Hypertension along with diabetes has become one of the most dreaded chronic illnesses in India. To understand the disease we first need to understand  the basics of blood pressure. Our blood flows through our arteries with pressure. This pressure is determined by the pumping of the heart as well as resistance to the flow of blood by the arteries. Due to genetics, high cholesterol or other reasons, the wall of the blood vessels get thickened leading to increased resistance for the blood to flow. Due to this, even the heart has to pump harder. This causes the blood pressure to go up causing hypertension. All the complications mainly stem from thickening of the vessel walls, leading to reduced blood flow to different body parts. Some of the more serious complications of hypertension include:

Coronary artery disease (CAD): Elevated blood pressure makes the arteries (blood carrying vessels) thick and narrow and damage their lining (endothelium). This acts as a starting point for the formation of a clot which can grow and this block the blood supply to the heart. When there isn’t enough blood supply to the heart, its efficiency is reduced and the tissues are damaged leading to angina (chest pain). The tendency to develop coronary artery disease is more if you have other risk factors like diabetes, obesity and family history.

Heart failure: When the blood pressure is high it increases the workload of the heart and the heart has to pump the blood against this elevated pressure and in this process the heart has the work more. The heart pays the price of this hard work by thickening its muscle wall especially the left ventricle and many times this thick heart(hypertrophied)  may not be able to pump enough blood to the different organs thus compromising the body needs and eventually leading to heart failure.

Brain haemorrhage (stroke): Hypertension increases the risk of brain haemorrhage by almost 10 times. It weakens the small vessels in the brain causing them to rupture. In fact high BP is responsible for 80% of all heart attacks and stroke.

Aneurysm: Hypertension also weakens the vessel wall causing it to bulge. This forms an aneurysm (distension or a pouch-like structure in the vessel wall) which can rupture and is invariably fatal.

Kidney damage: Elevated blood pressure damages the small vessels in the kidney. This reduces the blood supply to it and the kidney starts losing its normal functions and eventually leads to kidney failure.

Vision loss: Blood vessels in the eye (retinal vessels) are narrowed and the vision can get impaired leading to retinopathy and eventually blindness.

Sexual dysfunction: The arteries supplying the penis can get narrowed leading to reduced blood supply and erectile dysfunction in males.

Hypertension has also been associated with memory loss.

In pregnancy it can cause convulsions in the mother eventually leading to coma and preterm labour. The babies that are born are usually low in weight.

Hence, the high blood pressure is not just a reading on your sphygmomanometer/BP monitor but a warning to work towards reducing your BP and prevent the disastrous complications. In short monitor your BP, take proper treatment and bring about lifestyle changes and move towards a healthy life!

Our body has a natural immunity

We have miracle-fighters called antibodies which recognize anything that is ‘foreign’ to our body and destroy it. What’s even more awesome is how the immune system then ‘remembers’ these enemies and destroys them  everytime they attack, thus conferring what is called ‘immunity’ to the particular disease. The baby’s immunity is further enhanced by the mother’s breast milk in the first 4-6 months of life.

Then why give vaccines?

Giving vaccines for different diseases confers what is called ‘acquired immunity’ to the disease in the way described above. Some of the diseases like polio, TB, Diphtheria, Tetanus, Measles, Hepatitis B which can be deadly in children can be prevented with vaccines.

In public health practice, vaccination is given to confer community protection so that even unimmunized children will have a reduced risk of getting the disease. This is called as the ‘herd effect’ of immunization. 

What vaccines are available and what diseases are they effective against?

Vaccines recommended by the Government and available at Government hospitals at reduced costs include:

• BCG vaccine (mandatory) – Given as an intradermal injection soon after birth; prevents TB. Can cause a raised area at the site of the injection, do not apply any medicine to the site.
• OPV vaccine (mandatory) – Given orally as several doses till the age of five, this prevents polio. Poliomyelitis is a disease which affects the nerves causing muscle weakness and paralysis. It is given free of cost to all children below five years of age under the Pulse Polio programme.

• DPT vaccine (mandatory) – Given as an intradermal injection, it prevents three diseases (Diphtheria, Pertrussis and Tetanus).
  a. Diphtheria is an infection which starts with a ‘sore throat’ but can rapidly lead to formation of toxins (poisons) causing life-threatening complications.
  b. Pertrussis (whooping cough) affects the lungs in children below 15 months of age. Starting with cold and cough, it progresses to episodes of coughs with a ‘whoop’. Complications include pneumonia, brain damage and death.
  c. Tetanus starts when a wound is infected with bacteria found in soil, it affects the body’s muscles and nerves. The toxin produced by the bacteria causes muscle spasms, interferes with nerves and can be fatal.

