neck pain

Keep pain away - Your Health First published on 13-Dec-2017 Dr Gita Mathai  Many people suffer from pain in the neck, sometimes radiating down to the shoulders and arms. This used to be a disease of middle age. Now, young adults and even 11-year-olds complain of stiffness and pain. The human head weighs around five kilograms, approximately 8 per cent of total body weight. Seven neck bones (cervical vertebrae) support this relatively heavy head. These bones are the smallest and weakest of all the vertebrae. They are separated by natural "washers" - little gel-like discs that act as shock absorbers and provide stability, flexibility and motility. In childhood, the discs are composed of 85 per cent water. As age advances the water content decreases. The brittle discs can then break open, herniate or develop cracks. Damage heals poorly as the discs do not have good blood supply. The vertebrae come closer and the alignment is disturbed. The nerves to the shoulders and arms come out from between these bones. They can become pinched, causing pain and stiffness. In people over 40, 60 per cent of X-rays show degenerative disc disease. Not everyone is, however, symptomatic. Pain can appear gradually or suddenly. It is usually sharp like an electric shock and runs down the arm. The doctor makes a diagnosis from a physical examination, X-rays, and CT and MRI scans. Vitamin D, calcium and phosphorous levels should be checked to see if the problem started due to bone weakness. Treatment involves pain relieving gels, heat and ice. A soft neck brace can be worn intermittently, especially during travel. Physical therapy is the mainstay of treatment. It helps to strengthen the neck muscles so that the bones are held in place even if there is degeneration. Flexion and stability exercises improve the function of the neck. Traction, massage and manipulation may be used. Pain relievers, anti-inflammatory drugs and anti-spasmodics can be tried. Surgery to remove the offending disc is usually the last resort. School-going children with neck pain often have faulty posture while sitting in school, studying at home, watching television, or using cellphones and computers. They slouch, lean too far forwards, sit sideways, refuse to use the tables provided and manage to strain their neck muscles. In addition, they carry heavy schoolbags, often slung asymmetrically on one shoulder. As per government guidelines, the weight of a schoolbag - including all books - should not exceed 1.5kg before Class III, should be 2-3kg for classes III to V, 4kg for classes VI and VII, 4.5kg with regard to Classes VIII and IX and not more than 5kg for Class X. Unfortunately, these guidelines are seldom followed. In young adults, the commute to college or workplace may be a long one. While seated on a bike, the back should be straight. In a car, the distance between the seat and the steering wheel should be adjusted so that the arms are slightly flexed. While using a computer or watching television, the screen should be at eye level. Taking these precautions could save your neck. To prevent neck strains, pains and degeneration Maintain ideal body weight (height in meter squared X23) • Do regular flexion and stretching exercises. Yoga is ideal. • Maintain good posture while sitting and standing with shoulders straight and feet flat on the floor. • Do not use a high pillow while sleeping.

pre-clinical exams

The pre-clinical exams

Theory classes were the pits, especially the ones that started at 8 AM  and the after lunch sessions at 1:30 PM. People missed buses, slept in rest rooms , arrived late and disrupted classes. Finally, the college hit upon a solution.

“You don’t really have to attend classes, “ announced the administration, “you only need to get 50% in the weekly tests.”

Many in the class did not bother with the portions at all. After all, the study holidays were enough to cram the non- clinical subjects and scrape through.

The “best out going student “was in great demand. A bunch of boys sat around him as he dictated MCQ answers.

“Question 1 B,  11 D etc.”

As soon as the gang was confident about 50% marks, they submitted their papers and left. Nobody bothered with the short notes. No one wanted merit certificates.

An American professor arrived to teach for a year. He was meticulous  and systematic. He soon discovered the identical answers and the ploy.

The next week, everyone received a different question paper. Consternation was writ large on all the faces. Then one medical student flipped over the first page and discovered that the professor had only pinned the pages in a different order. The questions were the same, only the order was different!

He stood up. “That B----“ he said, “just coming from the USA does not mean he is smarter than us.  The whole class is going to get 100%.” Since he was the class don, no-one protested. Even the ones  who normally attended classes and studied were too cowed down and outnumbered to protest. The best outgoing stood in front and dictated MCQ answers. He followed it  up with the short note.

There was no invigilator as it was an “honour system.”

(Honour among thieves!)

The pharmacy department gave up and never tried that trick again.

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The evangelist

My friend said, “You don’t come to church regularly. I haven’t seen you since Good Friday.”

I moaned, “My leg is injured. I can’t stand for a long time.”

She looked disbelieving. “ You manage your work and exercise very well. Anyway, I will have a prayer meeting in your house,” she announced. “It will do your soul some good. I will set it up.”

(I think her family had refused.)

My  protests fell on deaf ears. The meeting was fixed and a visiting foreign gora (white) evangelist was to preside. I had to provide coffee and snacks. In addition,  the crowd swelled as word spread. Not about my cooking (very mediocre at the best of times) but the fact that he was an excellent speaker . His words were reputed to be a stairway to heaven.

