Dating, love affairs…and even pre-marital sex is no longer taboo

 

Dating, love affairs…and even pre-marital sex is no longer taboo amongst today’s teenagers. Not even in conservative cities. True, one may not see many boys and girls openly holding hands on the main roads or kissing in parked cars but many affairs are conducted on the sly…without the knowledge of parents. Parental disapproval and society’s contempt often drives friendship and romance with the opposite sex underground! Boys and girls from even traditional families may be dating but secrecy is the name of the game.

Rohit, 18, is having a secret love affair. He comes from a conservative Gujarati family as does his 16-year old girlfriend. ‘No one knows,’ he confesses, ‘but we think that’s exciting.’ They usually seek out deserted move halls or unknown cafes while both their parents’ are under the impression that they are out in a group. A group which covers for them. Love letters are exchanged through common friends, and calls made from cells.

If there are any guilt pangs for this elaborate deceit, they are suppressed by the overwhelming needs of these youngsters, needs which are no longer considered immoral. ‘I slept with my husband before marriage,’ admits Neelima, ‘we couldn’t stop ourselves.’ She even admits that she had to have an abortion once. ‘It was an accident and I don’t think I did anything wrong. There is no point bringing an unwanted baby into this world.’ Neelima’s attitude towards pre-marital sex does not reflect her background, as she was brought up in an extremely conservative Marwari family with plenty of restrictions. This perhaps alienated her from her parents. ‘I was not close to either of them,’ she says.

This lack of closeness, of belonging and warmth, often pushes teenagers into the warmth of sexual relationships. Dr. S.K. Som, psychiatrist, says, ‘First of all, there is nothing wrong or abnormal in teenagers having love affairs or going steady. In fact love is natural, given the circumstances.’ However, less time is devoted to children than before and in nuclear families there are often no substitute parents either. Further, there is a lot about sex in the media today. All this tempts teens to experiment. Sometimes it can go very wrong. ‘It is only when romantic relationships lead to problems like unwanted pregnancies, early marriages, eloping or emotional disturbances, that it can become problematic. Mostly I have seen parents worry far more than necessary,’ he says. Dr. Som has counseled both boys and girls disturbed by broken love affairs.
In contrast, Dr. Jayant Kumar Chakravarty, a child specialist, advocates greater restriction on free mixing. ‘Teenagers want to experiment without thinking of the consequences,’ he says.

If parents are worried about their kids, then they should make sure that the lines of communication with their child is kept open. Take the case of Mahesh. Sixteen years old and desperately in love with a girl, he completely changed his attitude after a chat with his girl-friend’s mother. She called him over and explained to him the futility of his love and the fact that there was no future in the relationship. What she did not do however was ridicule his desires which she felt were quite normal for his age. After a long chat with the broadminded lady, Mahesh decided to stop pressurising the girl to commit herself to him and he left the house a much happier person. He admits that he could never have had a talk with his own parents.

As far as teenage ethics go (at least amongst middle and upper classes) dating and being in love are acceptable, even desirable behavior. Holding hands, kissing, petting are accepted too. In fact teenagers with boyfriends and girl-friends are the butt of envy.

If a teenager does not have either romance or sex in his or her life, there could be many reasons for it – but it is certainly not peer pressure. He or she may be introverted, afraid of being caught, lack opportunity or maybe busy with studies.

It is also a mistake for parents to think that sexual maturing has not taken place – that teenagers are not ready physically. In fact girls are conscious of their sexuality from the age of 12. They inspect themselves intently in mirrors, taken pains over their appearance, and observe boys with interest. Boy look at girl’s bodies and become conscious of their own. We have to remember that in ancient times children married early. While this is not desirable, possible or practical now, we cannot halt the sexual rebellion amongst the young. No matter how much parents rave and rant about the evils of western influences, and the decline of Indian culture, the facts are that the desire to interact and romance the opposite sex is natural and has always existed in India! By denying the existence of such natural feelings parents are alienating their children.

(Article published in The Telegraph, Calcutta.)

Warning signals of five common drugs

Warning signals of five common drugs

• Anti-allergic medicines like Avil and Allegra: These may cause drowsiness, affecting ability to drive or operate hazardous machinery. May prove fatal if preceded or followed by alcohol.

• Anti-diarrhoea drugs like Ciplox-TZ and Norflox-TZ: When taken, avoid alcoholic drinks as the combination may cause flushing of the stomach leading to dehydration.

• Anti-angina drug Sorbitrate: Should dissolve under the tongue. Should be kept in an airtight dark bottle. It becomes ineffective after four weeks of opening the bottle.

• Anti-arthritis drugs like Voveran, Brufen, Indomethacin and Neproxen: They may be dangerous for patients with heart or kidney problems as they can worsen both.

• Aspirin: Take after meals to prevent stomach irritation. Avoid in case you have a history of bronchial asthma (it may cause an asthma attack) and stomach ulcers or severe indigestion as it can cause bleeding ulcers.

-Contributed by Dr Ashok Seth, chairman and chief cardiologist, Max Heart and Vascular Institute

Featured in Harmony Magazine
June 2007

Will I feel better or live longer with treatment?

High Blood Pressure the silent killer

EDITOR: DR. M. PAUL ANAND

High blood pressure is not a disease, but one indicator of a generalized systemic disease, which affects blood vessels supplying blood to most vital organs. It rarely makes people feel ill. No wonder more than half the person who have high blood pressure are not aware of its presence and half of those who are aware of it take no action as they do not feel ill. But the consequences of high blood pressure are deadly as it can strike suddenly in the form of a heart attack or a stroke.

