Prostate Cancer – Early detection and cure

Incidences of prostate cancer have been increasing in India over the last couple of decades.  According the research 7 out of every 100,000 men get diagnosed with prostate cancer every year.  However, early detection can lead to close to 100% recovery.  So here is a quick look at the prostate and how one can detect cancer early and make a full recovery.

What is the prostate ?
The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system. It is about the size of a walnut and is responsible for the production of the fluid that sperms travel in. It is located in front of the rectum and just below the bladder and wraps around the urethra.

Who is at risk of getting prostate cancer?
Prostate cancer is still relatively rare in India ( 7 out of every 100,000 get it) compared to developed countries such as the US ( 85 out of every 100,000). However, incidences of prostate cancer, both in India and among Indian men abroad have been steadily increasing and it is important to be aware of it so as to detect it early.  Incidences of prostate cancer are high among

1. Older men  – Typically men over the age of 60 are at risk.
2. Smokers
3. Men with family history of prostate cancer
4. Men who are obese, undertake very little physical activity and have a high intake of fatty foods.

Early stages, prostate cancer can be asymptomatic.  So it is good to have periodic prostate examinations done once you cross the age of 60.  However, look out for the following signs anyway:

1. Aching pains in genitals, lower abdomen and lower back.
2. Problems with sexual function
3. Painful, frequent, urgent urination
4. Slow urine stream and urination
5. Blood in urine
6. Loss of energy
7. Persistent swelling of legs
8. Hard growth on prostate
9. Enlarged lymph nodes.
10. Pain in the back, spine, hip or ribs.

The prostate check is a relatively easy and painless process.  The doctor will do a rectal examination by inserting a lubricated finger through the rectum and feel for enlargements, lumps and tenderness of the prostate.  The entire process will take less than a couple of minutes.

Post detection
If prostate cancer is detected, there are several procedures from radical prostatectomy (complete removal) to non-invasive procedures that can result in complete remission.  Your doctor would be the best person to suggest the way forward.

Bottom line
If you are a male over 60, every year as part of your regular medical checks, get your prostate examination done too.  Early detection can help you lead a long, active and healthy life.


Travelers Thrombosis – Precautions and prevention

Anti-Embolism StockingsFor many decades now and especially since the beginning of the IT boom, Indians have been settling down in all parts of the world, for business, work or other purposes.  The one thing common to all the Indian diaspora is their strong ties with their homeland, especially to their friends and relatives living in India.  This has resulted in a lot of travel back and forth making Indians among the largest populations of frequent long distance travelers.

Most families travel once a year to their home land and in turn parents who reside in India travel abroad to spend time with their children and grand children on a regular basis.  This article is specifically for the elderly who travel by air to be with their family and shows how some simple precautions can reduce the chances of Deep Vein Thrombosis(DVT).

The elderly who travel long distances by air are at high-risk of what is being called Travelers Thrombosis.  In medical terms this is known as Deep Vein Thrombosis (DVT) and  Pulmonary Embolism sometimes collectively called Venous Thromboembolism.  DVT is a common medical condition in the population. The disease process in DVT occurs because of blood clotting, most frequently in the large veins of the calves. Sometimes these clots break free and travel up the veins through the heart to lodge in the arteries of the lungs. This related condition is known as pulmonary embolism (PE), and it may cause sharp chest pain or breathlessness. PE may be life-threatening if the embolus (circulating clot) is large.

Causes for DVT can be both acquired and inherited.  The Inherited ones could be due to deficiency of one or more of Antithrombin, Protein C, or Protein S.  Additionally people with blood groups other than O are also at slightly elevated risks.

The acquired causes include:
1.  Old age.  [Most of our parents]
2.  Major surgery or orthopedic surgery [Many of our parents go through knee replacement surgeries.  This is one major cause for DVT].
3. Cancers, especially pancreatic.
4.  Immobilization, sitting in one position for long hours, and travel, especially by air. Bed-ridden patients also are at high-risk.
5.  Hormonal replacement therapy.

There are several other causes which are not limited to older people.  Please refer wikipedia for more details.

DVT can be quite painful and even life-threatening.  Here are some precautions you can take when traveling by air:

1.  Drink plenty of non-alcoholic fluids.  Ideally water, fruit juices, and isotonic drinks.
2. Regularly massage your calves and mobilize/rotate your ankles
3. Wear comfortable, loose clothing that does not restrict blood flow.  Light cotton wear is ideal.  Saris and salwars are fine. Avoid tight jeans.
4. Move around during transit breaks.  Avoid moving around in the cabin during the flight as you risk injuries due to turbulence.
5.  Be vigilant for the symptoms of DVT, in particular pain in the calves, during and for up to a month after long flights. If symptoms occur, seek medical advice without delay.

Finally, there are stockings called Anti-embolism stockings that apply about 15 -20 mm Hg of pressure at the ankle and reduced pressure as they go up the leg. These stockings help in preventing DVT.  They come in various sizes and in two models – Above knee, and below knee. At Rs. 800 to Rs. 1200 a pair, they are a steal when you consider how much pain and suffering they may actually save you from.

It is important to choose the right size and type for them to be effective.  Too loose and they will not have the desired effect and if they are too tight, they may become like a tourniquet and restrict blood flow.  Similarly some people find the thigh-length stockings uncomfortable and just end up rolling it down till their knees.  These people are better off buying the below-knee model at the outset.

Before measuring, please ensure that there is no edema (swelling due to fluid collection), deformity of the leg, arteriosclerosis and skin conditions such as dermatitis.  You can take measurements while lying down or standing up.  There are basically 3 measurements you need to take – thigh circumference(g), calf circumference(c) and ankle circumference(b).  Then compare these against the size chart provided by the manufacturer to choose the one closest to your requirements.

