urgentcare: April 2013

The colors & flavors of Holi are in the air again. Children are on the roads with water filled pichkaris and balloons splashing every passerby with colors of the season. A festival which is a favorite amongst kids and youth also brings lines of worry on parent’s faces. Are the colors used safe? Will they harm my child’s skin? What about slips, trips and falls during the Holi excitement? Every year a large number of people visit Emergency rooms for some or the other festivity related health problems during Holi time. Most common problems are allergic reactions to colors, asthmatic attacks, skin and eye problems, injuries due to slips & falls, road traffic accidents due to drunken driving, Bhaang intoxication, gastro – intestinal problems due to water or food borne infections. Urgent Care believes prevention is better than cure and thus we bring you some “Health Bytes” on Holi to help prevent these problems and tips on what to do in case any thing does happen.

Prepare yourself for playing holi –

• Choose clothes which cover most of your body parts

• Apply a thick layer of petroleum jelly or oil over your skin before going out to play. This helps to protect the skin from the damage caused by harsh chemicals and also helps the color to come off quickly.

• Apply oil to your hair also as it helps contradict the dyeing nature of certain holi colors and protects them from damage. If possible, cover your hair with a cap or a hat in order to protect them.

• Do not wear contact lenses when you are playing with colors. This is because color can come between your eye and lens, resulting in infection and in some cases, eye damage. Glasses can help protect your eyes from color.

• Coat your finger nails and toes with paint so that they remain protected.

• Get natural, herbal and skin-friendly products as too much of harsh chemicals used in the holi colours can be a major cause of itching. You can prepare colors at home from natural products like flowers, henna etc

While playing Holi -

• Respect other person’s independence on Holi. Do not force anyone to play with colors if they do not wish to do so.

• Do not rub colors too vigorously on anyone’s face – it can lead to skin damage.

• Be careful and avoid eyes and mouth when applying color. Keep your eyes and mouth tightly shut when someone is applying color on you.

• Avoid running on wet floors as one can slip and get injured.

• Do not use mud, grease, eggs or gutter water on Holi.

• Do not drink and drive. If you plan to have alcohol, ensure somebody else is driving.

• It is a traditional practice to consume Bhang on Holi. When consumed in large quantities Bhang can lead to effects like increased blood pressure and heart rate, psychosis. Never consume it on an empty stomach and do not mix it with alcohol

What to do in case of a problem?

• If you face any kind of trouble as soon as the colour comes into contact with your skin, wash the colour off immediately with water and apply a soothing calamine lotion. If the problem persists immediately seek medical help.

• Itching, redness, swelling, breathing difficulty are signs of a significant allergic reaction. Immediately report to nearest medical facility. You may need an injectable medication for your allergy. Urgent Care Centres are open 24×7 in your neighborhood.

• If you slip and fall check for injuries. In case of swelling, pain, inability to move a limb, apply an Ice pack locally and report to the nearest medical facility. You may have a fracture or soft tissue injury.

• If color goes into your eyes, wash with plenty of water immediately. If problem persists seek medical help.

• If someone falls from height or meets with a road traffic accident immediately call ambulance from nearest source. Call 1800 208 1188 if you are near an Urgent Care Centre, one of the Best Hospitals in Delhi. Moving such a victim yourself can aggravate spinal injuries.

• If you are a known asthmatic or suffer from severe dust allergy, it is advisable not to venture out to play Holi with colors, especially the dry variety. Keep you inhaler with you in case you go out. If you have an asthmatic attack immediately use your inhaler. If not relieved immediately report to nearest medical facility. Urgent care centres are equipped to deal with all asthmatic emergencies.

• If someone has consumed large quantity of Bhang and is complaining of palpitations, severe headache or is having uncontrollable abnormal behavior, seek medical attention. Urgent care centre in your neighborhood can help evaluate and manage Bhaang intoxication

Holi celebrates the arrival of spring, good harvest & is a time of enjoying spring’s abundant colors and saying farewell to winter. So don’t stay away from colors, just be color smart….play safe!! In case of any health problem Urgent Care is just round the corner to take care….at all times. We are the first response centre – aapke liye!!

Have a fun filled, healthy and safe Holi!!

