
E –
Environmental improvement (clean latrines, fly control, clean water supply, proper garbage disposal, etc.)
Corneal ulcer

A corneal ulcer is a discontinuity in the surface cells of the cornea (the cornea is the frontmost clear layer of the eye that allows light to enter). A corneal ulcer is a sight-threatening condition. It usually occurs due to abrasions or scratches on the corneal surface that get infected with bacteria, fungus, or virus. These scratches or abrasions result from trivial injuries and foreign bodies. Certain eye conditions like misdirected eyelashes (trichiasis) and granular deposits (concretions) on the under-surface of the eyelids can also scratch the cornea with every blink.

The following eye conditions predispose the eye to a corneal ulcer:

A corneal ulcer is an emergency situation. If you develop severe pain, redness, inability to tolerate light (photophobia), or watering/ discharge, consult your eye specialist urgently for immediate and effective treatment. Serious complications such as scarring and corneal opacity can occur, which can cause partial or total blindness.

How to prevent corneal ulcers
  1. Avoid scratches and abrasions in the eye. Do not let dirt or dust into the eye and, if it gets into the eyes, do not rub. Wash the eyes with plenty of clean water. If irritation persists, consult your eye doctor immediately.
  2. If you wear contact lenses, follow your doctor’s instructions. If pain and redness occur while wearing contact lenses, see your doctor to rule out a corneal ulcer.
  3. If you are a farmer, avoid getting vegetative foreign bodies into your eyes (leaves of sugar cane, maize, etc.). Such foreign bodies may be harbouring fungus. Fungal ulcers are difficult to heal. Whenever possible, wear protective (safety) glasses in windy or dusty conditions.
  4. If you have dry eyes (xerosis, etc.), use lubricant eye drops and oral Vitamin A as advised by your doctor.
  5. If you have facial palsy, the affected eye should be closed with tape at night as instructed by a doctor. People with facial palsy are prone to getting ulcers as the cornea becomes dry due to the inability of the eye to close (exposure keratitis).
  6. Correct misdirected lashes by surgery or get them pulled out by a doctor to avoid injury to the cornea.
  7. Treat the underlying diseases of the eye.
  8. If you have an ulcer,do not use steroid eye drops. Also try to avoid the intake of steroid and immunosuppressant drugs.
Television and our eyes

Watching television can strain the eyes. If you like to watch television, remember the following:

Computer vision syndrome (CVS)

The human vision system is not designed for long hours of computer viewing. The use of computers is growing exponentially. The amount of time one spends looking at a computer screen is also increasing. While computers enable us to be more efficient and more productive, this comes at a price – computer vision syndrome (CVS). CVS is a complex of eye and vision problems that are experienced during, and related to, computer use, and is a repetitive strain disorder. All computer-related eye problems are preventable and correctable.

Typical symptoms of CVS 10 Commandments to Avoid Computer Vision Syndrome (CVS)
  1. Screen distance: At least 25 inches.
  2. Monitor tilt: Keep monitor top slightly farther from eyes than its bottom.
  3. Screen: Dark letters on a light background.
  4. Vertical location: Viewing area of monitor 15°- 50° below horizontal eye level.
  5. Lighting: Ceiling suspended indirect lighting. Use blinds, shades and curtains to avoid outside light and reflection.
  6. Neck posture: Use chair with arms. Flexion (head-tilt pose) causes less fatigue.
  7. AC airflow: Avoid direct flow/draft of air on your eyes.
  8. Break: Short visual break every 20 minutes.
  9. Exercise: Blink eyes a few times. Close eyelids; roll eyes behind closed eyelids clockwise, then anti-clockwise. Take a deep breath; open eyes while releasing breath.
  10. Lubricate eyes: As advised by your doctor.

Eye problems of middle age

Diabetes and high blood pressure

Diabetes is a disease in which the amount of sugar in the blood is not properly controlled. It is caused by too little insulin, the hormone that is made by the pancreas and controls sugar levels in the blood. Diabetes affects all organs of the body including the eyes.

Warning! Diabetes can lead to blindness, most commonly because of damage to the blood vessels in the retina (the membrane lining the inside of the eye). In diabetic patients, additional risk factors to the eyes are pregnancy, smoking, obesity and high cholesterol levels in the blood.

Get your blood pressure checked yearly. There are usually no warning signs for high blood pressure, although the risk increases if you gain weight as you get older.

Warning! If you have diabetes and high blood pressure, you are at a much higher risk of eye disease than people with just one of these problems. Work hard to keep them under control with your doctor’s help. This will help you keep your eyesight in good condition.

In addition to the control of blood pressure and diabetes, fundus examination (internal examination of the dilated pupil after appropriate eyedrops) by an eye specialist is essential. See pages 92 – 107 for more information about diabetes.

Glaucoma (kala motia)

Glaucoma, commonly known as kala motia, is a blinding disorder. The vision loss that occurs in this condition is irreversible. Glaucoma includes a group of eye conditions which lead to gradual damage of the nerve that takes visual impulses to the brain (optic nerve). The condition usually affects both eyes.

The nerve damage is responsible for causing blindness in such people due either to high pressure inside the eye or to impaired blood circulation to the nerve. This may happen even in eyes with normal pressure. The nerve damage causes a reduction in the field of vision, and may eventually result in complete blindness.

Glaucoma is mostly a silent killer of vision. Most often the condition is painless and, by the time one is aware of it, harm to the vision may have already occurred. Vision, once lost, cannot be regained by any medical/surgical or laser treatment. However, once detected, the progress can be halted or slowed by any of the above-mentioned treatments and further loss of vision can often be prevented.

Disciplined and regular treatment as advised by the eye physician is required so that the existing vision can be preserved. The treatment required may have to be continued for the rest of one’s life because glaucoma cannot be cured. It can only be kept in check.

Some people are at high risk of glaucoma, such as those:

The risk increases with age. All adults should have regular eye check-ups to rule out glaucoma. Early detection of glaucoma and regular treatment will help to prevent blindness.

There is a kind of glaucoma that can happen quickly (acute angle closure glaucoma). Since it is a sight-threatening and emergency situation, seek medical help as soon as possible if you have one of the following. Note that both eyes will require treatment:

Glaucoma usually affects older people but can also affect newborn babies and infants. This is called ‘congenital glaucoma’ and must be treated as early as possible to prevent blindness. If your child has unusually large eyes, beware: it may be congenital glaucoma. Take him/her to an eye specialist.

Remember that you must play your part in maintaining your vision.

The hallmark of early glaucoma management:
Ensure early detection!
That means having regular eye exams.


Eye problems of old age

Cataract (safed motia)

‘Cataract’ means any cloudiness in the lens of the eye. This cloudiness gets in the way of light entering into the eye and so it makes vision worse. It usually occurs above the age of fifty years and is commonly seen in older people when it is also called ‘senile cataract’. The causes of senile cataract are not entirely clear. A cataract can also be present at birth (congenital cataract). It can also grow at a very young age (developmental cataract).

Causes commonly linked to cataracts are:
The following symptoms may indicate the presence of a cataract: Treatment of a cataract

There is no medical cure for cataract. Cataracts can only be cured by surgically removing the clouded lens and replacing it with a small artificial lens (intra-ocular lens or IOL) to restore vision.

Age-related macular degeneration (ARMD)

Age-related macular degeneration is a slowly progressing, blinding disease, due to progressive damage to the macula. The macula is the central part of the retina (the innermost light sensitive layer of the eyeball) that allows us to see the fine details and appropriate colours of an object. It affects both eyes. It is a leading cause of blindness in developed countries in the population above the age of sixty-five years. In India, blindness due to ARMD has also become significant due to the increase in life span and thus an increase in the number of the aged population.

ARMD is of two types:
  1. Dry armd: This is more common than the wet form of the disease and accounts for 90% of all ARMD cases. It is caused by the aging and thinning of the tissues of the macula. Vision loss is usually gradual and may take years. There is no effective treatment available. Low vision aids may help the patient to do reading and near vision work.
  2. Wet ARMD: This is less common but more severe than the dry form. It accounts for approximately 10% of all ARMD cases but causes 90% of the cases of profound blindness with ARMD. There is abnormal development of new blood vessels (choroidal neovascularisation, CNV) beneath the retinal pigment layer of the retina (RPE). The vessels can bleed and eventually cause macular scarring, which can result in a profound loss of central vision (disciform scar). It is therefore associated with comparatively rapidly progressive marked loss of vision. Fundus fluorescein angiography (FFA) helps in detecting CNV.
The risk factors Consult your eye specialist if: Treatment

Antioxidants: In early stages of ARMD, some specific antioxidants may help to slow down the progression of degeneration, so eat green leafy vegetables throughout your life.

Laser: May help in selected cases of wet ARMD. The vision lost cannot be regained with a laser. Low vision devices may be helpful in advanced stages of ARMD.

Photodynamic therapy (PDT) and transpupillary thermo-therapy TTT) are other newer techniques.

The aim of the treatment is to stabilize the existing vision.

Do’s of eye care Don’ts of eye care

Pledge eye donations during your lifetime.
Contact your local eye bank for more information.
For more information, see pages 145 – 147 of this booklet.

Dental Health

Oral and dental hygiene is an integral part of total body health. Oral (mouth) health problems like dental caries (cavities), periodontal (gum) diseases, malocclusion (crooked teeth) and oral cancer are highly prevalent in India. It is well known that the treatment of dental disease is quite costly. Therefore it is important that an alternative strategy be developed to combat these problems at the level of primary prevention.

The teeth

Teeth are a living part of the body. The outermost hard white cover is known as the enamel. The inner, relatively less hard part is dentine, which surrounds the pulp containing the blood vessels and nerves of the teeth. The teeth remain embedded in the jaw bone, which is covered on the outside by the gum. There are two sets of teeth:

Be it salty, be it sweet,
rinse your mouth after you eat.


Four Common dental diseases and their prevention:

1. Dental caries

Dental caries or tooth decay is a common disease in children as well as adults. It commonly occurs on the chewing surface or below the contact area of two adjacent teeth.

The cause of this disease is the interaction between the bacteria present in the food and food remnants and the tooth surface. Every person has bacteria in his or her mouth. These bacteria live in a slimy transparent layer covering the tooth. This slimy layer is called plaque. When food remnants come in contact with the bacteria, fermentation starts. The bacteria produce acid as a result of the fermentation, which in turn causes dissolution of the tooth surface leading to dental caries.

2. Gum diseases or gingivitis

Gum diseases (gingivitis) are also caused by plaque formation. The bacteria present in the plaque form toxic substances that cause inflammation of the gums. If plaque is not removed regularly it may harden to form calculus (tartar).

Teeth are friendly pearly white,
Brush them daily not once but twice.

Prevention of dental caries and gum disease

The major cause of dental caries as well as gum diseases is dental plaque, so control of dental plaque is the main factor in the prevention of these diseases. Dental plaque can be controlled by:

Mechanical methods

This method is the most important in plaque control. It involves the use of toothpaste and a toothbrush. For proper cleaning of the teeth, the teeth should be cleaned in such a way that the upper teeth are cleaned in a downward motion and the lower teeth in an upward motion both from the outside as well as the inside. On the chewing surfaces, circular brushing motions help to clean the pits and fissures. At the end of brushing one should not forget to rinse the mouth thoroughly, clean the tongue and massage the gums with a finger.

A stitch in time saves nine.
This holds true for dental ailments also.

Chemical methods

There are certain chemicals such as chlorhexidine and fluoride that help in reducing bacterial plaque. They are available as mouth rinses but should be used only on the advice of a doctor.

Role of the diet in caries prevention

Sugars have a major role in caries causation; therefore, it is very important to reduce sugar intake. Consumption of sweets, especially toffees, chocolates, cookies, cake, pastries, cold drinks, and ice creams, should be avoided, especially in between meals. The golden rule is to use sweets only during major meals. In between meals, one can have fruits, salads, nuts, corns, vegetables and sandwiches.

After eating sweets, rinse the mouth thoroughly. Vitamins and minerals are very important for normal growth and teeth development; therefore, during childhood, a diet rich in calcium and vitamins should be given. The same holds true during pregnancy and lactation. Bottle feeding of young children at night should be totally avoided.

Decay! Decay! Decay!
Go another way!
I brush my teeth
after I eat.
That protects my teeth
night and day!!

Role of fluoride in caries prevention

Fluorides make the teeth stronger and more resistant to caries. The simplest method of use of fluoride is by using toothpaste that contains fluoride. Fluoride toothpaste is recommended for all people above six years of age.

Specific control and prevention of gum disease

We know that brushing properly reduces plaque and bacteria and therefore it is beneficial for the gums too. Steps to keep the gums healthy include:

I brush my teeth twice a day.
In my life plaque has no say,
I smile all the way and I never smoke.

3. Malocclusion of teeth

In this disorder, there is excessive crowding or spacing between the teeth or the teeth may be placed abnormally forwards or backwards or abnormally rotated.

Malocclusion or crooked teeth affect almost 30 – 40% of the children of our country. Many cases are caused by faulty oral habits like thumb sucking, tongue thrusting and mouth breathing in children. The most common cause of irregularity or crowding of the teeth is premature loss of ‘milk teeth’ due to dental caries or other reasons. The ‘milk teeth’ help space the new permanent teeth properly as they come in. Malocclusion may also lead to increased caries or gum disease and temporal-mandibular joint (these two joints, one on each side, are the hinges of the lower jaw) problems.

