Aftercare support
You will spend a lot of time applying the newly acquired life skills and coping skills that you learned in your treatment programme and this will keep you happy, clean and sober. This alone can keep you so busy that some family members may even feel neglected. These are an essential part of the recovery process. Keep in mind, many families find it difficult to understand why re-entry to society after an addiction treatment programme takes up so much of your time in a successful recovery. Have patience and explain all the hard work you are doing on your sobriety to them it will pay off in the long-run.

New rules
Rules are the cornerstone of the treatment process. While in treatment, you may have grown accustomed to following rules, and come to appreciate this level of structure. After returning home, you may even suggest new family rules, the most obvious being a ban on alcohol or drugs in your home.

Roles and responsibilities
Before you went into treatment, you may have neglected certain roles and responsibilities. Other family members may have pitched in to compensate. Now that you have completed treatment, you will probably be eager to participate in family life, and resume your family roles and responsibilities. Often this change in the family dynamic can be difficult at first. Don’t worry it will get easier.

Communication
As part of the treatment process, you have learned to talk about personal issues, like relationships and feelings. Most treatment programmes stress the importance of open and honest communication. You will bring these lessons home, and encourage the rest of the family to talk and listen to one another. These conversations may be unsettling and unfamiliar at first. But open communication can help to solve problems and conflicts and, in the long-run, create a healthy home environment.

New people, places and things
While in treatment you will have learned to avoid people, places and things associated with your past drug abuse activities. This may affect your social life as a family, and may cause some conflicts in the home. Keep in mind that these challenges will be worth it in the long run.

Your feelings
Alcohol and drug abuse affects the whole family, and your feelings are important too. Make time for yourself, and talk to trusted family members and friends about your experiences.

‘Relapse’ is when a person in recovery uses alcohol or drugs. It can be a one-time occurrence or it can last for an extended period of time. Family members can help a person in recovery by looking out for warning signs a return to old behaviors, hanging out with friends who are using, unexplained absences. If you feel as though you are going to relapse or already have, contact the counselor or the doctor and ask for help.

Dr Sat Parkash

Sinuses are air containing cavity in the bone of face and head that lighten the skull weight, helps in resonance in sound production; also have some protective action against body defense by secretion. When these sinuses are infected due to bacteria, virus, fungus, people experience headache, lethargy, loss of interest, running nose, pain in the face beside nose, nasal obstruction, occasional bleeding from nose etc.

90 percent sinusitis is due to bacterial infections and 10 percent may be due to infections spreading from upper gum or dental origin by anaerobic organisms.

Sinusitis may be of acute or chronic. In acute sinusitis there will be severe pain, fever and other constitutional symptoms. Treatments with medicine like appropriate antibiotics, analgesic, nasal decongestant, steam inhalation usually cure it. But when sinusitis becomes chronic and medicine fails to improve the condition, surgical manipulation will be needed.

Sinus washout is the commonly practiced treatment for chronic sinusitis. In addition to this, radical and ablative surgery of the nose and paranasal sinuses are also used to treat sinus pathology. Due to wider complication of these procedures, Functional Endoscopic Sinus Surgery (FESS) has become as the most recent advancement in the management of the nose and paranasal sinus diseases.

FESS helps to maintain function or physiology of the sinuses, ciliary activity (that wipes out foreign substance from nose) and drainage of the sinuses. Thereby it helps clear the sinus infection. It is less manipulative, safe and complication is almost nil in expert hand.

In western world, obese children are no longer considered to be normal. But in our country over-weight or obesity is still out of sense of morbidity. Though we got the burden of malnourished children in our country, still many kids there with hi-fi lifestyle exhibiting obesity or over-weight. On the other hand, the conscious people of the west despite of all efforts could not cut down the figures of obesity. Globally one in six children is over-weight. So the consequence of obesity — hypertension in adolescent age is now pronounced more and more.

In our context, beside obesity, systemic and immune diseases play significant role behind childhood hypertension. Juvenile diabetes, familial hypercholesterolemia, chronic kidney disease due to glomerulo-nephritis, Henoch-Schönlein purpura (a bleeding disorder), drug induced nephropathy (kidney damage by drug) and severe dehydration — all may induce hypertension. But still we have many things to gather as researches are ongoing.

Unsurprisingly, teenagers are now experiencing the same ill effects from sleep deprivation that hypertensive adults do. Recently the study of 238 teenagers (13 to 16 years old) in the USA found that 11 percent slept less than 6.5 hours per night and 26 percent endured frequent awakenings. One in seven teens studied had either borderline high blood pressure or hypertension, which is defined as readings of greater than 140 mm/Hg over 90 mm/Hg. Those with less than 85 percent “sleep efficiently” had nearly three times the risk of high blood pressure. The results mimic established data on adults studied over the past several years, and because higher blood pressure in childhood is linked to the same condition in adulthood, a lack of restorative sleep can set up youngsters for lifelong cardiac problems.

Scientists believe that higher blood pressure results from less sleep because the normal blood pressure dip experienced during restorative sleep does not have as great an opportunity to take hold.

