1. R. Cutinha, Mangalore
* I am 34 years, I have high Cholesterol. Will you please inform me how it can be reduced through diet? I do my daily routine exercise for an hour. I want an advice to maintain cholesterol through diet.
** There are two main lipids found in the blood, cholesterol and triglycerides, also known as serum lipoproteins. Cholesterol is an essential chemical within the body, without it we will not survive. Yet, if our blood levels of cholesterol and triglycerides are too high, we are at risk for coronary artery disease which is a major cause of death among the young individuals today. Cholesterol is an essential element contained in all human cell membranes; it is a structural component of steroid hormones and bile acids. Triglycerides are important in helping to transfer energy from food into body cells.
Lipoproteins are categorized based on how dense they are. Density is based on the amounts of cholesterol triglycerides and apoproteins. The densest and smallest are called high-density lipoproteins or HDL, also know at "the Good Cholesterol". Lipoproteins that are a little less dense are called low-density lipoproteins of LDL. The least dense, and the largest of the lipoproteins, are the very low-density lipoproteins or VLDL.
In coronary heart disease, plaque accumulates along the walls of the coronary arteries. Coronary arteries are blood vessels on the surface of the heart which supply blood to heart musculature. These get blocked in atherosclerosis, the condition in which plaques of fat get accumulated inside the blood vessels. The Plaque can also accumulate in other major arteries within the body. The research has shown that high levels of LDL cholesterol increases the risk of coronary heart disease and atherosclerosis, just as high levels of HDL cholesterol lower that same risk.
Serum cholesterol testing in adults is recommended every one to five years. Early detection and early control of high cholesterol in persons without symptoms, is an important step in reducing the development and progression of coronary heart disease and atherosclerosis. Persons with diabetes and a family history of high cholesterol are more likely to have high cholesterol and may need to be tested at more frequent intervals.
In the prevention and treatment of high cholesterol, diet modification is considered by experts to be the cornerstone of therapy. Adjuncts to the prevention and/or treatment of high cholesterol also include a regular exercise regimen, cessation of smoking and reducing alcohol intake, the addition of antioxidants to the diet, and lipid lowering drugs.
Dietary guidelines set forth from the American Heart Association (AHA) to reduce the risk of heart disease and lower total serum cholesterol can be followed by all with high cholesterol. A summary of these and other standard guidelines include:
• Eating a diet that lowers total calorie intake and reduces total fat and cholesterol intake
• Limiting total daily fat intake to no more than 30% of total calories
• Cholesterol intake should be less than 300 milligrams daily
• Carbohydrate intake should total 55% to 60% of total daily calories
• Avoid foods high in sugar
• Fiber intake from foods, not supplements, should total 25 to 30 grams daily
• Use monosaturated oils such as olive, sunflower oil groundnut oil etc. Coconut and Palmolene oil is better avoided.
• Eat plenty of fruits and vegetables daily, thereby reduce eating fatty food.
• Limit salt intake to six grams a day; limit salt intake to three grams or less for patients with hypertension or diagnosed coronary heart disease
• Add the antioxidants, vitamin C, beta-carotene and vitamin E, in the recommended amounts, to your diet to help lower homocysteine levels and reverse the effects of oxidized LDL on the system. Anti-oxidant capsules are available. You may get them through your doctor.
• Eat a variety of foods; avoid eating the same foods every day; variation of the foods you eat, allows for a greater intake of the vitamins and minerals the body needs.
• Cholesterol-reducing drugs are medications that lower the levels of fats in the blood, which include both cholesterol and triglycerides. The cholesterol reducers and other antilipemic medications are often prescribed if people have high cholesterol levels or other elevated lipid levels (e.g., high triglycerides). Studies are also showing that cholesterol-reducing drugs can lower the risk of heart attack and stroke.
2. J. Lobo, Mangalore
*I am 36 years. My triglyceride levels have been very high (550) for the past three years though my LDL, HDL and total cholesterol and weight are normal. What could be causing this and what can be done for this?
** Triglycerides are the chemical form in which most fat exists in food as well as in the body. They're also present in blood plasma and, in association with cholesterol, form the plasma lipids.
Triglycerides in plasma are derived from fats eaten in foods or made in the body from other energy sources like carbohydrates. Calories ingested in a meal (ultimate form of food) and not used immediately by tissues are converted to triglycerides and transported to fat cells to be stored. Hormones regulate the release of triglycerides from fat tissue so they meet the body's needs for energy between meals.