Prevention of malocclusion

To prevent malocclusion, it is important to keep the milk teeth free from dental caries and to discontinue bad oral habits as soon as possible. Apart from this, planned extractions of over-retained milk teeth can in some cases be options. Always seek advice from a qualified dentist.

4. Oral cancer

In India, this is the third most common cancer. It is common where betel-quid chewing, bidi smoking, alcohol, and tobacco consumption are high. Other risk factors are:

Cancer of the mouth may remain undetected because initially
the symptoms may be mild. Alertness and prompt attention are needed in the following situations:

Order! Order!! Order!!!
Pan masala, gutka chewer,
and you, Mr Cigarette Smoker,
may be inviting the curse of cancer.

Prevention of oral cancer
  1. Stop various tobacco-related habits immediately and avoid alcohol
  2. Perform self examination for early detection and treatment of precancerous lesions:
    • The oral cavity can be examined easily in two minutes by standing in front of a mirror in good light.
    • Both lips, both cheeks, the tongue from the upper side, lower sides and margins, the floor and roof of the mouth, and the throat should be examined.
    • On each surface, look for changes in colour or consistency, the presence of swelling or growths or ulcers.

If you find any such feature, please contact the nearest doctor or qualified dentist.

Infant dental care

Children are the future of any country. Keeping our young ones free from disease will give us a healthy, progressive generation in the future. Expectant females and mothers should be informed and educated regarding the following:

Prevention of dental diseases in infants
1. Brushing two times everyday = healthy teeth
2. Healthy diet = healthy teeth
3. Healthy teeth = healthy body

Food minus sweets = 32 teeth intact

Prevention of oro-facial trauma in children

Children are quite prone to trauma of the oral and facial region, the most common being a fall, getting hit during playing, and cycling and roadside accidents. Sometimes, a small act of negligence can lead to a serious accident, hampering the quality of life of the child and family. Taking care of a few small things can avoid many major and minor mishaps:

Life is a hit if the teeth are fit.

Maternal and Child Health

Maternal and infant mortality in India remains unacceptably high. This part of the booklet aims to allay the anxiety and fears of young mothers who are worried about pregnancy, delivery, and the subsequent care of their newborn. Most of these fears arise due to ignorance about some basic aspects of care during pregnancy and care of the infant. We can avoid many maternal and infant deaths if we take just a few basic precautions in the care of mothers and children.

Antenatal care (care during pregnancy)
To ensure the good health of a mother and her child, it must be understood that the care of a newborn starts even before the child is born. This means that every pregnant woman must take good care of herself by following certain simple rules:

Iron Content in Food

High: More than 5 mg/100g
Whole wheat flour Turnip leaves
Wheat germ Onion stocks
Dalia Plantain green
Rice flakes Lotus stem
Bajra Watermelon
Peas dry Almonds
Soyabean Raisins
Rajmah Gingelly seeds
Lobhia Nigella seeds
Lentil Tamarind pulp
Bengal Gram Dal Coriander seeds
Bengal Gram, whole Zeera
Bengal Gram, roasted Ajwain
Bengal gram leaves Mango Powder
Colacasia leaves Turmeric powder
Cauliflower leaves Munakka
Mustard leaves Jaggery
Table Radish Leaves
Low: Less than 5 mg/100g
Jowar Peas, green
Maize Bathua leaves
Barley Sem beans
Rice Apple
Ragi Amla
Spinach Cashew Nuts
Methi Sapota
Amaranth

Natal care (during childbirth)

Place of delivery The five cleans during delivery
  1. To maintain clean hands, the birth attendant should cut her nails and wash her hands well with soap and water before conducting the delivery. She should not wipe her hands or touch anything.
  2. Perform the delivery on a clean surface or clean bed sheet.
  3. Use clean thread for tying the umbilical cord.
  4. Use a new, clean blade for cutting the cord.
  5. Do not apply anything on the cord. Keep the cord clean.
Delivery Do’s and Don’ts
Do’s
  1. Inform the dai, auxiliary nurse midwife (ANM), or nurse as the case may be.
  2. Keep ready a new blade, soap, thread or cord tie and gloves (the disposable dai kit), and a clean cloth for wrapping the baby, sanitary napkins for the mother, cotton gauze, and boiled water.
  3. Take plenty of liquids during labour pain.
  4. Walk in early stages of labour.
  5. Lie down on a bed and take deep breaths after the bag of water breaks.
Don’ts
  1. Do not press the abdomen from the outside and do not lie on your stomach.
  2. Do not break the water bag with a nail or blade.
  3. Do not take any injections to speed up the delivery.
  4. Do not push the baby down in between pains.
  5. Do not pull the baby out by force.
  6. Do not do frequent vaginal examinations.
After the delivery
  1. Wipe the baby clean with a soft, clean cloth at birth.
  2. Wrap the baby in two layers of clothes. Keep the baby by the side of the mother as her body temperature will keep the baby warm.
  3. Start breastfeeding within a half hour after delivery. Ensure that the baby is not exposed to a direct draught of air. Do not give a low-birth-weight baby (less than 2.5 kg) a bath for one week after birth.
  4. Ensure the baby is handled by only one or two persons.
Danger signs during delivery

The mother and/or baby should be shifted to a hospital immediately if any of these danger signs appear:

  1. There is excessive vaginal bleeding before or after the baby is delivered.
  2. The mother is in labour for 24 hours without delivering the baby.
  3. The baby’s hand or foot comes out first.
  4. There is dirty-looking discharge.
  5. The mother has fits during delivery.
  6. The mother has severe pains in the abdomen or severe paleness or breathlessness.
  7. The baby appears pale, blue or does not cry.
Care during the postnatal period (after the birth) Danger signs in the mother Care of the newborn

Care of the newborn starts with good antenatal care, safe delivery at a hospital or by a trained birth attendant at home, and includes:

Birth asphyxia (breathing problems at birth) In case of birth asphyxia:
Do’s
  1. Put the child under a warmer or bulb if possible.
  2. Place the child on its side so that fluid can come out easily.
  3. Suck out aspirated fluids with a mucus extractor if possible. Clean the baby’s mouth, nose and throat so that airways are not blocked.
  4. Respiration is stimulated with cleaning of airways and most newborns start crying thereafter. If not, stimulate the soles of the feet with your fingers, or the baby’s back can be rubbed softly.
  5. Mouth-to-mouth respiration should be given. Blow with the cheeks rather than full breaths as a baby’s lungs are very small and delicate.
  6. Take the newborn to the hospital immediately if the above measures fail.
Don’ts
  1. Don’t keep the child upside down.
  2. Don’t place the baby face down.
  3. Don’t pat the baby hard on the back.
  4. Don’t press the baby’s abdomen.
  5. Don’t sprinkle hot or cold water on the baby.
Hypothermia (low body temperature)

In hypothermia, a newborn loses heat from all parts of his body and is unable to generate heat to maintain its body temperature. Temperature falls very quickly if not properly maintained, which can be fatal. Low temperature can be assessed by recording axillary (under the arm) temperature. (Normal is 98.4˚ F.)

Cold stress

If palms and soles are cold, but chest and abdomen are warm.

Hypothermia

If all parts are cold. A normal newborn is warm to the touch and its colour is pink.

Prevention of hypothermia
  1. Wipe the newborn with a clean warm towel immediately after birth.
  2. Then wrap the baby in another warm dry towel or with cotton from head to foot.
  3. The newborn should be kept next to the mother’s skin.
  4. The room should be warm; fans should be switched off.
Treatment of hypothermia
  1. Put the newborn under a warmer if one is available, or 1½ feet away from a 200-watt bulb. Keep the room warm with a heater or a hot water bottle.
  2. Put the child between the mother’s breasts (kangaroo method).
Prevention of infections

A newborn is prone to infections, which are a major cause of death.

Do’s
  1. Take two injections of tetanus toxoid during each pregnancy.
  2. Choose a delivery place that is clean, airy and well-lit.
  3. Make sure the birth attendant should washes her hands thoroughly with soap and water before conducting the delivery.
  4. Cut with a clean new blade, tied with sterilized cord ties and left dry and clean. The care of the cord is important.
  5. Ensure that any person who has to hold the newborn washes his/her hands thoroughly for one minute before touching the baby.
  6. Cut the baby’s nails cut clean.
  7. Continue Breastfeeding for six months.
  8. Use clean clothes for the newborn.
  9. Get the child immunized.
Don’ts
  1. Don’t give the child honey, tea, gur, water or ghutti or bottlefeed.
  2. Don’t let a sick person hold or attend to the newborn.
  3. Don’t take a newborn to a crowded place.
  4. Don’t allow many persons to enter the room where the newborn is lying.
Low birth weight babies

The normal birth weight of a newborn is 2.5 kg. If a newborn weighs less than 2½ kg, it is known as a low-birth-weight baby. Newborn babies whose weight is between 2.0 and 2.5 kg can be managed at home. Babies who weigh less than 2 kg may have to be kept at a hospital.

Home management of babies with low birth weight
  1. During the first week, sponge-bathe the newborn daily. At the end of the first week, bathe the newborn.
  2. Managing hypothermia is important. Keep the newborn wrapped in woolens or next to the mother’s skin. ‘Kangarooing’ should be done by keeping the child between the mother’s breasts.
  3. Keep the baby in a clean and airy room; the room should be kept cosy.
  4. Exclusive breastfeeding should be practiced. Feed the baby frequently, every two hours at least, as it gets tired easily and may feed only for a short time.
  5. If a baby is unable to suck, express breast milk into the baby’s mouth or into a bowl and feed with a spoon.
  6. Watch for diarrhoea and acute respiratory infections. If there is diarrhoea, give ORS (oral rehydration solution) and take the baby immediately to a doctor.
  7. Immunization is very important as a weak child is prone to infections.
  8. The child should be handled by as few people as possible. Sick persons should not go near the child.
Prevention of low birth weight

The future mother should:

  1. Start taking iron tablets after 12 years of age.
  2. Avoid pregnancy before 21 years of age.
  3. Take one extra meal and avoid very hard work during pregnancy.
  4. Avoid smoking and alcohol completely.
  5. Rest for at least 2 hours in a lying down position during the day and get adequate sleep of 8 hours at night during pregnancy.
  6. Take folic acid tablets for the first three months and iron, folic acid and calcium tablets thereafter during pregnancy.
  7. Get at least three antenatal checkups by doctors.
  8. Detect any anaemia, high blood pressure and bleeding early for referral to hospital.
  9. Space births at least 3 years apart.
Identification of the high-risk newborn

Arrange to take the newborn to a hospital if:

Breastfeeding Pneumonia and respiratory problems

Look for the following signs in the newborn:

Do’s and Don’ts of Treating a Newborn with Respiratory Problems:
Do’s
  1. Give plenty of liquids.
  2. Continue breastfeeding.
  3. Keep child warm.
  4. Keep the child in clean, non-smoky air.
  5. Immediately take the child to the doctor or hospital if you see any of the above problems.
Don’ts
  1. Do not give home remedies if any of the above problems are present.
  2. Do not go to ‘roadside doctors’ (quacks) for treatment.
Immunization

It is absolutely essential to protect the child against deadly diseases like tuberculosis, diphtheria, whooping cough, tetanus, polio, measles and hepatitis B. A child who is not immunized is likely to become disabled or undernourished and may die.


Immunization schedule

1.At birthBCG/OPV zero dose
2.1½ monthsDPT and OPV 1st dose + Hepatitis B 1st dose
3.2½ monthsDPT and OPV 2nd dose + Hepatitis B 2nd dose
4.3½ monthsHepatitis B 3rd dose
5.9 monthsMeasles and Vit A 1st dose
6.16 – 24 monthsDPT and OPV booster + Vit A 2nd dose
7.2 yearsVit A 3rd dose
8.2½ yearsVit A 4th dose
9.3 yearsVit A 5th dose
10.4½ to 5 yearsDT and OPV booster + Hepatitis B booster
11.10 & 16 yearsT-T + Hepatitis B booster
Diarrhoea Consult a doctor immediately if:
  1. The child has uncontrolled vomiting and diarrhoea.
  2. There is blood in the stool.
  3. The child is not taking fluid or food orally.
  4. The child is sleepy and difficult to awaken.
  5. The child faints due to dehydration.
Signs of severe dehydration
  1. Weak crying, no tears from the eyes, dry mouth and lips
  2. Loss of skin elasticity
  3. Sunken eyes and sunken fontanel (soft areas in the child’s skull)
  4. Decrease in amount of urine
Prevention of diarrhoea
  1. Breastfeed exclusively: no ghutti or bottle for the first six months of life.
  2. Keep food and water for drinking covered and away from flies.
  3. Keep child clean, cutting nails regularly.
  4. Wash hands with soap and water before taking food and after using the toilet.

Malnutrition

Causes of malnutrition Symptoms of malnutrition Management of malnutrition
  1. Use 250 gms roasted channa + 100 gms of murmura.
  2. Grind separately and sieve.
  3. Mix and keep in airtight container.
  4. Mix 4 spoons in a bowl of milk with sugar for each feeding.
The adolescent girl

Health and Hygiene

The World Health Organization (WHO) tells us that health is a state of complete physical, mental, and social well-being, and not merely an absence of disease or infirmity. It enables enabling one to lead a socially and economically productive life.

Health goals for life

You can get the best out of life by keeping fit.
Health information is part of your success kit.

A healthy way of living

How you live, what you eat and drink, which physical activities you perform, and your good and bad habits is called all contribute to our lifestyle. If you follow a good lifestyle, you will fall ill less often and be full of energy. With a bad lifestyle, life will be cut short and made difficult by disease and disability.