Sleep deprivation’s effects are also system-wide, causing the kidneys to retain more sodium and effecting structural changes in organs that participate in blood pressure regulation, including the kidneys, heart and blood vessels.

So the concern of hypertension in younger group can not be ignored. Health awareness must grow up in both parents and children and to all to restore healthy lifestyle. One must be aware about those diseases and at the same time of healthy food habits. Here are some key points present before you to keep your pressure within limit.

- Eat a rainbow of colours (colourful food). Increase your fruit and vegetable intake.

- Eat fruit and nuts in their natural form as a snack.

- Be physically active. Try walking, biking, or swimming for 30 to 60 minutes on most days.

- Cut down on foods such as cheese, chips, bacon, table sauces, coated chicken, salted nuts and canned meats.

- Eat fewer processed and fast foods like cookies, breakfast cereals, bread, burgers, cakes, pies and pizza.

-Be food label conscious – get to know what you are eating.

-Make at least one vegetarian meal a week.

-Do not skip meals. Eat three adequate meals a day.

-Reducing your portion size and avoiding unnecessary carbohydrates is an easy way to cut back without feeling deprived.

Usually it is often prepared as vegetables dish with potatoes and other vegetables to balance the bitterness. But its health benefits are amazing. It is popular throughout the Indian subcontinent for its medicinal value. This is a popular medicinal food for diabetes. Many people make a mixture of equal amount of amla and karella juice with the belief that it helps reducing blood glucose level. It is also helpful in liver and spleen disorders.

Karella is also known as bitter gourd in English. From Colombia to China, there are different types of Karella throughout the world. But the medicinal value and taste are not the same. So, all types of available Karella do not bear the same medicinal quality. Concerned researchers can identify the real Karella that are really good for diseases like diabetes. For example, in Panama only the leaves of the plant (when ripe) are brewed in hot water to create a tea to treat malaria and diabetes. The leaves are allowed to steep in hot water before being strained thoroughly so that only the remaining liquid is used for the tea. This has been used in various Asian traditional medicine systems for a long time. Like most bitter-tasting foods, it stimulates digestion.

Below are ten easy tips for prevention of a hangover, so an evening of fun will not ruin the next day, next time:

1. Drink alcohol in moderation. Obviously the most key component of prevention of hangovers is that of not drinking too much in the first place. Know your limits
and remain aware of how much alcohol you take in.

2. Drink plenty of clear liquids. In between alcoholic beverages and before going to bed after your night out, ensure you drink plenty of water or other clear
fluids. Electrolyte and sports drinks are also very good for fighting the dehydration caused by the alcohol in your cocktails, wine, or beer.

3. Eat simple sugars and carbohydrates before going to sleep. When you arrive home after your night out, nourish your body with food that will help it metabolize the alcohol and neutralize an acidic stomach. A great suggestion for this is simply honey on toast. The honey contains the fructose for quicker processing of the alcohol and the toast is high in carbohydrates to soothe the acidity in your stomach. Beyond the carbs and sugars, eggs contain cysteine which may also help prevent a hangover and milk’s calcium can also be beneficial.

4. Take aspirin, but at the right time. Aspirin slows down the body’s ability to process alcohol, if taken before the alcohol is consumed. So contrary to popular belief, taking aspirin before drinking can aid in development of a hangover, not prevention of one. However, it is beneficial to take two aspirins before going to sleep after indulgence. Whatever you do, do not take acetaminophen which can cause liver damage if mixed with alcohol.

5. Avoid greasy foods. Eating heavy, greasy, or acidic foods after drinking is like adding fuel to a fire. You know which foods are considered “sketchy” for your own stomach on a good day, so really avoid those after alcoholic beverages when your stomach is even less resilient.

6. Take Vitamin B1 or Thiamine. In taking B vitamin complex you are replenishing some of what alcohol depletes and this may prevent the headache associated with a
hangover.

7. Exercise. It may sound slightly off balance to exercise after drinking, but if you are physically able to safely do so, consider getting some exercise to oxygenate your body’s cells and speed up metabolizing of the alcohol.

8. Take a spoonful of baking soda. In a glass of water this helps balance acidity of the stomach and prevents queasiness. Do this before bed or first thing in the
morning after your night out.

9. Drink bouillon or soup. Bouillon is high in both salt and potassium, both of which are depleted during consumption of alcohol.

10. Get plenty of rest. Sleep will provide the time your body needs to recover from the damage caused by alcohol.

Clearly the best prevention of a hangover is abstinence from alcohol altogether. But if a few drinks are in order, simply ensuring you replenish the right nutrients, rest, and otherwise help your body rebalance itself after the drinks will aid in ensuring the next day is misery free.

By Matthew Sawyer

Age related wear and tear of the knee — known as Osteoarthritis (OA) is mainly responsible for this. Although common, many people are not aware of the solutions that are currently available. Proper medication, physiotherapy, lifestyle modification and sometimes surgery can help stop or lessen the pain.

In Bangladesh, approximately 10 million people are suffering from Osteoarthritis. Women suffer more — 2 out of 3 women over the age of 65 have osteoarthritis. More than half of all men over the age of 65 have osteoarthritis.