Excess triglycerides in plasma are called hypertriglyceridemia. It's linked to the occurrence of coronary artery disease in some people. Elevated triglycerides may be a consequence of other disease, such as untreated diabetes mellitus. Like cholesterol, increases in triglyceride levels can be detected by plasma measurements. These measurements should be made after an overnight food and alcohol fast.
It is believed that in Indians with ischemic heart diseases hypertriglyceridemia is common than hyperlipidemia. Alcohol intake and smoking are the two factors blamed for this.
The normal accepted levels are:
Normal Less than 150 mg/dL
Borderline-high 150 to 199 mg/dL
High 200 to 499 mg/dL
Very high 500 mg/dL or higher
These are based on fasting plasma triglyceride levels.
Are increased triglyceride levels dangerous?
Triglyceride measurement is part of a standard blood lipid profile, but for the most part doctors don’t know what to do when triglyceride levels are modestly elevated. While high triglyceride levels have been associated with heart disease, no study has yet proven that high triglyceride levels are an independent risk factor for heart disease. So doctors don’t have the evidence they need to recommend aggressive triglyceride-lowering therapy.
The problem is, patients with elevated triglyceride levels almost invariably have other major risk factors for heart disease (mainly obesity, diabetes, and/or high blood pressure), and so far it has not been possible to sort out whether the triglycerides themselves pose an independent risk.
The most difficult-to-sort-out association is that between triglycerides and HDL cholesterol. It turns out that whenever triglycerides are increased, HDL cholesterol decreases. So is the increased risk seen with high triglycerides due to the triglycerides themselves, or to the associated reduction in “good” cholesterol? So far, nobody can say for sure.
However, recent evidence strongly suggests that an elevated triglyceride level is a significant risk factor for heart attack.
American Heart association recommendation — Dietary treatment goals:
Changes in lifestyle habits are the main therapy for hypertriglyceridemia. These are the changes you need to make:
• If you're overweight, cut down on calories to reach your ideal body weight. This includes all sources of calories, from fats, proteins, carbohydrates and alcohol.
• Reduce the saturated fat and cholesterol content of your diet.
• Reduce your intake of alcohol considerably. Even small amounts of alcohol can lead to large changes in plasma triglyceride levels.
• Be physically active for at least 30 minutes on most or all days each week. Exercises like brisk walking will help to reduce the triglyceride levels.
• People with high triglycerides may need to substitute monounsaturated and polyunsaturated fats — such as those found in sunflower oil, ground-nut oil, olive oil (or liquid margarine) — for saturated fats. Substituting carbohydrates for fats may raise triglyceride levels and may decrease HDL ("good") cholesterol in some people.
• Substitute fish high in omega-3 fatty acids instead of meats high in saturated fat like hamburger. Fatty fish like mackerel, lake trout, herring, sardines, albacore tuna and salmon are high in omega-3 fatty acids.
• When the triglycerides are very high, certain medications are now available with beneficial effects.
Because other risk factors for coronary artery disease multiply the hazard from hyperlipidemia, control high blood pressure and avoid cigarette smoking. If drugs are used to treat hypertriglyceridemia, dietary management is still important. Patients should follow the specific plans laid out by their physicians and nutritionists.
*My sister who is in mid twenties is diagnosed as having ‘Schizophrenia’ for more than a year now. She was on Risperidone 8 mgm, which was tapered to 3 mgm and was fine so was off the medication. Now after a year, there is relapse and again she is put on Risperidone. Now her fear is reduced, but not completely gone. Will she be alright? Whether she has to take the medicines continuously? Will there be further relapses? Can she get married? Will her family life affected?
** It may be better to discuss these issues in detail with the psychiatrist who is treating her. Medication may have to be continued till the treating doctor is satisfied with the progress. Marriage and family life are the issues that to be discussed with the psychiatrist and the prospective partner. Unless her condition is clearly known, it is not possible to give a proper advice about her future. For the benefit of others, let me give a brief account about this illness.
Schizophrenia is a serious brain disease. It affects people all over the world. Unlike some illnesses, the rates of schizophrenia are the same from state to state and from country to country. Whether you live in USA or in India the statistic is the same: about 1 in every 100 people has schizophrenia. In the United States, this brain disease often appears earlier in men, by about three to four years. Otherwise, schizophrenia affects men and women equally.