You can choose to live healthily by eating healthy food, exercising regularly and not using tobacco or alcohol in any form. You can also motivate others in your family to do the same. You can help society grow healthier by beginning with yourself and your family.

Let us all live healthy!
Your health is your responsibility too.
No one else can take better care of you than you.

Ask yourself how you feel about your present way of living?

To get answers to these questions read on.

With a healthy way of living you are going to:
Look good You will have a good build, strong muscles, bright eyes, and healthy skin and hair.
Feel good You will have more energy, sleep better and be more relaxed.
Be happy You will be able to perform better in your work or studies, and you will enjoy life much more with your family and friends.

You have it in you to do it yourself – enjoy life to the fullest.

Learn health! Earn health!
Health today and health tomorrow
are yours to earn, not to borrow.

What is a healthy way of living? It means:

In our country, diseases like heart attacks, high blood pressure, diabetes, cancer, breathing problems, and mental illness are increasing in frequency. A lot can be done to prevent these diseases by picking up good habits and giving up harmful ones. Developing good habits is easier when you are young. This will help to prevent lifestyle-related illnesses during the later years of your life. If you want to achieve success for yourself and for the country in the 21st century, you must ensure that you have good health to support your efforts throughout life. By taking care of yourself (eating well, being active, and not smoking), you will also feel good and grow strong, with energy for work and play.

What to do to move towards a healthy lifestyle?

Avoid heart disease, diabetes and high blood pressure,
and remain fully fit to enjoy life with pleasure
by having ideal weight for your height
and not becoming roly-poly.
Be specially careful about that unhealthy pot-belly.

How to keep healthy: Eat Right

Key words are regularity, balance, moderation, and variety.

For a healthy diet, eat more: And eat less: How food is prepared affects its quality!

Points to keep in mind while preparing food:

Please Remember: You need energy but you need nutrients too

You need energy to work and enjoy life. The body uses food as fuel (calories, food energy) to get this energy. However, if we eat more food than our bodies can use, the extra will be stored in the body as fat. In order to grow and do things like work, study, exercise, and recover from illness, we need not only fuel, but also nutrition.

Some foods give you lots of energy to GO but not many nutrients for you to GROW and GLOW. Foods that don’t give us many nutrients may cause us to get fat and sometimes will make us tired and less fit! Healthy foods like cereal, milk, dals, fruits and vegetables give nutrients and energy to help you GO, GROW, and GLOW. Reserve high calorie foods – rich foods, soft drinks, and chocolates – for special occasions, and restrict their intake.

Major Vegetarian Food Sources of Nutrients

Nutrients Food
Energy Cereals, pulses, roots and tubers, fats and oils, sugar and jaggery
Protein Milk and milk products, pulses, nuts and oil seeds
Fat Butter, ghee, vegetable oils, hydrogenated fats, nuts and oil seeds
Carbohydrate Cereals, pulses, sugar and jaggery, roots, tubers
Fiber Green leafy vegetables, fruits, unrefined cereals, pulses and legumes
Calcium Milk and milk products, ragi, green leafy vegetables
Iron Green leafy vegetables, rice flakes, whole wheat flour, ragi, pulses
Vitamin A, Beta Carotene, and Vitamin B Butter, ghee, milk, carrots, green leafy vegetables, papaya, mango
B Complex Milk, hand-pounded rice, whole wheat, whole grams, pulses, green leafy vegetables, nuts and oil seeds
Vitamin C Amla, lime, orange, guava, tomato, lettuce, sprouted grams
Vitamin D Milk, sunlight
Iodine and Health Conditions

The best source of iodine is iodized salt and kelp (dried seaweed). Other good food sources are yogurt, cow’s milk, and strawberries.

An iodine deficiency can create: fibrocystic breast disease, goiter, hyperthyroidism, hypothyroidism, and multiple miscarriages.

Avoid overeating
Nutrition Who’s Who

Energy-dense foods give you lots of calories but do not give the nutrients that you require to grow and keep well. Some of these foods are chocolates, ice-cream, potato chips, and soft drinks.

Nutrient-dense foods give you calories as well as nutrients in the right amounts to make you go, grow, and glow. Some nutrient dense foods are chappati, rice, dals, rajmah, vegetables, fruits, milk, and milk products.

Hygienic Habits

Washing hands keeps us healthy

Harmful bacteria and viruses can stick to our hands. Washing your hands is the single best way to reduce the spread of infection. It should be an essential habit for everyone. Ensure that servants also wash their hands before handling food or dishes.


Here’s how
  • Wet your hands under warm running water.
  • Put soap on your wet hands.
  • Rub soap all over the front and back of your hands and between your fingers for 5 to 10 seconds
  • Use a nail brush.
  • Rinse your hands well under running water.
  • Dry your hands with a clean towel.
When
  • After going to the toilet.
  • After taking a child to the toilet.
  • After changing diapers.
  • After wiping your nose.
  • Before and after caring for
    a sick person.
  • Before eating.

Covering your mouth and nose while coughing or sneezing prevents disease

Use a handkerchief to cover your mouth when you cough or sneeze. If you don’t have a handkerchief, it is better to cough or sneeze into the crook of your elbow, rather than into your hands, which are always later touching people or food. This will prevent the spread of airborne infections such as flu, colds, and tuberculosis.

Spitting in public places spreads disease

Spitting is a bad habit, as it makes the environment unclean. It also contains viruses and bacteria which can spread disease.

Your health is in your hands
Do Not: Sanitation ensures health
Do:

Tobacco

Keep away from tobacco in any form

Of 1000 teenagers who smoke today:
• 500 will eventually die due to tobacco-related diseases.
• 50 of these will die in their middle age. Compared to non-smokers, they lose 22 years of life on average.
• 250 will die in old age but will have suffered ill health due to tobacco-related diseases in middle age.

If someone is already a smoker

A person who smokes can quit smoking if they make up their mind to do so; it requires will power and determination. The addiction makes it difficult sometimes, but with individual effort and support from family and friends, it can be overcome.

If you are not a smoker Here are a few points you could use to persuade the smokers you know to give up smoking: Tobacco related cancers

Tobacco was introduced in India in the 17th century. Beginning in the 20th century, it became common. It is used in various ways; i.e., smoking, chewing, and snuff. Smoking is common worldwide. Harmful contents of smoke are hydrocarbons, benzene, and cadmium. Harmful substances in chewing tobacco include nicotine and nitrosamines. When tobacco in the form of Gutka is kept in oral cavity for long time, it plays a major role in development of oral cancers.

Oral cancer causes are: Warning signals

Treatment is usually by surgery, chemotherapy, and radiotherapy.

Lung cancer causes are: Signs and symptoms

Early stage is usually without symptoms. Later stage symptoms include:

Diagnostic Tests

Treatment is by surgery, chemotherapy and radiotherapy.

Once you stop smoking,
your body starts to repair the damage!

Please Remember:

Physical Activity

What is physical activity?

Physical activity involves any body movement that results in our body expending energy (burning calories). Any movement, therefore, involves physical activity. When we walk briskly, climb stairs, cycle, play sports, dance, or even clean the house, we are being physically active! Depending on the energy required for these activities, physical activity can be of different levels of intensity: light, moderate, vigorous, or strenuous.

Type and Amount of Activity

Active living Activity for
health
Exercise for
fitness
Training for
sports
Light to moderate
activity
Moderate activity Moderate to vigorous activity Strenuous activity
Ten minutes or more, a few times a day Twenty minutes or more, three times a week Thirty minutes or more, daily Duration and frequency according to individual fitness level
How is physical activity different from ‘exercise’?

Moderate levels of physical activity are adequate to provide many health benefits, especially in preventing several diseases. Although higher levels of physical activity (vigorous or strenuous activity) serve to increase fitness by increasing the efficiency and endurance levels of the heart, lungs and muscles, they are not essential for gaining other health benefits. Being fit enables you to undertake higher levels of exercise more efficiently, while moderate physical activity provides adequate health benefits. Vigorous exercise is also more beneficial for weight control, as it burns more calories.

Regular moderate physical activity = Health benefits (reduced risk of disease)
Frequent vigorous physical activity=Increased fitness plus health benefits

What are the benefits of physical activity?

Regular physical activity

The benefits will extend across your entire life!

A child will: An adolescent will: A young adult will: An older adult will:

Regular physical activity prevents deadly diseases

Heart attack

The risk of heart attack is greatly reduced by regular physical activity, which keeps blood pressure and heart rate at relatively lower levels. It raises the HDL (good) cholesterol, which protects against fat deposits in the arteries. Lowering of blood pressure also protects against stroke.

Cancer

Gut cancer is less likely to occur in persons who are physically active. Breast cancer may also be prevented by regular physical activity. Several other cancers are also less frequent in those who exercise regularly.

Diabetes

Risk is greatly reduced by regular physical activity, especially if combined with appropriate diet.

Osteoporosis Excess weight and obesity

Excess weight and obesity are risk factors for heart attacks, high blood pressure, diabetes, high blood fat levels, joint problems, lung disorders, etc. Regular physical activity helps to keep the body weight in check and prevents health problems. Those who are physically active and who do not gain weight as they grow older live longer and better lives.

Mental health

Mental health is often adversely affected by poor physical fitness. Physical activity helps to avoid anxiety and depression.

If you choose routine physical activity: Calories Burned during Exercise
Basic factors influencing the number of calories burned during exercise are the: To a lesser degree, certain individual factors such as age, gender, and muscle versus fat ratio may also affect the numbers of calories burned during exercise.

Calories Burned by Exercise Type

For the sake of this discussion, we will consider a workout time of 30 minutes and a person weighing 180 pounds. Here’s how many calories are burned during various exercises:

Aerobic Activities
(30 minutes, 180 pounds body weight)
Calories Burned
General aerobics, low impact 215
General aerobics, high impact 300
Bicycling, stationary, moderate intensity 300
Bicycling, stationary, vigorous effort 450
Rowing, stationary, moderate effort 300
Rowing, stationery, vigorous effort 360
Running 6 mph (10 min/mile) 330
Running 8 mph (7.5 min/mile) 450
Running 10 mph (6 min/mile) 533
Rope jumping, moderate speed 430
Rope jumping, fast speed 510
Stair climber treadmill, moderate effort 380
Swimming freestyle moderate effort 300
Swimming freestyle vigorous effort 430
Walking 3 mph (moderate pace), on level ground 140
Walking 4 mph (brisk pace), on level ground 215
Walking 3.5 mph, uphill 260
Strength Training Calories Burned
Calisthenics, moderate effort (pushups, setups, jumping jacks) 200
Calisthenics, vigorous effort 340
Weight lifting, free weights, moderate effort 200
Weight lifting, free weights, vigorous effort 260
Sports Activities Calories Burned
Badminton 200
Basketball, game 340
Basketball, non-game 260
Basketball, shooting baskets 200
Baseball/Softball 230
Billiards 110
Bowling 130
Boxing, in ring 510
Boxing, punching bag 260
Boxing, sparring 390
Fencing 260
Football 350
Golf, walking and carrying clubs 200
Golf, using power cart 150
Golf, miniature 130
Gymnastics, general 170
Handball, team 350
Hockey, ice or field 350
Horseback riding, walking 110
Horseback riding, trotting 280
Juggling 170
Kickball 300
Martial Arts (judo, jujitsu, karate, kick boxing, tae kwon do) 430
Polo 340
Roller skating 300
Skate boarding 215
Soccer 370
Table tennis 170
Tai chi 170
Tennis 300
Volleyball, game 340
Volleyball, general 300
Please Note:

To determine the numbers for your own particular case, see the Exercise Calorie Calculator.

Tips for Picking the Most Time-Efficient Exercises

The lists provide a comparative guide to the number of calories burned by various exercises. Of course, exercises that burn more calories over the same amount of time are more time-efficient.

You can see that among the exercises listed, the most time-efficient are: To pick a time efficient exercise: Interval training

Regardless of the type of exercise you choose, you may increase efficiency by varying effort intensity during your workout. Alternating intervals of high intensity with intervals of low intensity is more efficient than exercising at constant moderate intensity. This method is called interval training, and is widely used by athletes in their training programs.

Advantages of interval training:

If, for example, you choose running as your exercise, run at a moderate pace (about 6 mph) for a few minutes and then increase your speed as tolerated for 1 – 2 minutes (aiming to achieve 8 – 10 mph). Return to a moderate pace and repeat. As you become better conditioned, you may extend the duration of high-effort intervals versus low-effort intervals. The same applies for activities such as swimming, walking, bicycling, general aerobics, stationary rowing, and weight lifting.

Circuit training

The number of calories burned during exercise can also be increased by combining aerobic activity and strength training in the same workout. This particular type of exercise is called circuit training. It has the advantage of allowing you to sustain a higher intensity throughout your workout: As you shift from an aerobic segment to a strength training segment and vice versa, your body gets a chance to recover from the previous effort.

Exercise Calorie Calculator (per minute)

Estimated calories burned are based on activities per minute. Actual calories burned vary with your individual body weight; the more you weigh, the more you burn.