“The social cost of sickness is incalculable. The prevention of disease is for the most part a matter of education, the cost is moderate, the results certain and easily demonstrated.”
Haven Emerson (1874-1957) 

What is blood pressure?
The term “blood pressure” is applied to the pressure of blood in the arteries (small vessels or tubes), which carry blood from the heart to the rest of the body. The circulation of blood requires pressure to maintain the flow.

What is high blood pressure?
High blood pressure (or ‘hypertension’ as it is called by doctors) is a common condition, which affects between one in six and one in five of the adult urban population and one in twenty and one in twelve of rural population.

Systolic and diastolic pressure

The heart is not a continuous pump. It beats (contracts) and then relaxes. Each heartbeat produces a pressure wave and expels blood from the heart. The peak of this wave is called the systolic pressure and the trough or lowest point between beats is the diastolic pressure. The height of the systolic pressure is due to the amount of blood expelled when the heart contracts and also the resistance to flow of blood produced by the arteries. In young people the larger arteries are fairly elastic and produce less resistance, compared to the arteries of older subjects.

How is blood pressure measured?

Pressure is measured with an instrument called a sphygmomanometer. A cuff containing a rubber balloon is placed around the upper arm and inflated to a pressure, above the systolic so that no blood can get through. Pressure in the cuff is then slowly released while an observer listens over the artery at the elbow below the cuff. As the blood starts to flow again, at the height of the pressure wave, it creates a thumping noise and the pressure in the cuff at this time is equal to the systolic pressure. As the pressure in the cuff falls further the sound suddenly becomes muffled and then disappears as the flow is no longer obstructed. The majority of doctors use the point at which the sound disappears, as the diastolic pressure. When your pressure is being recorded, it is important that you should have rested for at least 10-15 minutes, you should feel relaxed and not tensed up, you should let yourself go floppy and concentrate on slow deep breathing. You should be lying or sitting comfortably. When you visit your doctor for recording of your blood pressure: 1) you should not be wearing a shirt or a blouse with tight sleeves, 2) you should not have smoked in the previous half hour, 3) your arm, around which the cuff is applied should be comfortably supported and be placed at the level of your heart, 4) if the pressure is high, the doctor would probably take three readings at 1-2 minutes intervals and record the average of the last two readings, 5) ideally, if the readings are high these must be confirmed on at least two subsequent visits 1-2 weeks apart. The doctor may also record your pressure in the standing positions, with the arm held horizontally, at the level of the heart, and well supported.

What is normal blood pressure (B.P.)?

Blood pressure values are expressed in millimetres of mercury and are recorded as systolic/diastolic e.g. 120/80. Optimal B.P. is < 120 systolic and < 80 diastolic, < 130 systolic and < 85 diastolic is referred to as Normal B.P. while readings of 130-139 systolic and 85-89 diastolic would be called High-Normal B.P. All readings > 140 systolic and or > 90 diastolic are classified as various grades of hypertension. Blood pressure in an individual is not fixed but varies from minute to minute depending on activity, mental status and time of day. It falls to low levels when you are asleep at night and may become very high when you are angry, in pain, startled or under stress: intense mental arithmetic for instance has quite a profound effect. In some subjects, blood pressure may rise transiently in response to anxiety generated by the doctor measuring the pressure. In most cases the blood pressure measured on the first occasion is higher than that recorded on subsequent visits, when patients are more at ease. Blood pressure, particularly the systolic pressure, tends to rise with age. This is partly due to the fact that the larger arteries become harder and lose some of their elasticity. A systolic blood pressure of 140 would be abnormal in a woman of 18, but would be quite acceptable in someone of 70.

What is the cause of high blood pressure?

In nine out of ten patients with high blood pressure, no underlying disease can be found, and for this we use the term “essential hypertension”. This means that high blood pressure is a sign or an expression of an underlying disease process, which is as yet ill understood. There is no definite cause to which ‘essential hypertension’ can be attributed to. Genetics or heredity certainly plays an important role. If your parents’ blood pressure was high, then chances of your developing hypertension are increased. In addition, there are several risk factors, which are commonly associated with high blood pressure. These factors are: obesity, diabetes mellitus (sugar diabetes), excessive alcohol intake, and excessive salt intake.

Are there any definite causes of high blood pressure?

On rare occasions a definable cause may be identified, such as narrowing of the artery to a kidney or abnormal production of hormones from the adrenal gland. Occasionally high blood pressure may be due to other forms of severe kidney disease or congenital narrowing of the major artery leaving the heart. These situations are very unusual however and can be easily identified by blood tests and X-rays.

Are there any drugs, which can cause high blood pressure?

Occasionally blood pressure may be worsened by certain medications. Some tablets used in treating ulcers, arthritis, depression, cough and cold, nose drops, steroids or oral contraceptives may raise blood pressure. If you are taking medicine which your doctor may not know about (either bought at a chemist’s or prescribed by another doctor), it is vital that you tell your doctor. It is preferable to take these with you when you go for blood pressure measurement.

The Pill and Pressure

Some oral contraceptives (the pill) increase blood pressure in a small proportion of women. For this reason measurements of blood pressure should be made at regular intervals. Although some contraceptive tablets have little influence on pressure, it is usually preferable for patients with high blood pressure to practice other methods of birth control. Advice on this aspect may be obtained from your own doctor or from Family Planning Clinics.

Pregnancy and Blood Pressure

Pregnancy may have an important effect upon blood pressure. Normally blood pressure falls in the first months, even in women who have been hypertensive and then rise again in the later stages of pregnancy. High blood pressure may also develop for the first time in pregnancy (pre-eclamptic toxemia).