• Measles vaccine (mandatory)– The vaccine is given subcutaneously (just below the skin) as the baby completes nine months. A very contagious viral infection, measles starts as cold and cough with rashes progressing from the hairline downwards. It can progress to diarrhoea, pneumonia, infection of the brain leading to death, if untreated.

The immunization schedule as per the Universal Immunization Programme in India:

Other optional vaccines recommended for your child

Things to remember during your child’s vaccination

He also said that he had nausea and vomiting. He could barely rise up from bed. 

He recorded a temperature of 104 deg F. He was shivering and also feeling cold. He was taken to a doctor and after a battery of investigations diagnosed with malaria.

India corresponds to 70% of malaria in the South East Asian region. Annually India reports two million cases and 1000 deaths.  The forested pockets in Orissa, Jharkhand, Madhya Pradesh and Karnataka are areas where the prevalence of the disease is very high. Malaria they say affects 36% of the world’s population; around 2020 million people in 107 countries are affected.

What is malaria?

Malaria is an infectious disease that is caused by plasmodium parasite which infects the red blood cells and is characterized by fever, body ache, chills and sweating. Similar disease has also been described in the holy Vedas. It derives its name from mal aria which means ‘bad air’ in Italian. Of the four species that cause malaria (plasmodium vivax, plasmodium falciparum, plasmodium ovale, plasmodium malariae) plasmodium falciparum is the most serious and can cause serious complications. An individual can be infected with two species at the same time.

How does one get malaria?

The life cycle of malaria is complicated and it involves two hosts- the human being and the mosquito. Once bitten by a female anopheles mosquito, the malarial parasite enters the blood stream. It travels all through his blood stream to reach the liver. In the liver the parasite matures and multiplies. Some of the parasites stay there whereas the other parasites move out from the liver attacking red blood cells. The parasite then multiplies in the red blood cells. In the next 48-72 hours, more parasites are released into the blood.  This is the reason why the chills of malaria are generally seen after 48 to 72 hours corresponding to the release of the malarial parasite in the blood.

What are the symptoms of malaria?

After been bitten by an infected mosquito, the disease takes around 14 days to manifest. Common symptoms are fever, chills, vomiting, nausea, body ache, headache, cough and diarrhoea.  The cycle of fever and chills usually repeats after 48 hours (this corresponds to the release of parasite from the blood cell). After a few cycles of fever the person also develops anaemia due to breakdown of red blood cells. The spleen which is an organ situated beneath the rib cage on the left side enlarges and is felt in the stomach.

Why is malaria dangerous?

If untreated within 24 hours of the symptoms showing up, it can be a very serious and life threatening disease because of the following complications:

• Severe anaemia caused due to the red blood cells being destroyed.
• Jaundice
• Dehydration
• Cerebral malaria: the infected red blood cells block the vessels in the brain and lead to seizures and coma and eventually death if not treated.
• Very low BP leading to ‘shock’
• Liver failure
• Kidney failure

These symptoms can be more severe in pregnant females, babies and the elderly.

How is malaria diagnosed?

Normally blood is taken from a finger prick at a lab and the parasite is seen within your red blood cells under a microscope. A variety of rapid tests are available that detect the malaria antigen and can diagnose the condition in 10 minutes.

How is malaria treated?

The National Institute of Malaria Research has developed guidelines on diagnosis and treatment of malaria:

• Chloroquine is given to the patient and dose is given depending upon the body weight of the patient. The use of Chloroquine has led to the emergence of many Chloroquine-resistant falciparum malaria cases. For such individuals, a drug called Artemisinin is given.
• Avoid giving anti-malarial drugs on an empty stomach. Always give the first dose under observation.
• Give plenty of fluids
• If no improvement occurs within 48 hours, call the doctor.
• Look for any warning signs of dehydration, reduced urine output, bleeding, seizures or coma.

 How can malaria be prevented?

• Mosquitos breed in stagnant water – whether it is a nallah near your house, a pond in the neighbourhood or a water puddle near your house from a long time. Get them closed, cleaned up as soon as possible. Even plants in pots, bird baths, fountains etc should not hold stagnant water. The water in the swimming pools needs to be circulated and chlorinated.
• If you store water in the house due to its shortage, close the container.
• Use mosquito screens, nets, fibre glass meshes or magnetic insect repellent screens for your windows if you live in a mosquito-infested area. If possible, avoid the time immediately after dusk to venture out especially so for children. If you need to, wear clothes that cover your body to a large extent. Cover the exposed parts with a mosquito repellent.
• Indoor residual spraying with an insecticide is also recommended.
• Insecticide treated bed nets should be used in areas where mosquitos and malaria are rampant.
• If travelling to a malaria-endemic area, chemoprophylaxis is given to travellers. Consult your doctor and discuss your travel.