Activity Your Body Weight (in pounds)
105-115 127-137 160-170 180-200
Aerobic dancing 5.8 6.6 7.8 8.6
Basketball 9.8 11.2 13.2 14.5
Bicycling, stationary
(10 mph)
5.5 6.3 7.8 8.3
Bicycling, stationary
(20 mph)
11.7 13.3 15.6 17.8
Golf 3.3 3.8 4.4 4.9
Hiking (backpack) 5.9 6.7 7.9 8.8
Jogging (5 mph) 8.6 9.2 11.5 12.7
Running (8 mph) 10.4 11.9 14.2 17.3
Skiing, downhill 7.8 10.4 12.3 13.3
Skiing, cross country 13.1 15 17.8 19.4
Snow shovel, light 9 9.1 10.8 12.5
Snow shovel, heavy 13.8 15.7 18.5 20.5
Stair climbing 5.9 6.7 7.9 8.8
Swimming (20 yds/min) 3.9 4.5 5.3 6.8
Swimming (60 yds/min) 11 12.5 14.8 17.9
Tennis (singles) 7.8 8.9 10.5 11.6
Volleyball 7.8 8.9 10.5 11.6
Walking (4 mph) 4.5 5.2 6.1 6.8
Examples of physical activity
Washing and waxing a car or motorcycle 45 – 60 minutes LESS VIGOROUS, MORE TIME
Cleaning/washing windows or floors 45 – 60 minutes
Playing volleyball or badminton 45 minutes
Gardening/digging 30 – 45 minutes
Walking 1¾ miles 35 minutes

(20 minutes/mile)

Basketball
(shooting baskets)
30 minutes
Bicycling 5 miles 30 minutes
(10 miles/hour)
Dancing fast 30 minutes
Walking 2 miles 30 minutes
(4 miles/hour)
Water aerobics 30 minutes
Swimming laps 20 minutes
Basketball game 15 – 20 minutes
Bicycling 4 miles 15 minutes
Jumping rope 15 minutes
Running 1½ miles 15 minutes
(10 minutes/mile)
MORE VIGOROUS, LESS TIME
Stair-walking 15 minutes

Getting Well Without Antibiotics

What are antibiotics?

Strong medicines used to treat infections caused by bacteria. Viruses are not killed by antibiotics.

Should antibiotics be used for common ailments like coughs, colds and ‘flu’?

No! These common ailments are usually caused by viruses (not bacteria). Instead, use over-the-counter medicines for colds, as needed; drink lots of water and rest.

What happens if we use antibiotics too often?

By over-using antibiotics for minor illnesses, some bacteria will no longer be killed by antibiotics. This is called antibiotic resistance.

Could we then use other antibiotics?

Yes, but they may not be as effective, and may have more side-effects. Eventually bacteria may become resistant to these antibiotics too. Humans may run out of antibiotics faster than new ones are discovered. If everyone abuses antibiotics, there will be an ever-increasing number of antibiotic-resistant bacteria in the world. This is already a serious problem.

How can antibiotic resistance be avoided?

By using antibiotics correctly for bacterial infections only.

When are antibiotics needed?

Sometimes, simple colds become complicated by bacterial growth along with the original viruses. Also, serious infections like meningitis, pneumonia, and kidney infections require antibiotics. Your doctor will decide when you need them.

How can I help?

Only use antibiotics when necessary and make sure to take the full dosage prescribed by your doctor. Antibiotics may be life-saving and they are more likely to work if they are used carefully. Antibiotic resistance is a global public health issue in which we all have a part to play. Bacteria will always try to survive by evolving and developing resistance to antibiotics, so we must stay one step ahead of the game. That means using fewer antibiotics, not more.

Early Detection of Cancer

Cancer is an abnormal and unrestricted growth of cells of any organ or tissue and at any age into a mass called a tumor. Cancer is dangerous mostly when it spreads to other parts of the body. If it is detected early, it can often be cured. This is why it is so important to seek help early if you have a lump or sore that will not heal.

Warning signals of cancer are:

If you have any of these symptoms or signs or other unexplained symptoms, make an appointment to see your doctor immediately. Early detection of cancer and early treatment give better chance of overall survival. Treatment can involve surgery, chemotherapy, or radiation therapy.

Equally importantly, cancer can prevented so you need to think about all aspects of your lifestyle such as eating, drinking, exercise, and body weight. You can protect yourself from cancer by eliminating the known causative factors from your life. You can be a victor and not a victim.

Health Care for Women

Early detection of cancer is done by screening. Common cancers found in women are breast cancer and cervical cancer.

Breast Cancer Screening

The most important step is breast self examination (BSE). It should be done every month before your period or, in menopausal women, on a fixed date of every month. Your physician should examine you every six months to one year. There are four methods for screening for breast cancer:

  1. Breast Self Examination (BSE) It is important that your doctor teach you how to do BSE. A general description follows. BSE involves two parts: looking at the breast and feeling the breast.

    Looking at the breast should be done either sitting or standing in front of a mirror in good light.

    Step l: Keep both arms by the side of your chest and look for:

    • Any change in contour or shape of the breast
    • Dimpling or pulling of skin
    • Dryness or rash around nipple
    • Retraction of nipple
    • Swelling, puckering or redness over breast
    • Fluid leaking from the nipple.

    Step 2: Raise both arms above or behind your head with locked hands.

    • Look for changes in breast contour/shape on both sides
    • Nipple line should be horizontal. If there is any change, there may be an abnormality.

    Step 3: Press both hands on your hips to make your breast prominent and look again for any change in size, shape or movement.

    Step 4: Lean forward and see that both breasts are falling equally on both sides with prominent nipple.

    Feeling the breast:

    Lying position

    First lie on your back and a put a pillow or folded towel under the shoulder to raise your breast. Use the pads of your fingers of the opposite hand.

    Gently rotate your fingers in circular pattern and press them gently to feel any lump, tenderness or irregularity in your breast.

    Squeeze your nipple for any discharge. Clear, red, or dark brown discharge is abnormal.

    Feel your breast towards the armpit. Feel in your armpit as well as your neck for any lump or swollen gland.

    Repeat for the other breast.

    Standing position

    The same examination can be done while you are taking your shower as soapy and wet hands can more easily be moved over the breast and to feel deeper into the breast tissue. Try to make a habit of examining yourself during bathing.

  2. Mammography In case of any abnormality, mammography should be done at 30 to 35 yrs of age, then every 3 year interval between 40 to 50 yrs of age and after that every year.
  3. Sonomammography A non-invasive method for detection of fluid-filled lumps. It is safe during pregnancy.
  4. Fine-needle aspiration (FNAC) and core biopsy are methods used to further examine suspicious lumps.
Please Remember: Cervical cancer screening

Cervical cancer occurs mainly in women who are or have been sexually active.

The following may increase the risk of cervical cancer:

Clinically, cervical cancers initially do not cause symptoms, but can be detected by having a regular Pap smear test and examination.

A Pap smear is taken from the neck of the womb with the help of a wooden spatula or brush. The watery smear is then spread evenly on a glass slide which is then stained (Papanicolaou stain) to make the cells easier to see. The slide is viewed under the microscope by a doctor or expert technician to detect any abnormal cancer cells.

Colposcopy. All smears that show evidence of HPV infection should be followed up by colposcopy – direct visual examination of the cervix. A biopsy will be taken from any suspicious-looking area and examined for cancer.

Please Remember:

If you have any of the following symptoms or signs, you should contact your doctor immediately.

With grateful thanks to www.breastcancer.org; this has been adapted for local women.

Colorectal (Bowel) Cancer

Both men and women are at risk for colorectal cancers.

Causes and risk factors include: Main symptoms are: Tests required for early detection The best prevention involves:

Healthcare for Men: Prostate Cancer

The prostate is a small gland the size of a walnut that is near the bladder. Often, the prostate grows larger in older men, but it’s not usually cancer. This is called benign prostatic hyperplasia (BPH). It can cause a variety of urination problems, including waking up to urinate several times at night and a slowing down of the flow. BPH is often treated effectively with medicines; if not, a simple operation is done to relieve the symptoms – like cleaning out a blocked drainpipe.

Some men develop prostate cancer. It takes years to develop and usually does not cause symptoms, especially in the early stages. If your doctor finds prostate cancer early, it can be cured.

Advanced prostate cancer can cause pain if it spreads to the bones, such as the back and ribs.

Who is at risk?

Men after the age of 40 are at risk, after which time the likelihood of getting this cancer increases progressively.

Men who have been exposed to cadmium, or too many x-rays, as well as farmers are at higher risk.

What can I do to ensure that, if I were to develop prostate cancer, it is detected early?

Request a prostate exam from your doctor, at least once a year, after the age of 40.

Your doctor may also recommend a blood test (if available) called PSA, which can also help to find it early.

If there is any suspicion, a biopsy (taking needle samples of the prostate) may be recommended.

What are the treatments for prostate cancer?

If caught early and curable, different forms of radiation as well as surgery are all effective treatment options.

Late cancer is initially treated by lowering blood levels of male hormones (called androgens).

Heart Disease

Indians around the world have the highest rates of sickness and death from coronary artery disease (CAD). CAD affects about 10% of the urban population of India. When compared to Europeans and other Asians, CAD rates are two to four times higher in Indians overall and five to ten times higher in those who are younger than 40 years of age. The prevalence of CAD in urban adults is estimated to be 7 – 10% in North India and as high as 14% in South India.

CAD is the commonest variety of heart disease, which manifests as angina pectoris (acute heart-related chest pain), acute myocardial infarction (heart attack) or sudden death.

The heart pumps blood through blood vessels to supply oxygen and nutrients to all parts of the body. Oxygen is the fuel for the energy needs of the body. The heart also needs blood to function, which is supplied by blood vessels known as coronary arteries. When an artery supplying blood to the heart gets clogged, then formation of a blood clot in it can lead to a heart attack. The artery gets blocked by the progressive deposition of cholesterol in the vessel wall leading to plaque formation.

Heart attack warning signs: What are the known coronary risk factors?

These can be put under two headings.

  1. Factors which cannot be modified:
    • Age >55 years in men, >65 years in women
    • Male sex (males are more prone to atherosclerosis)
    • Family history of CAD before 55 years of age (occurrence of CAD in a parent or grandparent before 55 years of age)
  2. Factors which may be modified:
    • High blood cholesterol
    • Smoking or tobacco chewing (present/past)
    • High blood pressure (BP)
    • Physical inactivity (sedentary lifestyle)
    • Diabetes mellitus
    • Mental stress
    • Obesity, especially abdominal fat deposit (waistto hip ratio >0.95 in males, >0.85 in females)
Reasons for high risk of heart attack in young Indians

The prevalence of hypertension (high blood pressure) in Indians is not extraordinarily high; smoking is more prevalent among westerners. The average level of cholesterol in Indians is also lower. Still Indians are prone to CAD at a young age. This so-called ‘Asian paradox’ is probably due to many factors such as:

At what time of day do most heart attacks occur?

Heart attacks most commonly occur between 4:00 a.m. and 10:00 a.m. The possible reasons are that blood pressure increases abruptly in the morning, the anti-clotting mechanism of blood is least efficient at this time, and coronary arteries are also in a state of constriction during morning hours.

What should be done if an acute heart attack is suspected?

Prevention of CAD

Role of diet in CAD prevention

Healthy eating and desirable lifestyles are the most important strategies. Medicines are required in some cases.

Basic principles of healthy eating To achieve these goals Standard advice for reducing cholesterol and fat intake Which oils are more desirable?

Unsaturated fatty acids (PUFA – polyunsaturated fatty acids, and MUFA – monounsaturated fatty acids) are preferred over saturated fatty acids. Saturated fatty acids increase LDL (bad cholesterol) production, thereby increasing the risk of CAD, while unsaturated fatty acids (PUFA and MUFA) reduce LDL cholesterol; hence they are preferred.

However, unsaturated fatty acids containing excessive PUFA can be detrimental because they may reduce HDL cholesterol also, which is a good cholesterol. There is no single oil available that contains both PUFA and MUFA in balanced amounts. Therefore, it is better to use a combination of oils having an appropriate balance between PUFA and MUFA and to minimize saturated fatty acid intake.

For example, one can use sunflower oil, having a high PUFA, combined with mustard oil, which has a high MUFA. Similarly, the following are examples of some oils that can be used together to achieve a balance between PUFA and MUFA:

Saturated fatty acids are normally solid or semi-solid at room temperature. Examples are coconut oil, vanaspati, and desi ghee. Unsaturated fatty acids are normally in a liquid state at room temperature. Examples are: safflower, sunflower, til, rice bran, mustard, ground nut, and soybean oils.

Role of dietary fibre in prevention of CAD

Dietary fibre is that part of food that is not digested in the stomach and small intestine. Soluble fibre prevents constipation and bowel cancer.

Sources of soluble fibre

Oats, legumes, gur, barley, apples, citrus fruit, carrots, etc.

Sources of insoluble fibre

Whole wheat, bran, green vegetables, fruits, etc.

Benefits of fibre Healthy options Why is it important to avoid excessive sugar intake even if a person is not a diabetic?

Too much sugar promotes undesirable weight gain and tends to increase the triglyceride levels.

When is drug treatment for high cholesterol called for?
Medication may be required in addition to dietary measures when:

Safety and effectiveness of drug therapy should be reviewed by periodic lipid profile and liver function tests. Drug therapy should be considered a lifetime commitment. Generally, if medication is stopped, cholesterol returns to previously high levels. Diet control and medication stabilise heart disease, stops further cholesterol deposition in arteries and may even result in some regression of established deposits.