Hypertension may require treatment with bed rest or drugs particularly in the weeks before delivery. Amongst the various drugs used for hypertension, ACE inhibitors and Angiotensin II antagonists must be AVOIDED in pregnancy. It is better not to use Diuretics too. High pressure usually returns to normal after the baby is delivered. In all cases, it is important that blood pressures are carefully watched and, if necessary, treated throughout pregnancy. It should be emphasized however that if you have hypertension, you should be able to have a family without undue risk to the mother or baby, although this extra supervision is necessary.

How do I know that I have blood pressure?

Most patients with high pressure have no symptoms. Occasionally patients have symptoms such as headache, but only if the pressure is very high. Symptoms like headaches are far more likely to be due to other causes such as anxiety. Because most people with high blood pressure have no symptoms, the condition commonly goes undetected. To identify hypertension, there is no substitute to having your blood pressure measured. Improved detection of high blood pressure depends on the increase in public awareness of the need to have blood pressure measured. This is particularly true for people approaching middle age when high blood pressure becomes more common and for people who have relatives with high blood pressure. It is often convenient to have a measurement during a routine consultation which has been sought for other reasons.

If it causes no symptoms, does it matter?

It has been known for many years that people with untreated high blood pressure have a greater than normal risk of developing strokes, heart attacks and kidney disease, with a consequent reduction in life expectancy. This was first observed by Life Assurance Companies from follow-up studies of people who had their blood pressure measured during medical examinations for insurance purposes. It was found that the higher the blood pressure, the shorter was life expectancy. If anything, the insurance statistics underestimate the importance of blood pressure since they take no account of the disability which often occurs when patients survive an illness such as stroke. A person at the age of 40, for instance, is 30 times more likely to have a stroke if his blood pressure is high compared with someone with a normal blood pressure. It should also be emphasized that strokes and heart attacks caused by hypertension often occur in individuals who have no symptoms up to the time of the illness.

Do I need special tests?

The doctor would take a full history, including family history of premature cardiovascular disease and carry out a complete physical evaluation. On occasions, this may reveal a cause for high blood pressure or suggest special tests to find such a cause. It also helps to detect any problem and also indicate the type of medicine which may be required. Some commonly used tablets are harmful, for example in patients with chest disease. Simple blood and urine tests, ECG and chest X-rays may give additional information in selected patients.

Factors which determine prognosis

Presence of high levels of B.P., age > 55 years in men and >65 years in women, smoking, cholesterol levels of >250 mg/dl. Presence of diabetes, family history of premature cardiovascular disease, presence of damage to heart, kidneys, brain or eye arteries at the time of diagnosis or already existing heart, brain, kidney or vascular disease can worsen the prognosis.

 What difference does treatment make?

It is now established that blood pressure-lowering drugs are effective in preventing strokes, heart attacks, heart failure and kidney failure due to high blood pressure. In the small proportion of patients with very high pressure and symptoms of headache, blurring of vision and breathlessness, treatment produces rapid relief of symptoms.

However, it should be emphasized that benefit has also been shown in patients with no symptoms and moderately raised pressure. Because the risks of blood pressure are greater when levels are very high, the potential benefits of treatment are greater in these patients. Patients with borderline hypertension have to be closely watched. Those with other risk factors and strong family history may need drug therapy if non-drug measures do not lower blood pressure.

What can I do to lower my blood pressure?

Overweight and blood pressure

“A mature fat man excites pity, like a ship well stocked for its last voyage”.

Santiago Ramon Y Cajal (1852-1934)

High blood pressure is particularly common in people who are overweight and successful reduction of weight by a calorie-restricted diet usually helps to reduce blood pressure. Occasionally weight reduction alone is sufficient treatment but more often it assists the tablets.

Alcohol and Blood pressure

“First the man takes a drink, then the drink takes a drink, then the drink takes the man”.

Japanese proverb.

Heavy drinking alone raises blood pressure. In general, hypertensive patients should therefore avoid alcohol. In case they find it impossible to leave alcohol completely, then the average intake should not exceed one pint of beer a day or its equivalent in other forms of alcohol.

Diabetes and Blood Pressure

Diabetes is a well-known cause for narrowing of the arteries and heart attacks. Diabetes also tends to aggravate blood pressure. About 50% of all diabetics have raised blood pressure and about 15-18% of all high blood pressure patients have varying degree of blood sugar disturbance (DIABETES). When diabetes and high blood pressure are present together, the chances of getting a heart attack or stroke increase several folds. It is very important that both the diabetes as well as the high pressure be controlled vigorously. The goal of treatment in diabetes is to lower blood pressure to optimal, normal or at least high normal levels.

Salt and Blood Pressure

There is also a connection between salt in the diet and high blood pressure. Salt is certainly important in some forms of high blood pressure, particularly when there is kidney damage. Although severe restriction of salt intake can lower pressure, such diets are difficult for most people to follow for long periods. Moderate salt restriction is more readily achieved, but its effects on blood pressure in the long term are not yet clearly established. Those who take excessive salt should cut back on their intake of added salt. To lower salt intake you should not use salt at the table, use less in cooking and avoid food with a high salt content, e.g. salted nuts, pickles, chutneys, papad, tinned juice, ham, etc. There is also some evidence that salt reduction increases the effectiveness of some blood pressure lowering drugs. There is at the moment no convincing evidence that low salt diets can prevent high blood pressure.

Fat and Blood Pressure

A decrease in total fat consumption and in the proportion of saturated (mainly animal) to unsaturated (mainly vegetable) fats in the diet is currently widely advocated as the means of reduction in the incidence of heart attacks. Since patients with high blood pressure are a particularly high-risk group, this is worth considering seriously. It can be achieved by cutting down on fatty foods (e.g. dairy products and fatty meat) and substituting polyunsaturated fat (e.g. corn oil, Soya and sunflower oil, etc.). Such a dietary change may also slightly lower blood pressure, and may be beneficial in this way as well.