On the fateful day, after a few mandatory hymns and introductions, the evangelist took off in full force. As far as I could tell he was a misogynist, convinced that women were responsible for all the ills of the world and the down fall of mankind. He worked his way backwards in time.

“Look at Paul, he said all women should cover their heads and be submissive and silent. Now,” he said angrily, ”we have world leaders who are women. Even England has had female prime ministers.”

I began to wish Margaret Thatcher had attended the meeting.

“Look at Samson, a great judge, Delilah with her wiles reduced him to a blind weak object of ridicule.”

He was just getting started.

“Look at King David, the rot in his kingdom started because of  his obsession with Bathsheba and his obedience to her words.”

The women at the meeting started lowering their eyes and heads , ashamed of what their sex had done. The men sat up a little straighter.

“Adam was  happy in the garden of Eden until Eve persuaded him to eat from the tree of life and knowledge. “

The women slunk into their chairs.

“Excuse me,” I interrupted, unable to bear theses insults to my sex and race a minute longer, “ they could have said NO!”

There was a stunned silence.

“Who could have said no?” asked the evangelist puzzled.

“All the men you mentioned”, I said, “If they are so superior and we women have to listen, surely when we say something like eat from the fruit God has forbidden or where do you get your strength from? They can say no.”

The convener had the presence of mind to stand up and burst out loudly into a hymn. The others joined and the meeting wound up.

As the evangelist left he politely thanked me, “ I didn’t think Indian women were like this. I will never forget you.”

Dr. Gita Mathai

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the little krishna

The little Krishna

The woman had married her maternal uncle, her mother and grandmother had done the same. This repeated consanguinity over three generations had resulted in a lot of miscarriages and abortions until  finally, glory  halleluiah after 15 years they had a son.

He was brought to the paediatric OPD , very sick, with methhaemoglobinaemia in a crisis. The infant was very sick and the professor told me to admit him immediately and give intravenous methylene blue. The calculation was really complicated. The child weighed 6.2 kg. The dose was Xmg/kg. The solution supplied was X% of methylene blue.

After starting the IV line (this was before the era of cell phones and Google) I sat down and calculated the dose. It was very complicated. Maths was not my strong point. I had given it up in 9^th std  in favour of English Literature. I administered the dose intravenously.

The effect was immediate. Before my horrified eyes the light skinned baby turned a dusky blue. For good measure, he pissed out urine that could be filled in my pen as a substitute for the ususal “Quink Royal Blue”.

This was a really precious baby and I thought the relatives would attack me.

All of a sudden the lady from the next bed said

“The child will live, Lord Krishna has returned in a new avatar.”

I slipped a way to the phone to find out what to do.

“Don’t worry”, said my professor after yelling at me for 5 minutes, “the methylene blue will be excreted by the kidneys.”

By the time I returned to the bed, someone had tied a peacock feather on the baby’s forehead.

He recovered and was discharged two days later after the urine was not “ink” any longer.

He apparently was “cured” and funnily enough did not have another episode.

Perhaps the “overdose” was correct?

His blue colour gradually faded over the next week.

“Lord Krishna left after saving my son,” said the mother when she brought the child to the OPD for a check up.

I nodded my head and said ,”Yes, yes,” just relieved that “alls well that ends well.”

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Bats in my Attic

Bats In my Attic

My husband and I were driving back from Chennai late in the evening. By the time we reached Porur it was raining cats and dogs. Visibility was near zero. To add to the melee, every lunatic on a motorbike or bicycle had placed plastic bags on their helmetless heads  and appeared to be driving with eyes shut as well, often on the wrong side of the road.

“Look”, I said, “there is a hotel. Let us stop for the night. We can continue tomorrow.”

The hotel was alright. It seemed mainly to cater to patients undergoing treatment in Ramachandra Medical College. We got  a room and retired for the night.

My husband started stroking my cheek.

“Stop it!” I said. “We have to get up at 4 AM.”

He did not answer.

Every time I nodded off ,he started again. The fourth time was too much for me.

“What is wrong with you? Leave me alone!” I switched on the bedside light. There was a large bat (looked like a giant) rubbing its  wings against my cheek.

“Aah” I shouted and ran to the door. “Come , Come” I yelled at my husband.

Used to obeying, he ran out too, groggy and quite unsure of what was happening. We fled outside.  ( Me without ankle support and crutch). The door slammed behind us, with the electronic key inside. I was in a nightdress, my husband topless in a pair of running shorts.

“Go to the reception” I said hysterically, ”tell them there is a vampire bat in our room.”

“I don’t have any clothes” protested my husband, “and there are no vampires”.

“Haven’t you read Dracula? Go downstairs. Otherwise we have to stand here all night!”

The receptionist sent up a couple of flunkeys. They were skeptical and obviously did not believe our story. Before entering the room one of them asked the other,

“Did they order room service? Brandy?”

They opened the door. The bat seemed to like me. It came straight at me. I started screeching again.

“Bat ! Bat! Help! Help!”

A few rooms opened and heads started poking out.

They gave us another room. I made them transfer my belongings, check the cupboard, under the bed and draw back the thick electronic curtains.

No more Vampires !

Velloretimes

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