About seventy-five percent of people who get schizophrenia become ill between the ages of 17 and 25. Some people who later develop schizophrenia may have seemed "different" from other children at an early age. It is unusual for someone to get sick with schizophrenia after age thirty.
A long time ago people had wrong thoughts about schizophrenia. They thought that schizophrenia was "all in someone's head." Today, we know the truth about schizophrenia. Schizophrenia is a brain "disease." There are differences, deep within the brain, of some people with schizophrenia. People who research schizophrenia found this out by taking detailed pictures of the brain.
What still is a mystery is why people get schizophrenia. Researchers think that genes may play a role in who is more likely to get schizophrenia. Genes are the "code of life" that determine what a person looks like (physical traits). Genes may also help determine what kind of personality someone has (personality traits). A person is more likely to get schizophrenia if they have a parent, brother or sister with the disease. For example, if a person's mother had schizophrenia, that child would have about a ten percent risk of getting sick. This risk is much less — about one percent — for a person who does not have a relative with schizophrenia.
Researchers are working hard, but there is still no known "cure" for schizophrenia. Prompt and effective treatment can make a difference. Research has shown that after 10 years:
• Twenty-five percent of schizophrenia consumers will be much improved and relatively independent.
• Twenty-five percent will be improved, but require an extensive support network.
Unfortunately, the illness makes some patients take their own lives. The patients and their loved ones should be aware of the facts about the danger of suicide. About ten to thirteen percent of schizophrenia patients do take their own lives, compared to only one percent of people who do not have schizophrenia. Obviously, schizophrenia can have a major — and even tragic — impact on a person's life. That is why treatment is so important.
Schizophrenia is a complex illness. The patients have periods when they are very ill, and periods when they do much better. There are three stages of recovery in schizophrenia. These three stages are:
Acute episode: This is a period of very intense symptoms. These symptoms may start suddenly or begin slowly over several months
Stabilization after an acute episode: This is a period when intense symptoms have been controlled with medication. This period is usually marked by a reduction of severe symptoms
Maintenance phase or between acute episodes: This is the long-term recovery phase of the illness. Many of the intense symptoms have been controlled by medication. Milder symptoms may persist. Improvement is possible, but at a slower pace.
4. L. Kunkel, Ocean City MD
*My 76 year old dad has a problem in which he produces to many platelets. He is on agrolyn, coumidin, and hydrea. However it only brings the platelets down slightly. He had congestive heart failure last year due to an overdose of agrolyn. This year he had an overdose of hydrea and ended up in the hospital for 3 weeks, where he received a blood transfusion. He went thru rehab. And now he is so weak, he can’t even get up to get dressed and goes to his doctor appointments. He eats but not like he used to and is very frail. I would like to know if it is the meds. Or is his system just not able to be helped. I’d like to get another opinion and try to keep and rather get him healthier. His mind is good and he has the will to live just no strength or energy.
**Your dad is having a problem known as Thrombocythemia. It is a myeloproliferative blood disorder. It is characterized by the production of too many platelets in the bone marrow. Too many platelets make normal clotting of blood difficult. There is no known cause for thrombocythemia. You may take second opinion, but continue the medication till you are advised to stop or change.
5. Roshan, Mangalore/ Mumbai
*I am 29 years of age. I am just married and we would like enjoy life and not to have the child after 2 years. Will you please suggest me what is the best method of family planning to follow?
**If you have no solid reasons to postpone the arrival of first baby in your married life other than to enjoy life, I feel it is not correct. A baby can be a boon to your married life. In fact a baby increases the understanding, co-operation and adjustment among the couple in their early years of married life. It becomes a common source of mutual interest and many of the minor causes of initial mal-adjustment disappear once the baby is born. It is said that the first baby is for the marriage as it builds solid bond between the couple. (Saying goes that the second baby is for the first!)
It is quite easy to follow harmless methods of family planning like natural family planning after the birth of a baby. The functions of the genital organs become regulated and even other methods like safe method, calendar method can be practiced. As many of the couples find it hard to follow natural family planning methods, other method like use of loop is possible after the first delivery. The loop is currently used by many to space the arrival of the second baby or to maintain a proper gap between the births of two babies. The loop can be very effective, relatively harmless and easily reversible.