Smoking and Blood Pressure

“Tobacco’s an outlandish weed,
Doth in the land strange wonders breed:
It taints the breath, the blood dries,
It burns the head, it blinds the eyes;
It dries the lungs, scourgeth the lights,
It ‘numbs’ the soul, it dulls the spirits”.

Anonymous

If you smoke two cigarettes, your blood pressure goes up by 10-15 mm Hg. It comes to normal half hour after smoking. Whether this short term acute rise of blood pressure can cause permanent hypertension has not been proved. All the same these surges or spurts of blood pressure have been shown to cause damage to blood vessels. Further more, cigarettes themselves undoubtedly, cause coronary heart disease and arterial disease in the legs. Subjects with high blood pressure already have an enhanced risk of developing such problems and cigarettes are therefore particularly harmful. The risks of smoking for patients with high blood pressure are very great indeed and every effort must be made to stop smoking.

Stress and Blood Pressure

Anxiety and vigorous effort can raise blood pressure to quite a high degree. Although at first sight this might seem dangerous, it is a normal response to the circulation “fight or flight”, which probably helped our ancestors to survive. Healthy blood vessels can cope with changes in pressure without any damage.

It is possible however, that repeated exposure of arteries to high-pressure cause thickening of their walls and that this limits the flow of blood through them and so permanently causes high blood pressure. It has been suggested that the repeated ‘spikes’ of blood pressure produced by the stress of everyday life accounts for the fact that high blood pressure becomes much more frequent when people move from ‘primitive’ to ‘civilized’ conditions. Relaxation could therefore theoretically be beneficial. Some studies using relaxation exercises, meditation and bio-feed back have shown that blood pressure is slightly lowered.

Exercise and Blood Pressure

“Those who think they have no time for bodily exercise will sooner or later have to find time for illness”.

Edward Stanley, Earl of Derby (1826-1893)

Physical exercise takes one of two forms: dynamic exercise such as walking, running or cycling and isometric exercise, such as heavy weight lifting or sustained handgrip. Carrying a heavy suitcase is a typical example of isometric exercise.

Isometric exercise raises blood pressure. Most blood pressure lowering drugs are ineffective in preventing the rise of blood pressure during isometric exercise. Dynamic exercise is safe for most patients with high pressure once the blood pressure has been brought down from very high levels to mild or moderate levels. Physical exercise helps lowering blood pressure in several ways. It is sensible to avoid excessive isometric exercise such as heavy weight lifting.

Sex and Blood Pressure

Both heart rate and blood pressure rise substantially during sexual intercourse. This is much more likely if the intercourse is extra marital. In an uncontrolled hypertensive patient the act could be dangerous. However, when the blood pressure is reasonably controlled one can go ahead and enjoy this pleasurable exercise but do consult your doctor before initial sexual activity. In some patients with blood pressure, because of reduction in blood supply to sexual organs, the urge as well as performance can be reduced. This being the case, you must inform your doctor, so that he would avoid using certain drugs, which have the effect of reducing sexual function.

Medicines for treating Blood Pressure

In the past decade, a large number of blood pressure lowering drugs have been developed. The perfect drug should be effective, simple to take and entirely free of adverse effects. Modern drugs have not quite attained this ideal but represent a considerable advance on the earlier preparations available in the 1950s, which were often not very effective and were unpleasant to take. Different preparations lower blood pressure in quite different ways. One class of drug (vasodilators) relaxes the muscles in the smaller arteries widening their diameter and so reducing the resistance to blood flows. Another drug (‘beta-blockers’) act upon the nerves which control the circulation whilst a third group of drugs (diuretics or ‘water tablets’) cause the kidney to excrete more salt and water. Other drugs (ACE-Inhibitors) antagonize a hormone which raises blood pressure. Another class of drug, Angiotensin II receptor antagonists is somewhat similar to ACE Inhibitors, but have fewer side effects. There are also the calcium blockers, which reduce the tone of blood vessels and allow the blood to move more freely. It would be impossible to list all the available blood pressure lowering drugs. The same preparation is manufactured by different pharmaceutical firms under different names. In addition, each drug has a generic or proper name and a commercial name which is used by the manufacturer. Some commercial tablets contain more than one preparation to make taking of tablets a simpler matter.

Why does my doctor keep changing my tablets?

In general the aim of treatment is to produce gradual lowering of blood pressure over a period of weeks or perhaps months. Unless blood pressure is extremely high there is no great urgency. Doctors usually start with a low dose of tablets and slowly increase the dose. If this is not enough, another different type of drug may be added. sometimes the changes can be achieved by changing the strength of the tablets or by using a combination of tablets which contain two drugs. Controlling the blood pressure effectively is a time consuming process. Your doctor should inform you but not alarm you. Do not get impatient under any circumstances by listening to readings of the blood pressure. Let your doctor do the worrying part. Do not change your doctor and follow his advice for repeated check-ups in the initial stages.

Will I suffer side effects?