Food Guide for a Healthy Heart

Foods Prefer Limit Avoid
Cereals Wheat, rice, ragi, bajra, maize, jower Foods prepared with maida (white bread, biscuits) Cakes, pastries, naan roti, rumali roti, noodles
Pulses Whole and sprouted, dals
Vegetables Green leafy vegetables and other vegetables Roots and tubers Fried vegetables, banana chips, canned vegetables
Fruits Fresh fruit Dried fruit, canned fruit in syrup
Dairy products Low fat milk, buttermilk, skimmed milk Whole milk, milk powder Cheese, butter, khoa, cream, condensed milk
Fat Vegetable oil combinations Total fat intake, coconut oil,

ghee

Oily dishes, vanaspati, deep fried foods, butter
Sugar and
sugar products
Sugar, jaggery Sugar in any homemade beverages, all nuts and oil seeds Sweets such as chocolates, ice creams, gulab jamun, jalebi
Nuts and oil seeds All nuts and oil seeds
Beverages Water, fresh fruit juice (no added sugar), light tea Coffee,
soft drinks
Alcohol
Salt Foods in natural state

without salt

Too much salt in preparations Pickles, salt, papad, sauces, biscuits, fried crispies

Sodium Content of Food

Vegetables Mg
Bitter gourd2.4
Parwal2.6
Brinjal3.0
Onion4.0
French beans4.3
Pumpkin5.6
Lady finger6.9
Peas, green7.8
Colocasia Arbi9.0
Sweet potato9.0
Yam9.0
Cucumber10.2
Potato11.0
Tomato ripe12.9
Radish, white33.0
Tinda35.0
Carrot35.6
Cauliflower53.0
Lettuce58.0
Spinach58.2
Coriander leaves58.3
Beet root59.8
Jack fruit63.2
Radish, pink63.5
Fenugreek leaves76.1
Lotus stem438.0
Other Mg
Buffalo milk19.0
Coriander seeds32.0
Cow milk curd32.0
Neem leaves72.0
Cow milk73.0
Cumin seeds126.0
Fruits Mg
Plum0.8
Anar0.9
Peaches2.0
Phalse4.4
Orange4.5
Guava5.5
Chikoo5.9
Papaya, ripe6.0
Pears6.1
Papaya green23.0
Mango, ripe26.0
Watermelon27.3
Apple28.0
Pineapple34.7
Banana36.6
Mango, green43.0
Melon104.6
Lichi124.9
Grains Mg
Jowar7.3
Wheat vermicelli 7.9
Wheat flour refined 9.3
Maize, dry 15.9
Wheat flour 20.0
Semolina 21.0
Green dram dal 27.2
Red gram dal 28.5
Bengal gram whole 37.3
Black gram dal 38.8
Lentil whole 41.1
Bengal gram 73.2
Amaranth230.0
Who should have a lipid profile?

Ideally, everybody should have a lipid profile at the age of twenty years. This is to assess the future risk of CAD. It also helps detect genetic abnormalities of cholesterol and TG levels. If the lipid profile is normal at twenty years, it may be repeated after five years.

Normal levels of lipids

Lipid Desirable range
Cholesterol <200 mg%
LDL cholesterol <100 mg%
HDL cholesterol >40 mg/dl for men
>60 mg/dl for women
Triglycerides (TGS) <150 mg/dl
Lipid profile at a young age is especially indicated in the following situations: How does regular exercise help?

Regular exercise prevents CAD and premature death and is one of the most important parts of a healthy lifestyle. The risk of heart attack is greatly reduced by regular exercise, which keeps blood pressure and heart rate at relatively lower levels.

Regular physical activity also raises the blood levels of HDL cholesterol, which protects against fat deposits in blood vessels and prevents heart attacks. Persons suffering from high blood pressure can avoid or reduce drug intake through regular physical activity. Exercise improves blood circulation to the legs and reduces leg cramps.

Modest exercise of thirty minutes, three to five times a week, is enough. The level of physical effort may always be increased gradually. Brisk walking, swimming, cycling or light games (badminton and table tennis) are good. Weight lifting does not help with fitness although it improves strength.

Safety rules for exercise Strategies to control stress in preventing CAD

Stress activates the sympathetic nervous system, resulting in a faster heartbeat, high blood pressure and constriction of the coronary arteries, all of which increase the oxygen requirement of the heart muscles. Stress also promotes clot formation within these vessels.

Although easier said than done, one should learn to cope with stress by: Role of tobacco/smoking in CAD

Smoking is a major risk factor for CAD. Smoking is in fact the major (often the only) risk factor for CAD in people below forty years of age. The prevalence of CAD in smokers is three to five times greater than that in non-smokers. The nicotine present in tobacco leads to an increase in heart rate and blood pressure and narrowing of the blood vessels.

Does giving up smoking help?

The risk of CAD begins to decrease within one year of quitting smoking even in lifelong smokers. The risk continues to fall further with abstinence from smoking. See also pages 54-57.

Managing stress

Stress management is a learning process. First, identify the particular cause of your stress. Second, take steps to change those circumstances that are stressful, whenever possible. Third, relearn ways to cope with stress in your everyday life.

The following are a few suggestions for coping with stress: Obesity and CAD
Obesity increases the risk of fatal heart attacks because:

A good measure of obesity is the body mass index (BMI). This is calculated as weight in kilograms divided by the square of height in meters.

Weight
Height2
Normal BMI 19 – 24.9
Overweight 25 – 29.9
Obese 30 – 40
Morbid Obesity >40
Does weight control help?

Yes, weight reduction often reduces blood pressure to normal levels. It improves glucose levels and control of diabetes. It also reduces the frequency and severity of angina and the risk of heart attack and improves the pumping efficiency of the heart.

Do not ignore signals of a heart attack.
Do not hesitate to seek medical help.

Diabetes

Diabetes mellitus has become a major menace in India. Every fourth or fifth household in urban areas has a diabetic patient. The incidence of diabetes has increased dramatically over the years. A few decades ago, approximately 2% of the adult population suffered from diabetes. In the last two to three decades there has been a sharp rise to approximately 8 – 10%. According to the World Health Organization (WHO), India will have 57 million diabetic patients by 2025. Although there is no known cure for diabetes, with modern treatment one can hope to lead as normal, as active, and as useful a life as any other person.

What is diabetes?

Diabetes is a condition in which there is too much glucose (sugar) in the blood due to defective insulin action or deficiency in its secretion. Insulin is required for glucose to enter the cells of the body, where it is utilised. It is as if insulin is a key which opens the doors of the cells to allow glucose to enter. When insulin is absent or is less efficient, glucose in the blood cannot enter the cells and remains in the blood in high amounts.

What happens in diabetes?

When glucose does not enter the body cells due to lack of insulin, it accumulates in the blood. After it reaches a certain limit, it starts appearing in the urine. Normal urine does not contain glucose. When glucose appears in the urine, it draws out more water with it and hence there is excessive urination. Because of excess urination (loss of water) there is excessive thirst. Although there is excess glucose in the blood, there is not enough in the cells due to lack of insulin. The cells are starved of glucose. This causes an increase in appetite. Hence a diabetic eats more, but the body’s cells do not get enough glucose. In a desperate effort to get energy, the “starved cells” begin using body fat and protein. This can eventually cause loss of weight and tiredness, but usually only in Type I diabetes.Because of high levels of glucose in the blood, some people become irritable. Sometimes very high blood glucose can lead to coma. Also there is a greater risk of developing infections. Symptoms may not be present.

Common symptoms of diabetes What causes diabetes?

Two main factors are responsible for causing diabetes:

  1. Inherited factors: Some genetic factors are inherited from parents. That is why it is more common in some families. If one parent has diabetes, there is a 20% chance of diabetes in the children, whereas if both parents are diabetics, chances increase to 20 – 50%.

  2. Environmental factors such as:
    • Obesity
    • Physical inactivity
    • Lack of exercise
    • Poor food choices, especially high-sugar, high-fat, low-fibre fast foods.

These factors precipitate diabetes in those who have inherited the trait.

Are all diabetics alike?

No, all diabetics are not alike. Diabetics can be classified into two main groups.

Type I Type II Preventing Type II diabetes is possible
  1. Primary prevention of diabetes is targeted in individuals who are at a high risk of developing diabetes. You are at high risk if you:
    • Have a blood relative who is a diabetic
    • Are overweight (BMI >25)
    • Delivered a big baby (birth weight was 4 kg or more)
    • Had diabetes or even a mild elevation of blood sugar during pregnancy
    • Are physically inactive, meaning you exercise less than three times a week
    • Have high blood pressure
    • Are pre-diabetic: fasting blood glucose of 110 – 126 mg%, postprandial (after eating) glucose of 140 – 200 mg%
    • Have triglycerides or cholesterol levels higher than normal

    Success in preventing diabetes depends upon:
    • Maintaining an ideal body weight or losing about 5 – 7% of your body weight (if your body weight is more than desired). Even 2 – 3 kg of weight loss can make a difference.
    • Diet should be of foods which have a low glycemic index, such as whole wheat, whole grains, beans, fruits, vegetables, etc. Fats should be only of an unsaturated type like liquid vegetable oils.
    • Undertaking a brisk walk or other forms of physical activity for 30 minutes, 5 times a week.
  2. Secondary Prevention: If you keep good control of your diabetic state (blood sugar, lipid profile, blood pressure) and take other measures such as a small daily dose of aspirin, statins and ACE inhibitors (if needed and under the guidance of your doctor), you can prevent the complications of diabetes.
  3. Tertiary Prevention: Even when complications such as eye, kidney, heart, vascular, or nerve problems have started, it is possible too prevent further damage and preserve the function of these organs if these problems are detected in the earlier stages.
Responsibility of a diabetic in preventing diabetes among blood relations
You know that if you are a diabetic, other members of the family may have diabetes. Try to convince your brothers and sisters to undergo screening for diabetes, particularly if they: Screening is simple

Get blood sugar tested two hours after a meal (postprandial). If blood sugar is greater than 140 mg%, re-check while fasting and two hours after 75 gms of glucose have been taken orally.

Fasting 2 hrs after a meal
Normal <110 mg% <140 mg%
Pre-diabetic 110 – 125 mg% 140 – 200mg%
Diabetic >200 mg%

Even if your fasting blood sugar is normal but, after the Impaired Glucose Tolerance (IGT) test your blood sugar levels are above normal, you should repeat the IGT every year. The IGT should not be ignored. Lifestyle modification can help in preventing diabetes.

Preventing diabetic complications

Diabetes, if not well controlled, affects other organs of the body and can lead to serious acute and long-term complications. It is possible to delay or prevent some of these complications if diabetes is controlled properly.

Acute complications

Patients with diabetes who neglect to control high blood sugar may lose excessive amounts of water and salt in their urine. This can lead to dehydration, which can sometimes be fatal.

The diabetic who knows the most
will live the longest.

Hyperglycaemia (high blood sugar/ketoacidosis and coma)

Burning of fats can be inefficient as a way of producing energy and the process results in products called ketone bodies which make the blood acidic. This condition, called ketoacidosis, is more common amongpatients who require insulin to control the diabetes. It occurs if the patient stops taking insulin or the insulin requirement increases (due to illness or fever). The patient suffers vomiting, abdominal pain, dehydration (excessive loss of salt and water), breathlessness, and a characteristic fruity smell like acetone on the breath. Unconsciousness and even death may occur.

Hypoglycaemia (low blood sugar)
Hypoglycaemia means abnormal lowering of blood sugar below the acceptable range, which leads to a variety of symptoms. Hypoglycaemia may also occur without any warning signals, or even during sleep. It may occur due to:

What are the symptoms of hypoglycaemia?

Minor Moderate Severe
Sweating Weakness Poor cognitive function; impaired capacity to solve problems, including loss of awareness of the need to respond to the hypoglycaemia itself
Palpitations Hunger pains Confusion
Nervousness Drowsiness Reduced ability to concentrate
Trembling Slowed reactions
How to avoid hypoglycaemia

Mild hypoglycaemia is self-limiting and is corrected by the body’s natural mechanism, whereas severe hypoglycaemia, if not treated properly, may result in coma.

Proper care about diet, exercise and medication can help to avoid hypoglycemia. Always carry something sweet and eat it the moment you observe the symptoms. Keep your relatives informed about hypoglyacemia. Always carry your identity card showing that you are a diabetic. Contact a doctor immediately if you are in severe hypoglycaemia.

2. Long-term complications

The common long-term complications are as follows:

Diabetes and blindness

Many diabetics complain of not being able to get proper glasses due to fluctuating vision. It is because of fluctuating blood sugar levels. To obtain new glasses while the blood sugar is uncontrolled serves no purpose. Therefore, it is advisable to control blood sugar for at least two to three weeks before obtaining new glasses and then maintain good control.

A change in the number of glasses prescriptions may be a sign of diabetic retinopathy, a condition which leads to blindness if due care is not exercised.

What is diabetic retinopathy?

Diabetic retinopathy is the most frequent cause of blindness in diabetics. Early detection and appropriate therapy may prevent blindness due to diabetic retinopathy. Diabetic retinopathy occurs when vessels in the retina are ruptured or produce a new growth (neo-vascularization), which leads to impaired vision and blindness.

The diabetic who knows the most
will live the longest.

What can be done to prevent blindness? Diabetes and heart attack

Heart attacks are about three times more common in persons with diabetes, and diabetics are prone to develop high blood pressure.

Preventing heart attack and stroke in diabetics
Diabetic patients have two to four times more chance of getting a heart attack or stroke as compared to the non-diabetic population. There are certain peculiarities of heart attacks in diabetic patients: Factors responsible for heart attack in diabetics If the above factors are taken care of, heart attacks are reduced by almost 50%. Try to achieve the following target values: Preventing kidney failure and damage in diabetics

Uncontrolled diabetes damages the kidneys, often leading to kidney failure. One third of all new cases of renal (kidney) failure seen today are the result of uncontrolled diabetes.