However if you are keen on postponing the baby for two years, natural family planning method may be tried. It should be followed strictly as the casual attitude towards it may result in failure. Many of the other temporary methods also are available. Both husband and wife should understand the principles and details of practicing them. They may opt any of the method of their choice. It should be remembered that none of the methods are 100% safe. There are chances of conception with every method. Such events are to be accepted as the God’s plan and should not be a temptation for abortion.
It is beyond the scope of this column to explain each method of family planning. You may go through my book on married sex life, where these aspects are dealt in detail.
6. J. P. USA
* I am 50 years. I am a single not married. I have not had sex in a while and wanted to someone I like and we get close I had premature ejaculation while I kiss or hug someone. A few times I had come close to having intercourse but could not get an erection and it is disaster. I get excited, but I do not get an erection. However, when I sleep and think of the person whom I was with I get an erection in the early hours of the morning. I wish this could happen when I am with someone? Also before I go to meet a person I have more negative than positive thoughts. Now is there anything I can take or can you advise me as to how to go about this issue or give me your suggestions.
** Your problem is purely psychological. The initial failures are the igniting factors for further failures. It only requires you to have self confidence that you are physically normal and the problem is psychological. If you are convinced that you are normal, you will achieve what you want. If it is practicable, marriage and a co-operative partner might solve the problem. I do not recommend pre-marital or extra-marital sexual ventures as they are normally bound to enhance the prevailing problems in individuals like you. You may go for counseling if facilities are available.
7. A. saxena, Lucknow
*I am 28 years, married. In Feb 04 my blood test was done. My TSH was 9. Rests of the reports were within normal limits. Doctor told me to take 50mg Eltroxin for 3 months after that TSH was 7. Again after 3 months TSH remained 7. Now I am taking 50mg Eltroxin. Doctor has told me to reduce the dose to 25mcg after 1&1/2 months. I would like to know what minimum dose I shall take. Can I take 12.5mg Eltroxin to slowly make the level in normal range?
**I hope you are aware that you are given this medicine to mask the deficiency you had. Your thyroid gland was not secreting the required amount of thyroid hormone as a result the level of TSH (thyroid stimulating hormone) had gone high. With that there were probably low levels of T4 and T3, two thyroid hormones. This defect is mostly permanent, except in some rare conditions. As the defect is permanent, you will have to take the medicine life long or till you are advised to stop.
A high TSH result often means an underactive thyroid gland caused by failure of the gland (hypothyroidism). Rarely, a high TSH result can indicate a problem with the pituitary gland, such as a tumor producing unregulated levels of TSH, in what is known as secondary hyperthyroidism. A high TSH value can also occur in people with underactive thyroid glands who have been receiving too little thyroid hormone medication.
Numerically reported test results are interpreted according to the test's reference range, which may vary by the patient's age, sex, as well as the instrumentation or kit used to perform the test. A specific result within the reference (normal) range – for any test – does not ensure health just as a result outside the reference range may not indicate disease. To learn the reference range for your test, consult your doctor.
Dosage of Eltroxin must be carefully adjusted according to individual requirements and response. The age and general physical condition of the patients and the severity and duration of hypothyroid symptoms determine the initial dosage and rate at which dosage may be increased to the eventual maintenance dosage. Adjustment of Eltroxine dosage should be based mainly on the patient's clinical response and confirmed by appropriate laboratory tests. Laboratory tests alone should not be relied upon to guide therapy. You should follow your doctor’s advice and do not alter the dosage yourselves.
8. R. Pinto, Udupi
*I am 24 years of age, unmarried. I would like to know for successful results when should intercourse be made in a monthly cycle of 28 days.
**Normally in regular cycle, the woman ovulates on the 14th day prior to the day of onset of next flow. If it is a regular 28 day cycle, the woman will ovulate on the mid-cycle that is 14th day from either side. Normally the ovum survives between 8 to 12 hours after ovulation. The ovum gets fertilized during this period if it comes in contact with healthy sperm.
In order to facilitate fertilization, it is ideal for the couple to know the exact day of ovulation. There are several methods to detect ovulation; one of them is mucus method. On the day of ovulation, the mucus in the female genital tract is thin, transparent and can be stretched between two fingers.
The couple should have sexual contact during the days of ovulation. It is advised to have physical contact at least for five days, on the day of ovulation and on two days before and two days after ovulation. This may not be successful in one or two attempts. Even if this is regularly followed it may take four to six months for the woman to conceive.