Serious side effects of blood pressure medications are now, happily, very unusual. It is natural to attribute any symptom which you have after starting a new treatment to that treatment. This is not necessarily the case. When new forms of treatment are being tested in research, patients are often given a totally inert tablet; this is technically called “placebo effect” and is a well-known factor in assessing treatment. At the same time occasionally, quite unexpected new side effects may be encountered. It is extremely important therefore, to discuss any new symptoms with your doctor. If blood pressure is reduced to low levels, then symptoms of light-headedness, dizziness and even fainting may occur. These effects are particularly noticeable on getting up from a bending or lying posture. In these circumstances, the dose of drug may need to be reduced or an alternative preparation prescribed. Some patients may be allergic to a particular type of preparation and develop a rash. Beta-blockers are highly effective drugs but occasionally side effect such as tiredness, cold hands and feet and wheezing may occur in some people. The heart rate is usually reduced and the response of the heart to fear and anxiety is modified. Drugs of this type may not be suitable for patients with some chest disease such as asthma and chronic bronchitis. Diuretics or ‘water tablets’ also lower pressure and tend to have few side effects although they cause lowering of blood potassium and this may need checking with a simple blood test. Gout and diabetes may occur on rare occasions. Occasionally patients experience sexual difficulties with some blood pressure-lowering drugs, and it is important to report such side effects if they occur. Some of the older drugs cause lethargy and sleepiness in some patients. Some of the newer converting enzyme inhibitors can produce dry irritating cough. You should not let this list of troublesome side effects make you apprehensive. The vast majority of patients receiving treatment for high blood pressure feel perfectly fit and well and the only problem is that of remembering to take the tablets. If you do not feel one hundred percent well on your treatment, it probably means that you have some other problem, or that your treatment needs altering.

How often should I have my blood pressure measured?

During the initial stage of adjusting you treatment, it may be necessary to have your blood pressure checked frequently, probably at intervals of between one and four weeks. Once blood pressure is satisfactorily controlled, it is usual to measure it every 3-6 months.

Is missing the tablets dangerous?

When most forms of blood pressure treatment are stopped, blood pressure only climbs slowly over days or even weeks. Missing out a single tablet will not therefore have any serious effect unless this is done frequently. In that case, control of blood pressure will be less than perfect. When a tablet is forgotten, you should not therefore take an extra tablet next time, but continue as though you had not forgotten a single dose.

One or two of the less commonly used tablets cause ‘rebound’ high blood pressure after a day or two if they are stopped suddenly. It is essential therefore that if for any reason you feel that your tablets have to be discontinued, you discuss this with your doctor. It is also of course a commonsense precaution to take an adequate supply of tablets when travelling.

Can I continue to take part in sport?

There is no reason why you should change your activities in any way unless you have an additional medical problem about which you should consult your doctor.

What if I need surgery?

There is no reason why a healthy person with well-controlled blood pressure should not undergo a dental or surgical operation. It is however, absolutely essential that both the surgeon (or dentist) and the anaesthetist know that you are receiving treatment for hypertension. Remember that, if your blood pressure is well controlled there may be no indication that you once had high blood pressure.

How about driving?

Once blood pressure is well controlled there is no objection to driving. Please remember that during the early phase of blood pressure control with some of the more powerful drugs, giddiness may occur if blood pressure falls too low. It is therefore worth asking your doctor about this possibility before starting new treatment.

Will I feel better or live longer with treatment?

Generally, you are unlikely to feel any better for having your blood pressure treated, unless you had hypertension related symptoms, prior to treatment. Thanks to modern developments, you should not feel any worse. By cooperating with effective treatment you will be helping yourself. You will be increasing the likelihood of enjoying a healthy active life and reducing the risk of developing some of the most common and dangerous diseases of middle and late life.

“There was temperance in eating and drinking. Their hours of rising and retiring were regular and not disorderly and wild. By these means the ancient kept their bodies united with their souls, so as to fulfil their allotted span completely, measuring unto a hundred years before they passed away”.
Huang Ti (The Yellow Emperor) 2697-2757 B.C.)
Your Treatment
Do

Take your tablets as prescribed.

Report any suspected side effects

(such as skin rash or giddiness) without delay.

Get your blood pressure checked regularly.
Don’t

Forget your treatment.

Run out of pills.

Start other tablets (cold cures or pills for arthritis)

without consulting your doctor

Courtesy–

Heart Care Publication of the National Society for Prevention of Heart Disease and Rehabilitation

Hospitals in Mimbai

Aakar IVF Centre

3, Gautam Building, Tilak Road, Ghatkopar (E)

25158875

Agarwal Clinic Surgical Centre & General Hospital

49 Daftary Road, Malad (E)

28893594, 28817105

Alok Shah’s ICCU & Nursing Home

4/6, Shroff Apartment, Sodawala Lane, Borivili

8060890

Ameeta Nursing Home

Ramgiri, 2nd & 3rd Floors, Ist Road, Opposite Natraj Cinema, Chembur

25281369

Ankur Hospital

1st Floor Kalpataru Building, Mathuradas Road, Opposite Punjab National Bank, Kandivali