Irritable Bowel Syndrome

By: Dr Himanshu Gul Mirani

Emergency Physician, Urgent Care Centre

Irritable bowel syndrome (IBS) is a very common and distressing condition, making the sufferers yearn for freedom to eat; with flare-ups not only draining them physically but also mentally. Called ‘spasmodic colon’, it can be a nightmare for the sufferers. They are constantly under threat, not knowing what may trigger the next acute episode. It’s particularly an issue for people travelling abroad often, as the options with food being available become limited.

The condition

Its characterised by varied presentations, with pain in lower abdomen associated with bloating sensation being a predominant condition. Although in reality there abdomen is not truly increased in size to the extent perceived by the patient, the subjective sense of discomfort often brings them to the medical facility for treatment.

Altered bowel habits are another common complaint of IBS. There is characteristic history of alternating episodes of increased frequency of passing stools with constipation. Stools aren’t voluminous, but there is a sensation of incomplete evacuation, with ‘squirting’ of small amount of stool each time. Stools are often laced with mucous.

Described by the patient as diarrhoea, careful history reveals that often these episodes of increased stool frequencies are confined to a particular part of the day, usually mornings, wherein most efforts to evacuate the gut are made, concentrated over a span of around half to one hour.

Some people come with complaints of intractable acidity/ indigestion/ heartburn (dyspepsia). Described as functional dyspepsia, these people find no relief from anti-acidity drugs and their other tests like endoscopies of the upper gut are normal.

There are a few associated complaints that help as pointers to IBS. Stress, panic disorder, type A personality character trait, sexual dysfunctions, sexual abuse specially in childhood – all these are linked with IBS.

Diagnosis

‘Bristol Stool Scale’ may help the patients to describe their stools. ‘Rome III criteria’ is often quoted to label an individual as a case of IBS. It is diagnosed if the symptom complex of recurrent abdomen pain or discomfort, along with altered bowel habits remains for at least 6 months and cannot be attributed to any other pathology. Two out the following three features must be present on at least 3 days of the last 3 months viz. ;

- Pain relieved by bowel movement

- Onset of pain related to change in stool frequency

- Onset of pain related to change in appearance of stool

Decoding the problem

The patients of IBS have lower pain threshold to rectal distension than other people. This has been studied by noting the volume to which the rectal balloon needs to be inflated to elicit pain. IBS patients experienced pain at a lower balloon volume than others.

These patients on PET scan evaluation seemed to have altered blood flow in the brain to the sensation of gut distension and that might also be a cause for the perceived altered sensation.

In an interesting study to understand the stress response, arithmetic problems were given to IBS patients along with non-sufferers as controls. Patients of IBS had an altered response compared to non-sufferers, as reflected by altered EEG patterns in such individuals.

Apart from these, there are many differences at molecular level in the gut physiology that seem to work in an altered manner in these patients making them prone to the IBS symptoms.

Workup

There is no gold standard test for the diagnosis of IBS. A detailed history along with the tests that rule out any other disease condition, point to the diagnosis of IBS.

Some of the common tests done to rule out other causes are –

• Stool routine examination with cultures

• Stool osmolarity and electrolytes

• Colonoscopy with biopsies

• Contrast radiological evaluation of the gut

• May need small bowel biopsies too

Lifestyle and dietary modifications for IBS

There are certain foods that trigger IBS acute episode. Most of the patients can identify what foods triggered the onset of pain and symptoms. But there are some foods that are routinely incriminated to precipitate an acute event. Some of them are high fat, low fibre foods; carbonated drinks; large meals; refined cereals & excessive alcoholic or caffeine intake.

Eating small and frequent meals, oats, wheat bran, fruits and vegetables, more of plant fibre, linseeds along with regular exercise and stress management helps IBS patients.

Treatment

The management of such patients calls for extensive counselling so that they understand the disease condition and gain enough insight to deal with the ordeal.

Better targeted therapy is expected for IBS in future as the molecular mechanics are being decoded.

Pharmacological management along with lifestyle modifications and psychiatric help go a long way to help these individuals.

Drug therapy is guided by the predominant symptom. IBS patients are grossly categorized based on their predominant presenting symptom as:

1.) Constipation predominant

2.) Diarrhoea predominant

3.) Pain predominant

Source: www.urgentcare.co.in, one of the Best Hospitals in Delhi.