Kidneys can be protected by: Blood vessels and circulation

The arteries may develop fat deposits, hindering the flow of blood. This can lead to stroke and gangrene of limbs at times.

Your attitude decides your success
in looking after your diabetes.

Diabetes and the nervous system

Uncontrolled diabetes affects the nerves, which can lead to loss of sensation. Because of loss of sensation, minor cuts and wounds go unnoticed. The wound can get infected, and when this happens in association with poor circulation, it can lead to gangrene or a need for amputation.

Show your doctor your feet at each visit
and ask your doctor if your feet are at risk.

Care for your feet (prevent gangrene and amputation) Diabetes monitoring schedule to achieve good control

Each and every test has some significance and offers important but limited information. Some parameters like blood sugar change minute to minute, others like cholesterol may not change for months. Hence, the tests are repeated according to this pattern of change and stability so that monitoring becomes effective and economical.

Which tests are to be done and when?
At the time of initial diagnosis of diabetes Once treatment has stabilized the diabetic state, the tests are meant to confirm:

Self care is more effective and
practical with best results.

Quarterly check-up for a diabetic Half yearly check-up for a diabetic Yearly check-up for a diabetic
  1. Comprehensive check-up of all systems
  2. Fundus (eye) examination
  3. Complete heart check-up
  4. Renal function test, liver function test

Merely having the knowledge is not enough,
you have to achieve its implementation.

Management of diabetes

What is diabetic control?
Diabetic control can mean different things to different people: To achieve good control, you must understand your disease. The doctor can help you to attain the goals that you wish to set, but remember, you are the key person in the management of the disease. The chief tools in the management of diabetes are:

When we eat any food, whether consisting of carbohydrates, proteins, fats or mixed in different ratios, the blood sugar rises. The blood sugar rise depends on the glycemic index (GI) of the particular food.

The GI is the ratio of blood sugar level after taking any food item to that after taking equal calories of glucose. The GI of glucose is very high. If we do not want our blood sugar to rise very quickly, our food should be of low GI.

Significance of the glycemic index

Glycemic Index of Some Food Items

Curd 14 Green peas 47
Cherries 22 Oatmeal 48
Kidney beans 29 Carrots 49
Lentils (green, brown) 30 Sweet potatoes 52
Whole milk 32 Mangoes 55
Skimmed milk 30 Bananas 56
Tomato soup 38 Potatoes 59
Apples 38 Wheat 66
Oranges 43 Watermelon 72
Grapes 46 Corn flakes 83
A mixed diet of different nutrients has a lower GI. If we eat roti with dal, the GI will be lower than that of roti if taken alone. General guidelines on diet

What are the main adjustments in a diabetic diet?

Diabetic diet instructions
  1. Weight should not exceed your expected ideal weight.
  2. Do not starve yourself. Take the free foods from the list below.
  3. Divide your whole day’s ration into 5 to 6 meals of equal quantity and nutrients, rather than eating 2 to 3 major meals.
  4. Exercise is good and should be a part of the daily routine.
  5. Feasts and fasts should be avoided.
  6. Cereals are the principal source of carbohydrates and should be consumed in prescribed amounts; use of mixed or whole grain cereals is desirable.
Free foods

Plain tea and coffee, nimbu pani, clear soup, plain aerated soda, vinegar, diluted khatti lassi, kheera, kakkri, tomato, muli, karela, sag, and leafy vegetables.

Foods to be avoided

Ice cream, pudding, mango, banana, sitaphal, kishmish, grapes, chikoo, khajur, dry fruits, nuts, alu, shakarkandi, kachalu, chukander, fried foods, pickles in oil, cakes, pastry, maida articles, and pineapple.

Meals by Caloric Content

Calories 800
Protein 40 g
Carbohydrates 14 g
Fat 130 g
Breakfast
Vegetable enriched dalia1 cup
Curd or milk1 katori or 1 cup
Missi or stuffed chappati or1 small
Curd or1 katori
Skimmed milk1 cup
Mid morning
Vegetable soup or lemon water 1 cup
Lunch
Chappati without ghee1 small
Dal½ katori
Curd½ katori
Seasonal boiled vegetable1 katori
Salad¼ plate
Evening Tea
Skimmed milk (reduce curd in lunch) or1 cup
Tea1 cup
Marie biscuit1 biscuit
Dinner
Vegetable soup1 cup
Chappati without ghee½ small chappati
Dal¼ katori
Seasonal boiled vegetable1 katori
Salad¼ plate
Note:
  1. 1 katori of dal is 150 mL or 25 g
  2. 1 cup of milk is 150 mL
  3. Use only skimmed milk for drinking and for preparation of tea and curd
  4. 1 katori of curd is 25 g

Meals (continued)

Calories 1300 1600 1900
Protein 50 g 60 g 70 g
Carbohydrates 30 g 36 g 43 g
Fat 210 g 260 g 310 g

Breakfast
Milk 1 cup 1 cup 1 cup
Dalia 1 katori 1 katori 1 katori
Stuffed/missi roti 1 roti 1 roti 1 roti
Curd 100g 100g 100g
Mid-morning
Tea, lassi or nimbu pani Tea, lassi or nimbu pani Tea, lassi or nimbu pani Tea, lassi or nimbu pani
Sprouts or fruits Sprouts or fruits Sprouts or fruits Sprouts or fruits
Lunch
Chappati 2 small 3 small 2 medium
Dal 1 katori 1 katori 1 katori
Vegetable 1 katori 1 katori 1 katori
Curd 100 g 100 g 100 g
Salad ¼ plate ¼ plate ¼ plate
Evening Tea
Tea 1 cup 1 cup 1 cup
Biscuit 2 – 3 biscuits 2 – 3 biscuits 2 – 3 biscuits
Poha or upma 1 katori 1 katori 1 katori
Dinner
Chappati 1 small 1 small 2 medium
Dal or
cheese curry
½ katori 1 katori 1 katori
Vegetable 1 katori 1 katori 1 katori
Curd 100 g 100 g 100 g
Salad ¼ plate ¼ plate ¼ plate

Vegetable Exchange
Negligible carbohydrates and calories – use as desiredContains 10 g of carbohydrates and 50 calories
Leafy VegetablesRoot VegetablesQuantity (g)
Amaranth (Chawli) Beet root 75
Bathua Carrot 105
Cabbage Colocasia 45
Coriander leaves Onion (medium) 90
Fenugreek leaves Potato 45
Curry leaves Sweet Potato 30
Lettuce Yam 45
Mint
Spinach
Soya leaves
Other Vegetables Other vegetables
Ash gourd Broad beans 90
Bitter gourd Cluster beans 90
Brinjal Double beans 50
Calabash cucumber Jack tender 105
Cauliflower Jack fruit seeds 30
Cucumber Peas 45
Drumstick Plantain green 75
French beans Singhara 45
Mango green
Lady’s fingers
Onion stalks
Parwal
Plantain flower
Pumpkin
Radish
Snake gourd
Ridge ground
Tinda
Tomato green
Turnip

Fruit Exchange
Carbohydrates 10 g, Calories 50
FruitsQuantity (g)Approximate Quantity
Amla 90 20 Medium
Apple 75 1 Small
Banana 30 ¼ Medium
Cape gooseberry 150 40 Small
Cashew fruit 90 2 Medium
Custard apple 50 ¼
Dates 30 3
Figs 135 6 Medium
Grapes 105 20
Guava 100 1 Medium
Jambu fruit 50 10 Big
Lemon 90 1 Medium
Loquat 105 6 Big
Mango 90 1 Small
Melon 270 ¼ Medium
Orange 90 1 Small
Papaya 120 2 Medium
Peach 135 1 Medium
Pear 90 1 Medium
Pineapple 90 1 ½ Slice (round)
Plum 120 4 Medium
Pomegranate 75 1 Small
Sweet lime 150 1 Medium
Strawberry 105 40
Tomato 240 4 Medium
Watermelon 175 ¼ Small

Legume and Pulse Exchange
30 g = 100 Calories, Carbohydrates 15 g, Protein 6 g
Bengal gram Kabuli channa
Bengal gram, roasted Lentils
Besan Moth beans
Lobhia Rajmah
Green gram Peas, dry
Red gram (Arhar)

Cereal Exchange
30 g = 100 Calories, Carbohydrates 20 g, Protein 2 g
Bajra Rice flakes
Barley Rice puffed
Bread (to meet carbohydrates and calories with 5 g sugar)
Jowar Samai (vermicelli)
Cornflakes Suji
Maize, dry Wheat flour
Oatmeal Maida
Rice Dalia
Ragi Sago (requires supplementation with other high protein foods, when used)

Milk Exchange
Calories 100, Protein 5 g
FoodQuantity
Butter milk750 mL
Cheese30 g
Curd210 g
Khoa30 g
Milk buffalo90 mL
Milk Cow180 mL
Milk skimmed*260 mL
Milk skimmed powder*30 g

* provides 10 g of protein

Fat Exchange
Calories 100, Fat 11 g
FoodQuantity (g)
Almonds15
Butter15
Cashew nuts20
Coconut30
Ghee11
Groundnuts roasted20
Vanaspati ghee11
Oil11
Walnuts15
Pista15

Nutritive Value of Commonly Used Portions of Indian Foods

Food Units Household Measure Protein (g) Calories (kcal
Milk and Milk Products
Milk, cow’s 250 mL 1 glass 8.00 167.50
Milk, buffalo’s 250 mL 1 glass 10.75 292.50
Milk, skimmed 250 mL 1 glass 6.25 72.50
Curd 125 g 1 katori 3.87 75.00
Paneer 25 g ½“x ½” x 2″ 6.00 87.00
Buttermilk 250 mL 1 glass 2.00 37.50
Skimmed milk powder (cow’s) 100 g - 38.00 357.00
Cereals and Pulses
Wheat flour chapatti, thin 25 g 1 chappati 3.03 85.25
Chapatti, medium 30 g 1 chappati 3.63 102.30
Chapatti, large 40 g 1 chappati 4.84 136.40
Wheat porridge 25 g 1 katori 2.95 86.50
Suji 15 g 1 Tbsp 1.56 52.20
Rice 30 g 1 katori 1.92 103.80
Dal Moong wash 30 g 1 katori 7.35 104.40
Dal Malka Masur 30 g 1 katori 7.53 102.90
Dal Arhar 30 g 1 katori 6.69 100.50
Bengal Gram Whole

(Black Channa)

40 g 1 katori 6.84 144.00
Channa Dal 30 g 1 katori 7.20 104.10
Vegetables
Palak 100 g 1 katori 2.00 26.00
Methi 100 g 1 katori 4.40 49.00
Patta gobhi 100 g 1 katori 1.80 27.00
Brinjal (Baingan) 100 g 1 katori 1.40 24.00
Ghea 100 g 1 katori 0.20 12.00
Pumpkin

(Halwa kadhu)

100 g 1 katori 0.10 25.00
Cauliflower

(Phool gobhi)

100 g 1 katori 2.60 30.00
Potato 100 g 1 katori 1.60 97.00
French Beans 100 g 1 katori 1.70 26.00
Mushrooms 100 g 1 katori 3.10 43.00
Fruits
Orange 100 g 1 piece 0.70 48.00
Banana 100 g 1 piece 1.20 116.00
Papaya 100 g 1 piece 0.60 32.00
Apple 100 g 1 piece 0.20 59.00
Guava 100 g 1 piece 0.90 51.00
Nuts and Oil Seeds
Almonds 15 g 1 Tbsp 3.12 98.25
Cashew nuts 15 g 1 Tbsp 3.18 89.40
Coconut, dry 15 g 1 Tbsp 1.02 99.30
Walnuts 15 g 1 Tbsp 2.34 103.05
Raisins 20 g 1 Tbsp 0.36 61.60
Ground nuts 15 g 1 Tbsp 3.80 85.05
Fats and Oil
Ghee and oil 15 g 1 Tbsp 135.00
Butter 20 g 1 Tbsp 145.80
Misc. Food Stuffs
Honey 15 g 1 Tbsp 47.85
Sugar 15 g 1 Tbsp 59.70
Jaggary 20 g 1 Tbsp 76.60
Sago (Sabudana) 20 g 1 Tbsp 70.20
Bread Brown 25 g 1 slice 2.20 61.00
Bread White 25 g 1 slice 1.95 61.25
Corn flakes Kellogg’s 30 g 1 cup 2.40 114.00
Nutrinuggets 5 g 5 – 6 pieces 4.11 43.10
Threptin Biscuits 5 g 1 biscuit 1.50 22.00
Jam 20 g 1 Tbsp 55.00
Jelly 18 g 1 Tbsp 50.00

Merely having the knowledge is not enough,
you have to achieve its implementation.

Adjustment of diet should take into account:
  1. Composition of food:
    Carbohydrates 65% of total calories
    Proteins 15 – 30% of total calories
    Fat 20% of total calories
  2. Distribution of meals:
    Bed tea 5 – 10% of total calories
    Breakfast 20% of total calories
    Lunch 30% of total calories
    Evening tea 10% of total calories
    Dinner 30% of total calories

Low-GI Recipes

For 1 chapati, mix: For bran biscuits (20 g each), mix:
15 g Wheat atta

10 g Channa atta

 5 g Barley atta

100 g Wheat atta

100 g Wheat bran

 10 g Oil

  5 g Salt

  1 g Ajwain

  ½ g Baking powder

Exercise

Exercise helps to reduce the long term complications of diabetes.