28610671/28070401/28074385

Arihant Heart Clinic

103, Lancelot, S. V. Road, Borivili

28057717/ 28058015

Aseem Orthopaedic Hospital

B-Wing, Rizvi Park, Near S.V. Road, Santacruz

26117946, 26117947

Asha Parek BCJ General Hospital

S.V. Road, Santacruz (W), Opposite Petrol pump

26491203

Ashirwad Orthopaedic & Surgical Nursing Home

2, Sambhav Darshan, Opposite Jain Temple, Jamil Galli, Borivili

Ashvini Children’s Hospital

L.J. Road, Mahim

4452536

Bai Jerbai Wadia Hospital for Children

Acharya Dunde Marg, Parel

24129786, 24129787

BARC Hospital

Anushakti Nagar

25563137-40

Beramji’s Hospital

266 Patel Building, Churni Road, Opposite Central Cinema, Girgaum

3690220

Bhagawati Hospital

Mandepeshwar Road, Borivili

28932461-3

Bhaktivedant Hospital

Sector-1, Shuristi Complex, Mira Road

28128888

Bhatia General Hospital

Dadaji Davuji Road, Tardeo

56660000

Bombay Hospital Trust

12 New Marine Lines, Near Liberty Cinema

22067676

2080871

Breach Candy Hospital & Research Centre

60 A Bhulabhai Desai Road

23696194, 23633651, 23671888, 23672888

Children Orthopaedic Hospital

Hajali Park, Opposite Wellington Sports Club, Clerk Road, Mahalaxmi

24920030

Copper Municipal General Hospital

Vile Parle

26207254-57

Cumballa Hill Hospital & Heart Institute

93/95 August Kranti Marg, Cumballa Hill

23803336

D.S. Kothari Hospital

Kasturi Chowk, C.P. Tank Road, Bhuteshwar

2420957

Disha Pathology Services Shroff Eye Hospital, 2nd floor

222 S V Road, Bandra (W), Mumbai

91 22 5694 9876, 5692 1000 Ext 200

91 22 5694 9880

dishapathology@vsnl.net; http://www.shroffeye.org

Dr. Balabhai Nanavati Hospital

S.V. Road, Vile Parle

26135534

Dr. C.L. Jhaveri Hospital

224 Jaya Deep, T.H. Kataria Marg, Matunga Road, Western Railway, Matunga

4376823

Dr. Das Surgical Hospital

2nd Floor, Gagangiri Complex, 18th Road, Near Ambedkar Garden, Chembur

5282101, 5281960

Dr. Khatav’s Mother & Child Hospital

Arunoday Shopping Centre, Opposite Ajanta Talkies, Borivili

8013814, 8013285

Dr. Mahajans Hospital and Industrial Trauma Centre

R-831, Rabale TTC, Rabale, Navi Mumbai-400708

27691981

27691679

mahajanpv@hotmail.com

Dr. Patkar’s Surgical Nursing Home

Anant Nivas, Keluskar Road, Shivaji Park

4458271

ESIS Hospital

Akruli Road, Kandavilli (E)

28877501

Gandhi Nursing Home

Chandra Apartments, Mandokeshwar road, Borivili

8954255

Ghatkopar Hindu Sabha Hospital

H.J.Doshi, Shradhanand Road, Opposite Ghatkopar Railway Station, Ghatkopar

25153260, 25154013

Gokuldas Tejpal Hospital

Lokmanya Tilak Marg Road

22630553

Guru Nanak Hospital

Kalanagar, Bandra

6456818-19

Guru Nanak Hospital

S-341, Gandhi Nagar, Bandra (E)

022 – 26592853-54/55/56/57/59/60

26592862

gnhosp@vsnl.com

Harilal Bhagwati Municipal General Hospital

S.V. Road, Mandpeshwar Road, Borivili

022 – 28932461/63

Holy Spirit Hospital

Mahakali Caves Road, Andheri

28378822 / 28372748 / 28386653

28221430

hsh@bom3.vsnl.net.in

Hurkisondas Nurrotamdas Hospital

Raja Rammohan Roy Road, Girgaon

23855555 / 23810707

23857432 / 23822706

INHS Ashwini Hospital

Colaba, Near R.C. Church

022-22151666

J.J. Hospital

Byculla

022-23735555, 23755555, 23759031-40

Jaslok Hospital & Research Centre

15, Dr. Deshmukh Marg

022-56573333/ 56573175/ 76/ 33/ 71

23520508

info@jaslokhospital.net

http://jaslokhospital.net/

K.B. Bhabha Hospital

R.K. Phatakar Road, Near Bandra Police Station, Bandra

26125555

K.B. Bhabha hospital

Kurla Police Station Road, Kurla

25140241

K.J. Somaiya Hospital

Sion-Trombay Road

Kalajot Hospital & ICCU

‘Devidas Mansion’ Mereweather Road, Apollo Bunder, Behind Hotel Taj

2833187

Kamdar Children’s Hospital

56, Indralya, Sion Main Road, Sion

4091808

Kanamwar Nagar Hospital

Kanamwar Nagar, Vikorali

25782283

Karuna General Hospital

Jeevan Bima Nagar, Borivili

Kasturba Hospital

Sane Gurji Marg, Near Author Road Jail

23083901

KEM Hospital

Dr. Borjes Road, Parel

24136051, 24131763, 24137511

Khandelwal ENT & General Hospital

301 to 305 Jainson Plaza, S.V. Road, Opposite Malad Shopping Centre, Malad

400064

Leelavati Hospital and Research Centre

A-791, Bandra Reclamation, Bandra

26438281/2

LokmanyaTilak Municipal General Hospital

Sion (E)

24076381/24076380/24092020

Lotus Hospital Trust

30 North South Road, Opposite Juhu Bus Terminus

26207352/ 26207534

2620 5590

maparekh17@hotmail.com

M.W. Desai Hospital

Haji Bapu Road, Govind Nagar, Malad (E)

28401215/7857, 28774215, 28777857

Mangal Anand Hospital

48, Swastik Park, Sion S.T. Road, Chembur

25227539

Manisha Hospital

Sant Savata Mali Marg, Byculla (E)

23776656

Mumbai Port Trust Hospital

Nadkarni Parle, Wadala (E)

24145100

Nair Hospital

Dr. A.L. Nair Road, Opposite Maharata Mandri Theatre, Bombay Central

23081490

Nanavati Hospital

S.V. Road, Vile Parle

26184389

P.D. Hinduja National Hospital & Medical Research Centre

Veer Savarkar Marg, Mahim

022 24448524/9199, 24451515

022 24449151, 24447518

Pandya Surgical & Maternity Hospital

Rama Niwas, Sodawala Lane, Borivili

022 28014511

022 28021284

Parleshwar Maternity & Surgical Hospital

Shashi Vihar, Datta wadi, Hanuman Road, Vile Parle (E)

022 26175137, 26141255

Parsi General Hospital

Cumballa Hill, Bomanjee Petit Road

022 23633041

Parvish Nursing Home Pvt. Ltd.