9. A. Newman. Mississippi
*I am 18 years of age. My boyfriend and I are planning to have a baby in the future, and I am worried that I will have a baby that there is something wrong with it. My boyfriends little brother had something wrong with his heart, he was lacking a nictitates or something. It started with "CR". Anyways the doctors thought he had a cold and he ended up dying at four months old.
** Though you are not sure of the congenital heart problem your fiancée’s brother had, you can be rest assured that majority of the congenital heart defects are not genetic. There are hardly congenital conditions of the heart which are genetic-in the sense all or majority in the family will get them through their parents. If you can send the exact name of the congenital problem you are worried about, I shall give you more details.
10. D. D'souza
* I am a female, 26yrs old. I am getting married in few months. I want to have a natural family planning. I heard there are only few days which are fertile days, and only during that period we can conceive. Can you please tell me which the fertile period is and also which is the safe period to have intercourse when we are not planning for a kid soon. As few of my friends suggested...5 days before & 5 days after the flow (period) is the safer period. Is it true? Mine is a 32 days cycle.
** It is rather difficult to teach about Natural Family Planning (NFP) on a column like this. The couple should have personal teaching about the method. More than the knowledge, the commitment to follow it is required. During pre-cana teaching sessions conducted by the church details about NFP are taught. If you were not taught of NFP, there are resource persons in each diocese who will enlighten on this. You may consult them personally through your parish priest.
Some questions regarding NFP are answered in the previous editions of this column. After attending the sessions on NFP, still if you have any specific doubts about it, please send your queries to me.
11. Thomas W. Chicago
*I am 24 years, unmarried. I have a peculiar problem. I do not get sexual pleasure because I do not have sensation on my organ. I was tested for diabetes, consulted n an urologist. The urine test and testosterone levels were normal.
I also consulted a neurologist there was nothing wrong but I still have no feeling in my penis during sexual intercourse. What is wrong with me? And what can be done to correct it.
** As you are examined by all possible consultants, I feel your problem is psychological. You may consult a psychiatrist.
12. A. Kumar, U.A.E
* I am 21 years. I have a habit of masturbating since last 7 - 8 years. I can not stop this habit and I dot it almost every day but sometimes I give a gap of a week. I want get rid of this and what will be the effect of this.
** I have answered these types of questions several times on this column before. But, many youngsters keep on repeating the question.
First of all, masturbation is a perfectly normal method of relieving sexual tension. It is estimated that over 70% of the male population masturbates. Masturbation is one of those issues that guys normally can't talk about. Most people masturbate. It doesn't matter who people are, what they do, or what they say, chances are they masturbate. In fact, many people masturbate throughout their lives regardless of whether they have a sexual partner or not.
Masturbation is a common and harmless habit during youth. Almost every man would have masturbated during youth. In a few of the men the habit persists even in marriage without affecting their marital life. It has no effect on general or sexual health.
But if one worries about it then there can be psychological stress which might lead to sexual difficulties. The person with such worries has to be convinced that masturbation is a common habit and every man had this habit at one or other part of his life. If he is convinced that there are no problems because of masturbation, he will be able to lead a normal sex life.
Here are few more points to note about it:
1. Masturbation is not evil, dirty or harmful - it will not make you go blind, drive you insane, turn you in to a pervert, stunt your growth, give you an STD, make you sterile.
2. Both guys and girls masturbate; it is a normal and healthy part of sexual development.
3. Masturbation is a very personal thing and should not be done in public places.
4. You are normal if you masturbate, normal if you wonder about it but don't do it, and normal if you never give it a second thought and don't do it - it is one of the few things in life that is "normal if you do and normal if you don't".
5. Masturbation alleviates stress and releases endorphins (the pleasure hormones) in to your system making you more relaxed.
6. Masturbation as exploration of the body is common in children between the ages of 3 and 6, in teens masturbation becomes more sophisticated and sexually motivated.
7. Surveys have shown that 80% of males and 59% of females have masturbated by age 18.
8. Many experts believe that masturbation is more prevalent in the teen years due to a strong fluctuation of hormones; masturbation alleviates the strain of this build up and is a necessary part of development.
9. The only real problems that come with masturbation are psychological and are the result of unhealthy or weary attitudes toward doing it (if you do it but are ashamed) or abnormal practices (for example, public masturbation).