If there are so many advantages of regular exercise, what makes you go against it – sheer laziness? The common excuses are: When not to exercise Watch your prescription

Many of you have felt that you are taking too many tablets; it may be inconvenient and expensive, and may be having some side effects too. You may not be convinced about the usefulness of these drugs, as there are no immediate results. The doctors, on the other hand, are responsible not only for immediate benefit but also for prevention of long-term complications.

Both are right, the patients and the doctors. The doctors ought to explain, and patients have to understand, why a particular drug is given and for how long. Always ask if you do not understand what has been said or advised.

We can classify medication approaches as follows:
  1. Drugs which are essential for normalizing blood sugar levels for:
    Type I diabetes: Insulin is essential and has to be taken lifelong.
    Type II diabetes: One can take tablets which:
    1. Reduce insulin resistance, like biguanides and thiazolidinediones
    2. Increase insulin secretion, like sulphonylureas
    3. Reduce digestion of carbohydrates, like alpha-glucosidase inhibitors
    One may need only one or two of these drugs, or sometimes three, and insulin as well.
  2. Drugs to keep the blood pressure below 130/85. The first choice is an ACE inhibitor. It also prevents kidney and heart damage.
  3. Drugs that correct the lipid profile – like statins.
  4. A small dose of aspirin, 75 – 150 mg. a day, is effective in preventing blood-clotting disorders responsible for heart attack and cerebral stroke.

These drugs are important and most diabetics need them.

Discuss with your doctor
before taking any medicine.

Calorie requirement

Determining the basic calorie requirement for your weight and height is an essential component of treatment strategy. Follow these steps to determine the basic calorie requirement that is right for you.

  1. Determine the ideal body weight for your height:
    Men Women
    Height152 cm152 cm
    Weight48 kg45 kg
    Add for each additional cm1.1 kg0.9 kg
  2. Multiply your ideal weight by 22 Kcal per kg to get the daily basic calorie requirement.
  3. Add: For a sedentary life style: 25% of basic calories
        For moderate exercise: 50% of basic calories
        For strenuous exercise: 75% of basic calories
  4. Add or subtract 500 Kcal if you are underweight or overweight respectively.
Example: 170 cm male adult weighing 80 kg with sedentary lifestyle

  1. Determine ideal body weight: For 152 cm, the ideal body weight is 48 kg. To add 1.1 kg for each additional cm, subtract 152 from 170, which equals 18. Then multiply by 1.1, which equals 19.8. The ideal weight is 48 + 19.8 = 67.8 rounded to 68 kg.
  2. Determine basic calorie requirement for a weight of 68 kg: 22 Kcal/kg is the formula. For a 68 kg person, the basic calorie requirement is 68 x 22 = 1496 (approximately 1500) Kcal.
  3. Add calories for lifestyle: Add 25% of basic calories for a sedentary lifestyle. 25% of 1500 = 375 Kcal; 375 +1500 = 1875.
  4. Add or subtract calories for weight: Since the man is over-weight (his ideal weight is 68 kg, but he is 80 kg), subtract 500 from 1875 Kcal, for a calorie requirement of 1375 Kcal per day.

Therefore, a male adult weighing 80 kg with a height of 170 cm with a sedentary lifestyle requires 1375 Kcal per day.

A walk a day keeps diabetes away.

HIV and AIDS

AIDS is a serious and often fatal disease for which there is no cure or vaccine to date. Each one of us is at risk for this deadly disease; we are each responsible for protecting ourselves from it. That is why everyone should know about AIDS.


AIDS can happen to anyone…
but everyone can avoid it.

Information is the only prevention

No complete cure for AIDS has been established at present,
so prevention is the single most important factor.

What is AIDS?
AIDS stands for:

A Acquired (something that you get)
I  Immune (related to the capacity of the human body to fight diseases)
D Deficiency (shortage/reduction)
S Syndrome (a group of symptoms and signs)

AIDS is a communicable disease, meaning it can spread from an HIV-positive person or AIDS patient to other uninfected persons through some specific means. However, it is not a contagious disease; that is, it does not spread by usual casual social contact.

What is HIV?

HIV stands for Human Immunodeficiency Virus. It is this virus that causes AIDS.

How does HIV cause AIDS?

The human body has a way of fighting disease and protecting itself. This defence mechanism can be compared to a country’s army. When a virus or ‘enemy’ enters the body, the body’s defence mechanism or ‘army’ attacks and kills the enemy.

Simply put, the army is the body’s immune system, which fights against infections and diseases. One of the most important components of this immune system is a cell called the ‘CD4 cell’. Usually the number of CD4 cells in a healthy body ranges from 500 to 1800 per millilitre (mL) of blood.

The HIV virus starts attacking CD4 cells by multiplying within them and destroying them. The virus is particularly problematic because it hijacks part of the very system (the immune system) that normally protects us against disease-causing micro-organisms such as fungi, bacteria, and viruses. Over a period of several years, the number of CD4 cells starts declining. The immune system becomes weak, with the result that the body can’t fight infections and diseases very well. This leads to development of certain illnesses that typically affect people with HIV infection. When this happens, it is called AIDS.

Some of the typical illnesses affecting people with AIDS are tuberculosis (TB), diarrhoea, fever, weight loss, pneumonia, fungal infections, herpes, and certain cancers. Many of the germs that cause these illnesses are quite harmless to people who have a normal immune system. But, if the body’s immune system has been weakened by HIV, they can cause severe life threatening illnesses and even death.

What is the difference between being HIV-positive and having AIDS?

Being HIV-positive means that you have been infected with the virus. It is within your body and this can be established by a blood test. However, when various diseases begin to appear or when the number of CD4 cells falls to less than 200 per mL, it is called AIDS. From the time you have been infected with the virus, it may take anywhere from 5 to 10 years for AIDS to develop.

Ultimately, HIV-positive persons develop the AIDS disease and then die, so the sequence of events is as follows:

NORMAL PERSON

HIV INFECTION

HIV-POSITIVE

ASYMPTOMATIC HIV-POSITIVE

EARLY HIV DISEASE

LATE HIV DISEASE

AIDS

DEATH

HIV status can be determined by testing.

Where is HIV found in the body?

HIV can be found in body fluids such as the semen, vaginal secretions and blood of an infected person.

Though there is evidence that HIV is present in tears, saliva, sweat and mother’s milk, the concentration of HIV in tears, sweat and saliva is so low that it usually does not infect others.

How does HIV enter the body and cause AIDS?
HIV spreads from one person to another mainly in three ways:
  1. Entry into the body via semen or vaginal secretions as a result of sexual intercourse with a person infected with HIV (unsafe sexual practices).
  2. Entry into the body via infected blood or blood products such as by blood transfusion or sharing syringes and needles used by HIV-infected persons (usually drug addicts).
  3. From an infected mother to her baby through birth fluids or breast milk.

Sex is the most common cause for the spread of AIDS. When a man or woman has sex with another man or woman who is HIV-positive or is a patient with AIDS, the uninfected person is at risk of getting the HIV infection and AIDS if a condom is not used. The disease can spread through unprotected sex or unsafe sexual practices (i.e., sex without using condoms).

HIV/AIDS ...

AIDS also spreads through the following: AIDS does NOT spread by: HIV/AIDS...

Preventing HIV/AIDS is very easy

Observe restraint and faithfulness in sexual relations. Use clean syringes and instruments. Make sure blood transfusions are safe. What are the blood tests for HIV/AIDS?
If you suspect that you may have AIDS, contact a doctor immediately. The doctor will clear your doubts and, if needed, after counselling he may order a blood test. HIV/AIDS can be diagnosed by blood tests, which are:

The Elisa test should be done only three months after the last possible exposure to HIV/AIDS because of the window period – it can take some time after coming into contact before HIV-positivity is detectable Before that, the Elisa test is not useful. It may give false negative results.

Window period

Once the HIV enters the body of a human being, the blood tests (e.g. Elisa) cannot identify the HIV immediately. About three months have to pass before these blood tests can identify the presence of HIV antibodies in the body. During this period the blood tests may be reported as negative even if the HIV infection is present in the body. A person infected with HIV who tests negative during these three months is fully capable of spreading HIV infection to others. This period is called the ‘window period’, i.e. the period between getting the HIV infection and the appearance of HIV antibodies in the infected person which will test HIV-positive.

Where are the tests done?

Under the National Aids Control Programme being run by the National AIDS Control Organization (NACO), Elisa tests are done at a nominal cost by the voluntary counselling and testing centres in most District Hospitals.

What symptoms should an HIV-positive person watch for?
As mentioned earlier, people who are infected with HIV have a higher chance of getting other infections and diseases. However, this is not common if the HIV-positive person is taking their medicines regularly as advised by their doctor and if their CD4 cell count remains above 200. Watch out for the following symptoms:

As the disease progresses, these symptoms become more obvious or more frequent and the patient becomes weaker and weaker. Some infection or disease is then almost always present. Life may be prolonged with treatment, but AIDS cannot be cured.


What should an HIV-positive person do to stay healthy?

There are many things that an HIV-positive person can do in order to stay healthy. Maintaining a positive attitude and attention to one’s general health is extremely important, as it helps the immune system to fight HIV/AIDS. Do not fall prey to any addictions, whether to legal or illegal drugs.

Follow the golden rules:

HIV-positive persons can lead almost normal lives. This is important as they may have many years of productive healthy life in front of them.

Once the diagnosis of HIV has been confirmed, your doctor will talk to you and send you for some additional blood tests. These tests may include the CD4 cell count and viral load. Both these tests will help your doctor to decide when to start giving you antiretroviral therapy (ART). These medicines do not cure the disease; they hold it in check.

Over the years, many people have claimed to have discovered a treatment for AIDS, but no such claim has been found to be true by scientists or doctors. To date there is no cure for AIDS.

Antiretroviral drugs / therapy (ART or HAART – Highly Active Antiretroviral Therapy)
HIV/AIDS patients can live normally for a long time after regularly taking antiretroviral therapy (ART or HAART). These medicines are available free of cost at specific government hospitals for certain categories of persons such as: ART is not a cure for HIV! Please remember:

Please behave normally and affectionately with such a person just like you behave with patients with other diseases. All sick people need our care and support.

Blood Donation: A Great Humanitarian Act

Blood is an essential part of life and primarily consists of 55% plasma and 45% of cellular contents – red cells, white cells and platelets. Plasma is mainly composed of three types of proteins – albumin, globulin, and fibrinogen along with some coagulation factors.

Each millilitre (mL) of blood contains: These cells and platelets float in a pale yellow fluid called plasma. Indications for transfusion

Blood transfusion is important in the treatment of:

Accidents Haemolytic disease of the newborn
Anaemia Haemorrhages
Bleeding after childbirth Leukaemia
Bleeding diathesis Major operations
Burns (plasma only) Thalassaemias
What is the role of the different components of blood?

Become a life saver – donate blood

ABO blood groups

A person’s blood group never changes throughout his or her life. It is classified according to the proteins (antigens) present in the red blood cell membrane.

Blood group Red blood cells that have...
AB both A- and B-proteins (antigens)
A the A-protein (antigen) only
B the B-protein (antigen) only
O none of these proteins (antigens)
Rhesus blood group (Rh factor)
The Rh group is named after the macacus rhesus monkey, as it resembles the protein in the red blood cells of rhesus monkeys. Who can donate blood? Postpone blood donation if you have: You may not be able to donate blood if you have: Helpful and healthful tips for blood donors
Before donating blood: After donating blood: What will happen when you donate blood?

Remember, body fluids lost due to the donation are completely replenished within 24 hours.

That’s all except when you leave,
you feel so good!

What happens to the blood you have donated?

After collection of blood in a plastic bag containing an anticoagulant solution to prevent the blood from clotting, it is processed for ABO, Rh grouping and screening for all transmissible infections like HIV, hepatitis B, hepatitis C, syphilis and malaria, and stored in a refrigerator operating at 4 – 6˚C.

The blood collected for preparation or separation of platelets is stored at room temperature in a platelet incubator or shaker. Platelets can be preserved for five to seven days, while fresh frozen plasma can be stored at – 30˚C for a period of one year. Before blood is issued for transfusion it is cross-matched with that of the patient to ensure that the donor and the recipient have compatible blood groups.

It is important to note that blood has different components that can be prepared in a blood centre. The usual components include packed red cells, platelets, cryoprecipitate, plasma, etc. The shelf life for each component varies, but the real advantage is that one unit of blood can be used for four or five patients depending upon the specific requirement of the patient. For instance, a case of anaemia will require red blood cells, a case of bleeding or leukaemia will require platelets, and a burn case will require plasma. Cryoprecipitate will be utilized specifically for a case of haemophilia or allied bleeding disorder.

I don’t know your name…
…but thanks for your gift of life.
Donate blood!

Become a life saver –
Donate blood!

Blood – the Elixir of Life
Information from the Voluntary Blood Bank

Plasma Donations

In addition to donation whole blood, you can donate plasma.

Plasma – the most versatile component of your blood
Blood is composed of red blood cells, white blood cells, and platelets suspended in a fluid called plasma. Why donate plasma?
Thirteen different products can be made from plasma donations. Some of the most needed products are:

Help people put up a good fight –
donate blood!

What is involved in donating plasma? What happens during the donation?