12, Shiraz Building, Telligully, Andheri (E)

022 – 26824868, 26820620

Pikale Nursing Home

M.M. Chotani Cross Road No. 2, Near Mahim Railway Station

022 24467138

Podar Hospital

Worli

022 24933533, 24931846

Prince Aly Khan Hospital

Aga Hall, Nesbit Road, Mazgaon

022 – 23754343-42, 23758871, 23734422-60

022 – 23743820

Radhibai Watumull Chest Hospital

120, Veer Savarkar Marg, Mahim

022-24441920

Raheja Hospital

Raheja Road, Mahim

4467570

Rajawadi Hospital

Vindhyavihar (E)

5115066

Rhushabh Nursing Home

C-2/201, Anjana Apartments, S.V. Road, Borivili

8992261

Rose Petal Nursing Home

Nand Dham, L.T. Road, Opposite St. Anne School, Borivili

8012209

S.K. Patil Hospital

Bafpari Road, Malad (E)

8894381

Sanjeevan Nursing Home

175 A, Kum Kum Building, Scheme No. 6, 13th Road, Gujarat Society

4072669

Sanket Clinic & Hospital

Nand Dham, Opposite St. Anne’s School, L.T. Road, Borivili

8017814

Seth AJB ENT Hospital

7 Maharishi Dodichi Marg, Opposite VSNL Bhawan, Fort

2043322, 2052526

Shah Nursing Home & Child Health Centre

Manu mahal, 1st floor, Above Tipsy Topsy hotel, Maheshwari Udyan, King’s Circle, Matunga

4037318

Shashikant Hospital & Polyclinic

82/B, Syndicate Bank Building, Near Chembur Station

5513182

Shraddha Nursing Home

Behind Shanti Ashram, Off. Ekshar Road, Borivili

8918321

Shree Samasta Parajiya Suvarna General Hospital

Kastur Park, Shimpoli Road, Borivili

8999494

Silver Mind Psychiatric Hospital

Shiv Krupa Complex, 4th Floor, Opposite Canara Bank, Navpada Gokhale Road, Thane

5421159

Smt. Sunita Devi Singhania Hospital

P.O.J.K.Gam, Pokhran Road No. 2, Thane

5426431-32

St. George Hospital

Near CST Railway, Behind GPO Post Office

2620242-47

Suchak’s Maternity & General Hospital

186, Manchhubai Road, Malad (E)

8885229

Tandon Hospital

Gagangiri complex, 1st Floor, 18th Road, Near Ambedkar Garden, Chembur

5281884

Tata Memorial Hospital

Parel, Mumbai

4146750

Veer Savarkar Hospital

Mahatma Phule Road, Opposite Deshmukh Garden, Mulund (E)

5686225

St. George Hospital (CST)	Phone : 2262-0242
Sarvodaya Hospital (Ghatkopar W)	Phone : 2515-2332
Saifee Hospital (Charni Road)	Phone : 2386-1418
Sushrusha Hospital (Dadar)	Phone : 2444-9161
Tata Memorial Hospital (Parel)	Phone : 2416-1413
Wadia Childrens Hospital (Parel)	Phone : 2414-7843
Bhakti Vedant Hospital (Mira Road)	Phone : 2812-8888
Dr. Mankikar’s Hospital (Virar)	Phone : 95250-2523282 STD : 0250-2523282
Cardinal Gracious Hospital (Vasai)	Phone : 95259-2324220 STD : 2322683

Hospitals In Vasai

Fever of unknown origin

Fever of unknown origin

A fever of unknown origin (FUO) is a temperature that reaches 101°F on and off for at least 3 weeks with no known cause. Fever is a symptom of another condition, so your health care provider will continue to carry out tests for a fever that persists, to narrow down the causes and determine how to treat the underlying illness. In 5 – 15 percent of cases, however, no cause is found.

Your health care provider may prefer not to give you medication while your fever remains undiagnosed. Research suggests that fever helps fight off infections. Treating the fever without knowing the cause might reduce your body’s ability to deal with the possible infection. However, health care providers will prescribe drugs to reduce fever in children who suffer seizures caused by fever (febrile seizures). Because a higher temperature increases your need for oxygen, your health care provider may prescribe fever-reducing medicines if you have heart or lung problems.

Signs and Symptoms

• Fever of more than 101°F (38.3°C), either continuous or intermittent, for at least 2 weeks
• Fever above 101°F with no known cause even after extensive diagnostic testing

What Causes It?

Fever is a symptom of several conditions. Health care providers can use a series of tests to try to narrow down the list of possible reasons for a high temperature.

What to Expect at Your Provider’s Office

A health care provider trying to diagnose the cause of a fever of unknown origin must look for every possible clue. The provider may ask you questions about:

• Your work, because some workplaces contain organisms that can cause fever.
• Places you have visited recently. Locations overseas, and even areas in the United States, can harbor diseases that can cause fever.

Your health care provider will also examine you closely, paying particular attention to your skin, eyes, nails, lymph nodes, heart, and abdomen. The health care provider will also take blood and urine samples. You may have an ultrasound, computed tomography (CT scan), and magnetic resonance imaging (MRI). If the cause of the fever is still unknown, your health provider may want to inject you with “labeled white blood cells.” These are white blood cells that contain a harmless radioactive compound. Once injected, the white blood cells travel to infected parts of your body. The radioactivity allows your provider to see on an x-ray where the cells have moved. This may show location of the infection responsible for your fever. If that test shows no results, your health provider may want to perform minor surgery to take biopsy samples of, for example, your liver or bone marrow.