With the increasing longevity of life, the problem will multiply itself within a very short time. Osteo-arthritis occurs when the knee undergoes age-related wear and tear around its joint. Almost every one is affected by it to some extent, as they grow older.

Osteoarthritis can also occur in weight bearing joints mainly hips and ankles. This form of arthritis slowly and gradually breaks down the overlying bony ends which forms the joint.

With osteoarthritis, the smooth surface of bones becomes rough and pitted. In advanced stage it may wear away completely. Without the normal gliding surface the bones, eroded bones grind against one another causing pain, swelling, restricted knee motion, crispy sound inside the joint and sometimes bowing of the knees.

In addition to age related wear and tear, athletes, labourer and highly physically active persons often stress their knee joints that lead to prolong wear and tear, which places them at increase risk of developing arthritis.

Arthritis has been linked with joint injuries and damaging events like fractures and infections that can harm the internal tissues of the joints. Individuals who experience repeated knee injuries are much more likely to develop osteo-arthritis as they get older.

Lack of exercise can weaken the thigh muscles that support the knee joints, eventually making the under-used joint stiff, painful and dysfunctional. Lastly, heavy individuals are at increased risk of developing osteoarthritis, because their knees become strained by excessive weight. Research indicates that people who are overweight as young adults are likely to develop osteoarthritis of the knees as they age.

“When and how would I understand that I have osteoarthritis?” is a common question I face in my clinical practice. People start limping and the knee may become swollen with fluid. There may be a reduction in the range of motion of the affected knee — the knee bends less than normal and may lose the ability to completely straighten out. Finally, as the condition becomes worse, the pain persists all the time and may even keep you awake at night.

Repeated knee pain is the main symptom. It tends to be worse after activity. Knee stiffness occurs after rest, the joint feels stiff and it hurts to get going after sitting for any length of time. In time, the joint gets stiffer and you are unable to fully straighten or bend the joint. Knee swelling is also common especially after excessive activity. Knee bowing is seen if osteoarthritis is severe, your joint may become deformed what we call bowlegged.

Most people suffering from osteoarthritis can be treated by non-surgical means which include pain killer, physiotherapy, life style modification and injection in to the knees. Unfortunately if the medical measures are not successful in relieving pain, surgery may be considered. Among the surgical options, arthroscopic washout of the knees is relatively new method in Bangladesh used to relieve pain for sometimes.

When medical measures and arthroscopic washout fail; knees become progressively worsened both in pain and deformity, total knee joint replacement are the better option which is now being done in state-of-the-art hospitals under skilled care of experienced Knee Consultants.

Dr M Ali

In my surgical practice the most common question that I face from the patient — “Is it cancer?” Breast lump has become synonymous with breast cancer. The fact is only 20 percent of breast tumours turn out to be malignant or cancerous!

Commonest benign (non-cancerous) breast lump is called fibroadenoma which is typically found in young women. It is generally smooth, spherical, painless and very mobile without any attachment to skin or surrounding breast tissue. More than one lump may be present. It gradually increases in size and may eventually fill the whole. During pregnancy fibroadenoma may increase in size, but returns to the original size after delivery of the baby.

Fibroadenoma is usually treated by surgical removal. It is a minor operation commonly done under short general anaesthesia. It is possible to plan the cut in the breast skin in such a way that there is almost no post-operative scar marks. In case of unavoidable large cuts, it is placed in such a way that the scar is hidden under the clothing.

The other common breast lump is due to an abnormality in female hormone level. In this condition, multiple lumps of various sizes are found in the breast. Typically both breasts are involved, although patients may complain about one breast only. Lump size maybe somewhere between a size of grain to 3-4 cm. The breasts are painful and tender. The pain may become intense at or near the time of menstruation. The pain may radiate to the arm or back, and may be so severe to interfere normal life.

In most patients it is the pain that brings them to a surgeon and not the lump. There may be nipple discharge in the form of clear sticky fluid.

The disease called Fibroadenosis is a disease of the reproductive age. It may be self-limiting, usually disappearing after the first pregnancy. In most patients the disease is of mild form and simple painkiller with adequate explanation usually brings about a relief.

More resistant cases are treated with hormone therapy. Surgery is reserved for extreme cases. A particularly painful cyst or lump is removed under general anaesthesia. As in fibroadenoma, it is possible to plan the skin cut to provide best cosmetic results. The most important point to remember from the patient’s point of view is the possibility of recurrence, and more than one operation may be required.

A breast lump is particularly a concern in women with risk factors. Risk factors include age, family history, early onset of menstruation, late menopause, late first pregnancy, obesity, hormone replacement therapy etc. More than 66 percent of women with breast cancer are above the age of 50 years and 80 percent are at least 40 years old. The chances of developing cancer are two to three times higher in case of women with a close female relative (mother, sister) who had breast cancer.

Early diagnosis is the key to effective treatment for breast cancer. Most breast cancers are detected by the patient herself. This is why, self-examination by the patient is important.