Generally, at an overall level, if fever, body ache, a feeling of ill-being and unexplained loss of weight are troubling you for more than three months, one can suspect cancer. Do visit your physician and get your blood tests done. There could also be chronic tiredness & fatigue because in certain cancers, the bone marrow does not produce enough red cells leading to reduced hemoglobin and weakness.

Though we obviously cannot enlist every presenting symptom here as every person is unique and it may present differently every time, we have attempted some of the more common ones:

• Alternating diarrhea and constipation for a prolonged time period: could be a symptom of intestinal cancer.
• Persistent cough and hoarseness of voice: If it persists despite full course of antibiotic therapy, it could indicate cancer of the throat.
• Blood in stools: could indicate gastrointestinal cancer.
• Blood in urine: If you happen to see reddish-colored urine and have fever and pain in the abdomen, it could be a cancer of the kidney.
• A non-healing ulcer in the mouth: It could indicate an oral cancer, especially if you are a smoker or chew tobacco (as gutka, tambaku).
• Prolonged menstrual bleeding: If you witness periods for more than 10 days to weeks, it could indicate uterine cancer.
• Blood in sputum/ phlegm along with cough: If you have persistent cough leading to blood in your phlegm/ sputum, it could indicate lung cancer.
• Recurring jaundice: If you’ve been suffering from jaundice off and on, it’s time you screen yourself for liver cancer.
• Lump in the breast: Although not all lumps in the breast are cancerous, it is worthwhile to get them examined by a good breast surgeon. Women over 35 years of age should ideally get mammography done every one or two years.
• Change in the size of a wart, mole: It could indicate skin cancer.
• Thickening or lump anywhere on the body which is either growing or lasts for more than a few days should be shown to the physician too.

 Now that you are aware, do get yourself or your loved ones screened early for better chances of survival. Do spread the word – it could save someone’s precious life

Also read: War on Cancer

Your doctor might order a CBC test if:

• If you experience fatigue, weight loss, fever, bruising etc.
• If you have abnormal bleeding, to check for its cause and possible effects on the blood cell counts.
• If you have infections
• There is a possible diagnosis of certain blood cancers like leukemia
• Diagnose certain conditions like asthma and allergies
• You are scheduled for a surgery
• You are undergoing radiation and chemotherapy for cancer, to check their effects on your blood cells

Read: Blood tests: Understanding the basics

Red blood cell (RBC) count:  Normal values are 4.5 to 5.5 million cells/cubic mm. Since RBCs are essential to carry oxygen to different parts of the body, reduced levels mean decreased oxygen supply to the body leading to fatigue and weakness (anaemia). Low levels of RBCs are seen in iron deficiency anemia, thalassemia, stomach ulcers, sickle cell anemia and certain cancers.  If the levels of RBCs are increased, they stick to each other, form clumps and block blood vessels. High levels are seen in case of chronic smokers, alcoholics, people with long-term lung, kidney, heart or liver disease. It may also be increased in cases of dehydration, burns, diarrhoea and vomiting.

White blood cell (WBC) count: The white blood cells are a group of 5 cells that help to protect your body from infection. The five cells are neutrophils, lymphocytes, basophils, eosinophils and monocytes. The normal WBC count is 4000 – 11000 cells/ cu mm. A value above 11000 is termed as leucocytosis and a value less than 4000 is termed as leucopenia.

When your WBC counts are high, the first thing to rule out is infection.  Sometimes very high count could indicate leukemia, a type of blood cancer. Slightly elevated counts can also be seen in pregnancy or in children below the age of 2 years, which is absolutely normal.

 Normal % of each type of WBC:

Neutrophil  40-70%

Lymphocytes  20-40%

Eosinophil   2-6%

Basophil   0-1%

Monocyte  2-8%

If the percentage of neutrophils shows an increase, look out for bacterial infections. Elevated levels of lymphocytes could indicate a viral infection. Increased levels of eosinophils could be an indicator of allergies or parasitic infection.

Low levels of WBC are found in patients who have taken steroids (or medicines containing them) or are undergoing treatment for cancers.  Very often, it could be an indicator of a bone marrow failure.

Platelet count:

Platelets  are the tiny cells in your blood that help in forming blood clots. Normal platelet count is around 1.5 to 4 lakhs/cu mm. A platelet count is a very important investigation especially in malaria and dengue cases. Dengue causes fall in platelets and this can be very dangerous as platelet levels below a certain level could cause bleeding in the brain.