Treatment Options

Your health care provider will advise you to rest and drink plenty of fluids. You may be asked to stop taking medications for other ailments, because those medications may be causing your fever. If you have a heart or lung problem, or in the case of a child who has seizures as a result of fever, your health provider will probably prescribe over-the-counter remedies to bring the temperature down.

Drug Therapies

• Acetaminophen
• Aspirin and other nonsteroidal anti-inflammatory drugs. Avoid aspirin in children and teenagers.

In cases of infection, your doctor may also prescribe an antibiotic, antifungal, or antiviral drug, depending on the cause of the infection.

Complementary and Alternative Therapies

General immune support with nutrition and herbs may alleviate fevers. Most natural medicine practitioners will treat fever as a sign that the body is trying to heal itself, rather than as an illness. In addition, most natural therapies attempt to support the body’s own healing processes rather than suppress the fever. It is important to speak to your medical doctor about any natural therapies you may be considering. Prolonged fever can be dangerous, and some natural therapies and conventional medications can have dangerous interactions.

Nutrition and Supplements

• Eliminate alcohol, caffeine, refined foods, and sugar.
• Drink water or electrolyte replacement (sports) drinks.
• Vitamin C (1,000 mg four times per day), beta-carotene (15,000 – 50,000 IU per day), and zinc (10 – 30 mg per day) help your immune system work better and reduce inflammation.

Herbs

Herbs are generally a safe way to strengthen and tone the body’s systems. As with any therapy, you should work with your provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 – 10 minutes for leaf or flowers, and 10 – 20 minutes for roots. Drink 2 – 4 cups per day. You may use tinctures alone or in combination as noted.

The following herbs may help reduce fever and improve immune response:

• Coneflower (Echinacea purpurea)
• Yarrow (Achillea millefolium)
• White willow bark (Salix alba)
• Lemon balm (Melissa officinalis)
• Spearmint (Mentha spicata)
• Catnip (Nepeta cateria)
• Elder (Sambucus nigra)

Combine 1 part coneflower and 1 part white willow bark with equal parts of two or more herbs. Drink 3 – 4 cups per day. Although white willow bark has not been linked to Reye’s syndrome, it is similar enough to aspirin to cause concern in children under 16. Consult your doctor before giving white willow bark to a child. Also avoid white willow bark if you are allergic to aspirin or if you take blood-thinning medication.

Andrographis is often used to treat colds and sore throats and may also help reduce a fever. One study suggested 6 g per day for 7 days was effective with no side effects. Do not use andrographis if you have gallbladder disease, an autoimmune disease, or if you are pregnant or trying to become pregnant.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of fevers based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type — your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Aconitum — for fever that comes on suddenly and alternates with chills, heat, and flushing of the face. You may be anxious and crave cold drinks.
• Apis mellifica — for fever associated with alternating bouts of wet (sweating) and dry body heat.
• Belladonna — for sudden onset of high fever with hot, red face, glassy eyes, lack of thirst, and hot body with cold hands.
• Bryonia — for fever with symptoms that are aggravated by the slightest movement.
• Ferrum phosphoricum — for the first stages of a fever with a slow onset. This remedy is generally used if Belladonna is ineffective.
• Gelsemium — for fever accompanied by drowsiness and lack of thirst.

Physical Medicine

• Constitutional hydrotherapy — Involves the application of hot and cold packs to the body by a trained professional in order to evoke a general healing response by the body. With any hydrotherapy technique, it is crucial to avoid becoming chilled. All treatments should end with a vigorous rubdown.
• Wet socks treatment — This hydrotherapy technique can be done at home. Before going to bed, soak a pair of thin cotton socks with water and then wring them out so they are damp but not dripping wet. Put them on your feet, and then put on a pair of dry thick socks (preferably wool) over them. Wear these to bed. As you sleep, your body will send blood and lymphatic fluid circulating in order to fight off the wet feeling on your feet. This stimulates the immune system and puts the body in a parasympathetic state that supports healing and restful sleep. By morning the socks should be completely dry. This technique can be done for 5 – 6 nights in a row. Then take 2 nights off and continue.

Acupuncture

Acupuncture may be helpful in supporting immune function.

Special Considerations

Fever can be dangerous if you are pregnant. Nutritional, herbal, and homeopathic treatments for fevers are generally safe in pregnancy, yet you should use them with caution.

Supporting Research

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:182.

Berkow R. Merck Manual, Home Edition. Rahway, NJ: The Merck Publishing Group; 1997.

Berkow R, Beers MH. The Merck Manual of Diagnosis and Therapy. Rahway, NJ: The Merck Publishing Group; 1992.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicine. Boston, Mass: Integrative Medicine Communications; 1998:427.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Cummings S, Ullman D. Everybody’s Guide to Homeopathic Medicines. 3 ^rd ed. New York, NY: Penguin Putnam; 1997: 53.

Duke JA. The Green Pharmacy. E mmaus, Pa: Rodale Press, 1997.

Fiebich BL, Appel K. Anti-inflammatory effects of willow bark extract. Clin Pharmacol Ther. 2003;74:96.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors’ Guide. New York, NY: Warner Books; 1996: 169.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:6, 58, 62.

Thamlikitkul V, Dechatiwongse T, Theerapong S, et al. Efficacy of Andrographis paniculata, Nees for pharyngotonsillitis in adults. J Med Assoc Thai . 1991;74:437–442

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 84.

Walker LP, Hodgson E. The Alternative Pharmacy. Paramus, NJ: Prentice Hall Press; 1996.

• Review Date: 6/30/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

http://www.umm.edu/altmed/articles/fever-unknown-000060.htm