During plasma donation, whole blood is drawn from one arm into a sterile collection kit inside a cell separating machine. The machine separates the blood so that only plasma is collected. The other blood components (red and white blood cells, and platelets) are returned to the donor through the same line.

Is the plasma donation process safe? How often can a plasma donation be given? How do I become a plasma donor?

Give someone the gift of life – donate blood!

Frequently asked questions

How much blood will I lose?

The human body contains about 5 – 6 litres of blood. Each full donation is 350 mL. Your body naturally replaces the lost fluid in a very short time (within 24 hours) and you do not even feel anything from it. That is why some people going for planned surgery donate their own blood, 3 – 4 weeks in advance, and this can be used for them during their surgery (operation). This procedure is well accepted and is called autologous blood donation.

Why are voluntary donors preferable to professional ones?

Professional sellers are motivated only by the desire to earn money. They may conceal their ailments and some types of infections or use of drugs which cannot be readily detected by any tests. Blood from professional sellers exposes the patient to serious risk, whereas voluntary donors freely disclose any ailments they may have, and their donations are safe and reliable.

How will giving blood affect my health?

Your donation will be accepted only if you are fit and well. Only about 5% of your blood volume is taken and there is usually no weakness or other ill effect noted. The volume of liquid lost is replaced within 24 hours and the blood cells will take a few weeks to replace themselves.

What if I need blood?

If you need blood urgently, the hospital will provide it. Most hospitals like to replace blood given to patients with donations from relatives or friends of patients.

Can I smoke after giving blood?

It is best that you do not smoke for two hours after the donation, as this can cause dizziness or even make you faint. Better still, don’t smoke at all!

Can I bring a friend?

Yes. Your friend may be interested when he or she sees how painless and simple it is to give blood.

Can I go back to work?

Yes, as long as you have the full rest and some refreshment before you leave the blood donation session. On rare occasions, people can faint some time after donating blood. So, if you are in an occupation where this could endanger yourself or others, you should not go on duty after giving blood that day.

If you drive a lorry or train, for instance, or work in an emergency service, or your work involves heights (e.g., climbing ladders), you should not go back to work on the day that you donate blood. You should come and give blood at the end of your shift.

Where can I go to donate blood?

You can donate blood at a blood donation camp near your home, work place or school, or you can go to a recognized blood bank in your area. Please call the local Indian Red Cross Blood Bank for information.

A Healthy Habit
Donation of blood from time to time has certain personal benefits: Please Remember:

Blood cannot be manufactured. It has to be donated by human beings. If every eligible person made blood donation a way of life, there would be no shortage and no one would have to go without it.

Let us work together to save more lives –
Donate blood today!
Be responsible. Be a blood donor.
Help save a life.

Eye Donation

From Darkness To Light

One million blind in our
country can get back their
sight if you help them;
they need corneal transplantation.

It can make a difference if you –
pledge your eyes today
donate your dear one’s eyes.
Do not close their eyes,
keep them open even after death.

Eye donation is a priceless gift
which only you can give.

You can help make this happen. Let eye donation be your family tradition. Donate the eyes of your dearest. Age doesn’t matter. What is corneal blindness?

The cornea is the clear window covering the front of the eye. It transmits and focuses light. Vision is dramatically reduced or lost if the cornea becomes cloudy from infection, injury or any other disease.

Common causes of corneal blindness are:

Fortunately, in most cases lost sight can be restored through the medical intervention of corneal transplantation from a donated eye.

Which patients benefit from eye donations? Which part of the eye is used?

Mostly the transparent part of the eye (cornea) is used. Sometimes the white portion (sclera), conjunctiva and stem cells at the corneal periphery are used.

How can I pledge my eyes?

Fill an eye pledge form available at any eye bank and get it signed by a relative.

What else can I do for eye donation? Join the EYE DONATION MOVEMENT

Organ Donation: A Gift of Life


There are stars whose radiance is visible on earth though they have long been extinct. There are people whose brilliance continues to light the world though they are no longer among the living. These lights are particularly bright when the night is dark.
Hannah Senesh

Life is precious

Death is a fact of life! We are born to live and die. In the words of Tagore, “Death belongs to life as birth does. The walk is in the raising of the foot as the laying of it down.” Some might assume that death is the end of life. But a person can live on even after death. And death can be made as meaningful as life by giving the precious gift of life to many terminally ill patients by donating your organs.

Life is too precious to be lost to an organ failure. But millions have lost their lives when a vital organ ceased to function properly. The fact is that medical advances in the field of transplant immunology, surgical management, and organ preservation have made the transplantation of vital organs possible. This provides a viable approach to the management of diseases that cause irreversible organ failure. So all you need to do is pledge to donate an organ and help precious lives from being lost before their time.

Transplantation has meant a significant improvement in quality of life, offering the opportunity for many organ recipients to resume healthy and productive lives. For renal patients, kidney transplantation offers the opportunity to resume a normal life, no longer subjected to the need for regular dialysis treatment. For some heart and liver patients, for whom there is no equivalent of dialysis, trans-plantation is their only chance of survival.

Many patients are dying and families are grieving because of the critical shortage of donor organs. The cruel irony, however, is that an organ shortage need not exist, if even a fraction of our population pledge to serve the living by donating organs after death.

Ask yourself whether the dream of heaven and greatness should be waiting for us in our graves or whether it should be ours here and now and on this earth.
Ayn Rand

What is organ donation?

Organ donation means gifting someone a life. When people donate organs, it means they are donating more than just an organ. It means they are gifting a life. In simple terms it means that they pledge during their lifetime that, after their death, organs from their bodies can be used for transplantation to help terminally ill patients, giving them a new lease on life.

We make a living by what we get,
but we make a life by what we give.

Norman MacEwan

Two ways you can donate organs:
  1. Living donors: As per the Transplantation of Human Organs Act 1994, only immediate blood relations (brothers, sisters, parents and children) can donate while living. A living donor can donate only a few organs. For instance, one kidney (as one kidney is capable of maintaining the body functions), a portion of the pancreas (as half of the pancreas is adequate for sustaining pancreatic functions), and part of the liver (as the few segments that are donated will regenerate after a period of time) can be donated.

  2. Cadaver organ donors: All organs and tissues can be donated after brain death.

When exactly can you donate your organs?

Organ donation can take place after one is declared ‘brain dead’. Now what do we mean by ‘brain dead’? It is the irreversible and permanent cessation of all brain functions, when the brain can no longer send messages to the body to perform vital functions like breathing, sensation, obeying commands, etc. Such persons are kept on artificial support (ventilation) to maintain oxygenation of organs so that the organs are in healthy condition until they are removed. Most cases of brain death are the end result of head injuries or the death of brain tumour patients from intensive care units. The organs of such patients can be transplanted into patients whose organs have failed to provide them with a new lease on life.

After death at home, only corneas (eyes) can be removed, whereas for removal of other tissues such as heart valves, bones, middle ear, ligaments and skin, the body needs to be brought to the hospital, preferably within a few hours after death.

Take me from falsehood to truth.
Take me from darkness to light.
Take me from death to immortality.
Support Life.

How is brain death diagnosed?

This is done by the independent advice of a team of doctors whose qualifications and experience are accepted by the hospital for such purposes. Doctors carry out a set of tests to confirm brain death.

The two sets of tests are carried out at an interval of at least six to twelve hours. Legal time of death is the time at which the second set of tests is carried out. Once a person is declared brain dead, further artificial support is futile and causes emotional and financial trauma. At this time a decision to donate the organs of the deceased can be made.

How quickly should the organs be donated?

Healthy organs should be transplanted from the donor to the recipient as soon as possible after brain death.

Who can be a donor?

Anyone, regardless of age, race or gender, can become an organ and tissue donor. If you are under the age of eighteen, you must have the consent of your parent or legal guardian to pledge your organs. Medical suitability for donation is determined at the time of death. People suffering from some diseases like HIV, hepatitis B, hepatitis C, etc. are unsuitable donors.

Who can give consent for organ donation after brain death?

Donors who, during their lifetime, have given consent for organ donation in writing in the presence of two witnesses (at least one of whom is a near relative) should carry their donor cards with them and also express their wish to their near and dear ones. In case no such consent or donor pledge form was filled before death, then the authority to give consent for organ donation lies with the person lawfully in possession of the dead body.

Which terminal diseases can be cured by transplant?

Here are some terminal diseases which can be cured by a transplant:

Organ/Tissue Disease
Heart Heart failure
Lungs Terminal lung illnesses
Kidneys Kidney failure
Liver Liver failure
Pancreas Diabetes
Eyes Blindness
Heart valve Valvular disease
Skin Bums
Bones Birth defects, injuries, cancer, etc.
What organs and tissues can be donated?

The major donor organs and tissues are heart, lungs, liver, pancreas, kidneys, eyes, heart valves, skin, bones, bone marrow, connective tissue, middle ear, and blood vessels. Therefore, one donor can possibly give the gift of life to many terminally ill or other patients in need who would not otherwise survive.

What lies behind us and what lies before us
are tiny matters compared to what lies within us.

Ralph Waldo Emerson

Organs and Tissues that can be Donated
  1. Eyes are the organs of vision. They are roughly spherical in shape. Light enters them through the corneas, and passes through the pupil (circular opening) which is located in the iris. Eye/corneal transplantation restores the vision of the patient.
  2. The lungs are the organs of the breathing system, which brings inhaled air into close contact with the blood so that oxygen can pass into the body and waste carbon dioxide can be passed out. Lung transplantation is required when illness, injury or infection reduces the breathing capacity of the patient, e.g., cystic fibrosis.
  3. The heart is the central organ of circulation, which forces blood around the body through a circulatory system. Heart transplantation is required when the pumping of the heart decreases and blood cannot be circulated effectively throughout the body, e.g., cardiomyopathy.
  4. Liver transplantation is required for people with advanced liver failure, and also children born with biliary atresia. The liver receives the products of digestion, converts glucose to glycogen and breaks dowm fat. It removes excess amino acids from the blood.
  5. Kidneys are responsible for fluid regulation and excretion of waste products. Kidney transplantation is required when kidneys cannot perform renal functions, e.g., renal failure.
  6. The pancreas help digest starches, proteins, and fats. It contains cells which secrete hormones like insulin that regulates the blood sugar level.
  7. Skin: The exterior surface of the body is covered with skin. The skin contains nerve receptors for sensations of touch, pain, heat and cold.
  8. Bones forms the rigid or semi-rigid framework that supports and gives form to the body. Donated bones can be used for helping people with fractures that do not heal, bone cancer, knee reconstruction due to torn ligaments and spinal fusion surgery.
Who will receive your organs?

Your vital organs will be transplanted into those individuals who need them most urgently. Gifts of life (organs) are matched to recipients on the basis of medical suitability, urgency of transplant, duration on the waiting list and geographical location.

Is there any charge to my family for organ donation?

No. There is no charge or payment for organs/tissues used in trans-plantation. Organ donation is a true gift.

Does organ/tissue removal affect cremation/burial arrangements or disfigure the body?

No. The removal of organs or tissues will not interfere with customary funeral or burial arrangements. The appearance of the body is not altered. A highly skilled surgical transplant team removes the organs and tissues that can be transplanted to other patients. Surgeons stitch up the body carefully, hence no disfigurement occurs. The body can be viewed as in any case of death, and funeral arrangements need not be delayed.

Life’s unfairness is not irrevocable;
we can help balance the scales for others,
if not always for ourselves.

Hubert Humphrey

Will the doctor ask permission for donation from my family, once the signed donor card is found?

Yes. Doctors will always ask permission for organ donation from the family if your signed card is sighted. Therefore, it is important that you discuss your decision with family members and loved ones so that it will be easier for them to follow through with your wishes.

What is the legal position on organ donations?

It is legal. The Govt. of India enacted the “Transplantation of Human Organs Act 1994” in Feb. 1995, which has allowed organ donation and legalized brain death.

Is it permissible to sell human organs?

No. The “Transplantation of Human Organs Act 1994” prohibits the sale of human organs and tissues. Violators are subject to fines and imprisonment.

Can organs be removed after death at home?

No. Organs can only be removed when a person is brain dead in the hospital and immediately put on a ventilator and other life support systems. After death at home, only eyes and tissues can be removed.

In the face of uncertainty,
there is nothing wrong with hope.

O. Carl Simonton

Where to donate?

Organ transplantation has become a reality with the establishment of the Organ Retrieval Banking Organisation (ORBO), which has been set up at All India Institute of Medical Sciences (AIIMS), New Delhi. This is the nodal centre for the nation with the objective of encouraging organ donations, and the fair and equitable distribution and optimum utilization of human organs.

ORBO maintains a waiting list of terminally ill patients requiring transplants and donor registers. It provides matching of recipients with donors, coordination from procurement of organs to transplantation, dissemination of information to concerned hospitals and individuals, awareness activities, promotion of organ donation and transplantation activities. It has networking with most of the hospitals located in Delhi and is further expanding.

Pledge an organ donation!
For further information, contact:

ORBO
Organ Retrieval Banking Organisation
All India Institute of Medical Sciences,
Ansari Nagar, New Delhi 110029
Phone: 1060 (Special 24 hrs. helpline),
2659 -3444/2658 8360
Fax: 011 -2658 -8402
Email Addresses
Stem Cells: [email protected]
ORBO: [email protected] / [email protected]
Web site:www.aiims.edu/aiims/orbo www.orbo.org

Facilities for organ transplantation have also been set up in other parts of the country such as Chennai, Bangalore, Mumbai, Hyderabad and Chandigarh and are expanding throughout the country.