Haemoglobin: 

Haemoglobin is the substance in the red blood cells that carries oxygen. A normal haemoglobin count in a male is 13-15 gms/ dl. In a healthy female it is 12 – 14 gms/ dl. A value less than 12 gms/ dl is termed as anemia. This could be either due to deficiency of iron, vitamin B12 or Folic acid. Deficiency of these could be due to a diet deficient in these nutrients, blood loss in your body or your body is unable to absorb these even though you are are taking it in adequate quantities. At times low haemoglobin could be an indicator of some chronic disease.  Low haemoglobin would result in the person complaining of tiredness, swelling of legs, strange desire to eat chalk or cement ( pica)   especially if you have iron deficiency anemia and sometimes even tingling and numbness in legs in case of Vitamin B12 or Folic acid deficiency which is called as megaloblastic anemia.

Peripheral smear:

Sometimes, your doctor could also ask for a peripheral smear. In this a drop of blood is taken on a glass slide, spread and stained to see the RBCs, WBCs and platelets. It also helps to look for any parasite in cases of malaria or filaria. In case of anemic patients, the smear also gives information about the type of anemia one is suffering from.

ESR (erythrocyte sedimentation rate):

Normal values are 2-6 mm at the end of one hour.  High values may be seen in infections. Very high values if reported might indicate tuberculosis or multiple myeloma (a form of cancer of the bone marrow).

Preparing for a CBC test:

A technician ties a band around your arm so that the veins on that hand are more prominent. The site of withdrawal of blood is cleaned with an alcohol swab. A new disposable syringe is used for each patient. The vein is entered with the syringe and the blood withdrawn.

After the procedure, you might get a bruise or two. Just maintain some pressure with your other hand on the site for a while. 

If you suffer from bleeding or clotting disorders or are taking medicines like aspirin, warfarin or other blood-thinning agents, the bleeding might take a while to stop. Do tell the doctor and the people at the lab before the test about the same.

 Also read: Blood tests: Understanding the different kinds 

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A few statistics

India has approximately one lakh people affected with Haemophilia with an estimated prevalence rate of 1:100,00. Around 14000 are registered patients. Sadly, almost 75% of Indians suffering from the disease cannot afford the treatment costs.

So, what is haemophilia?

It is a rare hereditary bleeding disorder. In India, the incidence of haemophilia is nearly 1 in 5000 males. It has been postulated that in our country 1300 children each year are born with haemophilia. This disease occurs due to deficiency of clotting factors resulting in the blood taking prolonged time to clot.

What exactly happens in the disease?

Every time you hurt yourself and bleed, an army of clotting factors and platelets becomes active in your body trying to seal the wound changing your blood from the liquid to the solid state forming a scab (clot). But, in some people having a low levels of platelets or clotting factors this does not happen and they continue to bleed hence suffering from bleeding disorders like haemophilia.

How does one ‘get’ haemophilia?

Recognizing haemophilia

If there is a family history, an infant will be tested for the same at birth or even before birth.

There may be no symptoms at birth. However, some symptoms like unusual bleeding during teething and vaccination, severe bruising in the joints when the child is learning to walk may be indicators.

Depending on the missing clotting factor, Haemophilia is classified into Hemophilia A or B. The Type A is again classified into mild, moderate or severe based on the % of deficiency of the clotting factor.

In mild cases, you may not be aware of the problem till you have a trauma, dental procedure or surgery when bleeding doesn’t stop or is prolonged.

In moderate or severe cases, there may be spontaneous bleeding, pain and bleeding into the weight bearing joints (especially the knee), bleeding in the muscles, brain, digestive tract or urinary tract.

Can haemophilia be prevented?

If there is a family history of haemophilia, you can test the infant at birth or can even before birth, in the first three months of pregnancy (with Chorionic villous sampling or amniocentesis).

Severe Haemophilia is diagnosed by one year of age and the diagnosis is confirmed after a panel of coagulation profile is conducted on the patient’s blood. Lab results which indicate hemophilia include:

• Normal platelet count
• Normal bleeding time
• Normal prothrombin time (PT)
• Normal thrombin time (TT)
• Prolonged activated thromboplastin time
• Low level of clotting factors VIII or IX

What is cholesterol?

Just like the fat you have in your body, cholesterol is also a fat/ lipid that is produced in the liver and its normal levels are necessary for the proper functioning of the body.

If our own body produces it, why is cholesterol harmful?

When cholesterol levels are in the normal range, in a healthy body, the blood flows freely through the veins and arteries. When the cholesterol levels are high, it starts forming clots (plaques) in the blood vessels causing hypertension (high BP), angina (chest pain), heart attacks, strokes and peripheral vascular diseases. 

Read: Cholesterol is manageable: Dr Vijay Surase, cardiologist

What do the terms LDL, HDL and VLDL that figure in my lipid profile reports mean?

As cholesterol is a fat that is insoluble in blood, it needs something to carry it or transport it in our body. LDL, HDL, VLDL are small molecules called lipoproteins that help with the same.

Read: Know your heart health terms – part 1

I’ve heard there is ‘good’ and ‘bad’ cholesterol. What are they?

‘Good’ cholesterols are good because they help get rid of excess cholesterol by transporting them from the blood vessels to the liver for excretion. HDL (High Density Lipoprotein) is a good cholesterol.

‘Bad’ cholesterols are bad because they deposit more cholesterol in the blood by transporting it from the liver, causing more plaques and dangers of high BP, chest pain, heart problems etc. VLDL (Very Low Density Lipoprotein) which is eventually converted to LDL (Low Density Lipoprotein) is the “bad cholesterol” as it mobilizes the cholesterol from the liver depositing it in your blood vessels. 

What are triglycerides?

Triglycerides are another type of fat or lipid that combine with cholesterol to form plasma lipids and gets deposited in the vessels.  When your calorie intake is more than what you need, the excess is converted and stored in the form of triglycerides. In between meals, when the body needs more energy, this triglyceride store is burned to convert into energy.

Read: Know your heart health terms – part 2 

Read: Know your heart health terms – part 3

How do I know I have excess cholesterol and lipoproteins?

 A simple investigation called the Lipid Profile done by drawing your blood is the answer (after an overnight fasting on consuming a diet low in fat for three days) is recommended. It measures the Triglyceride levels, Total cholesterol, LDL, VLDL and HDL levels. 

The normal ranges are as given below:

If your values are slightly deranged or ‘borderline’, you need to be careful but there’s no cause for alarm. They could also result due to an interplay of genetic and acquired factors. While nothing can be done about one’s genes, efforts to modify our lifestyle can really prove beneficial.  Modify your diet, increase your level of physical activity and keep your weight under watch!

What foods can help me control my cholesterol levels and maintain heart health?

Just a few simple tweaks to your daily diet can help you get your cholesterol levels under control:

 1. Olive oil:  Switch to olive oil for cooking. Research has shown that the Mediterranean people consume olive oil and have very low incidence of cardiovascular diseases and stroke. Olive oil contains a mix of various anti-oxidants which lower your bad cholesterol (LDL). Use it for your tadka or add it as a dressing to salads. Extra virgin olive oils are even more beneficial as they are less-processed and retain more anti-oxidants than the other varieties.

 2. Nuts: Walnuts and almonds are rich in omega three fatty acids and PUFA (poly unsaturated fatty acids) which help reduce LDL cholesterol and keep the blood vessels healthy. A handful of these nuts (unsalted, unfried) should help.

 3. Oats: Being high in soluble fibre, oats reduce the absorption of cholesterol (Total & LDL) in your blood. Eating 1 ½ cups of cooked oats with milk and bananas or apples gives you your daily requirement of soluble fibre.

 4. Fish: High in omega 3 fatty acids, it helps increase the levels of the good (or HDL) cholesterol.

It is recommended that you have atleast two servings of Salmon (rawas fish), herring (bhing) or mackerel (bangda) per week. For restricting calories, they are best eaten grilled, shallow fried with very little oil or baked.

If you do not eat fish or do not have access to good fish, add ground flax seeds (alsi), pumpkin seeds, sesame seeds (til), soyabean oil, canola oil to your diet. Omega 3 fatty acid supplements are also available.

 5. Garlic: Though the cholesterol lowering effects of garlic has been debated in recent times, it has been shown that allicin in the garlic does help.

 What foods need to be avoided?

 Avoid processed foods like biscuits, cookies, cakes and fried stuff. Avoid red meat and egg yolk.

 How much exercise do I require?

 Just a walk daily isn’t enough, as is often recommended. The intensity and the amount of time spent exercising is very important to have significant beneficial effects. If you have been a sedentary person all your life, you can start with a 45 minute walk but should soon increase the intensity by adding jogging and other forms of cardio exercises to your routine. Try and change some of your sedentary habits – walk down the road for shopping, climb those stairs, play football with kids, do your household cleaning yourself.  Every calorie you shed counts!

 Start your fight against cholesterol today and let us know what your next lipid profile reads.

Also read: Angioplasty is safe for the elderly (Expert speak) 

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