If you are a senior citizen and are traveling by air, don’t leave home without it.  You can buy your Anti-DVT stockings here.

Shaving as you age

As one ages, even simple routine activities such as shaving and grooming can become difficult. Things become further complicated if you suffer from tremors of the hand.

Essential tremor is the most common tremor. It is rarely seen when the hands are not being used. It becomes most apparent when you are trying to do something, such as reaching for an object or writing. It is not caused by an underlying disease. This type of tremor may also run in families.

Other causes of tremors can be

  • Tumours
  • Alcoholism / Withdrawal
  • Smoking/Withdrawal
  • Parkinsons syndrome
  • Multiple Sclerosis
  • Fatigue/Tiredness/Excess Caffeine/Stress
  • Stroke
  • Overactive thyroid

Tremors lead to shaky hands which can make wet shaving with razor difficult and dangerous.    But there are simple ways to work around these issues and remain well-groomed.  Obviously, one way is to keep your beard.  The barber can trim the beard when you go for your haircut.  Of course, if you are not used to having a beard, it can be quite uncomfortable.

The other option is to get an electric razor, a foil type or a rotary type.  These do not have exposed blades and are absolutely safe to use.  The foil type provides close shaves but may not be able to handle longer hair (if you shave regularly, this should not be a problem).  The rotary types usually do not give the kind of close shave that we need, but can handle longer hair easily.

Safe ShaverShown here is a foil type, entry level razor that could be a good place to start if you have not used an electric shaver before.  It is easy to use, can be charged and used CORDLESS, even in the shower.  It is from BraUn, a company that has been manufacturing shavers for many years now and are a market leader.  You can buy it here.

The free float system of this men’s shaver adjusts to all the contours of your body and gives you a safe shave without any rashes or injuries. The body of the shaver is slim and fits comfortably in your hand. The hand grip of this men’s shaver gives you an uncomplicated shaving experience. The cleaning brush that comes with this Braun shaver allows you to easily dust the hair off the shaving head in dry conditions.  This Braun men’s shaver runs on a rechargeable NiMH battery that gives a powerful cordless shave of 30 minutes after a quick charge of 60 minutes. The LED charging indication on the 190 shaver gives you the battery memory status.

Simplest way to avoid dengue

It appears that dengue is rearing its ugly head again.  In the last week or so, Chennai has reported several cases of dengue with at least a handful of fatal cases.  Dengue and other mosquito borne diseases are set to rise given the imminent arrival of the monsoon.

With incomplete storm water drains providing excellent breeding grounds, the mosquito population is going to skyrocket once the monsoon sets in.

Protecting oneself from getting bitten by mosquitoes can be quite difficult, but not impossible.  Here are a few things you can do to protect yourself.

1. Make sure there is no stagnant water in and around your house.

2. Use a fine mesh to cover all windows and doors.  There are several types of meshes available (Netlon is a popular brand) and there are many local providers who will come and  understand your requirements and cut and fix the mesh appropriately.

Mosquito Net

3.  Use a mosquito net when you go to bed.  There are wonderfully simple to use models available that do not require any complicated assembly or external support.  Click here or on the image to buy.

Here’s to a dengue-free monsoon.

Making your bathroom senior friendly and safe

If you have perused a copy of house beautiful or homes and gardens or some such magazine, you would have seen photos of wonderfully spacious, carpeted, dry and glistening bathrooms.

Unfortunately Indian bathrooms are a completely different matter.  Most of them are small and ill-lit, have narrow doorways, have the slipperiest tiles on the floors and walls and are almost always wet.

No surprise then that most of the accidents that happen at home happen in the bathroom, especially where senior citizens are involved.

However, with a few changes and some precaution, your bathroom can be made safe (though they will never look like the picture above) and usable. The changes we are recommending here are cost effective and do not require any major remodeling or masonry work.

1.  Remove the latch/lock on the inside of the bathroom.  

Most Indian bathrooms have a strong latch on the inside that ensures that nobody can gain access to the bathroom from outside when the bathroom is already occupied.  With elderly people in the house, it is very likely that sooner or later, the person inside may not be able to open the door by themselves and will need assistance from outside.  In such cases, the only option is to breakdown the door and this means that any help that can be rendered will be delayed.

One easy way to circumvent this problem is to remove the latch on the inside and replace it with a typical aircraft toilet door vacant/engaged type of door latch.  This allows people to quickly enter the bathroom if required as well as ensures that people know when a bathroom is occupied.  This will cost very little and could save a life next time an elderly family member has a dizzy spell or falls down in the bathroom.

2.  Use anti-slip mats where necessary.

Indian toilets and bathrooms are always wet and this is an indisputable fact.  On top of that most bathrooms have tiled floors that make the bathroom floor cold and slippery all the time.  One simple way to ensure people do not slip and fall is to cover the wet areas with an anti-slip mat.  These mats are similar to those used around swimming pools and so are designed to keep the top dry while allowing water to flow freely through the gaps.

A simple device that ensures that you don’t have to lay a new floor for your bathroom, something that can not only prove costly but will also put your bathroom out of commission for a week or so.

The mats are in-expensive (at about Rs. 170 per sqft), are easy to remove and clean and extremely durable.  The mats stop people from slipping even when there are minor/major oil spills or talcum powder spills (both of which are deadly when combined with water on any hard flooring).

3.  Convert Indian toilets into western toilets.

They say that sitting on your haunches is the fastest and best way to evacuate your bowels and personally, I quite agree.  However, as people get older, it gets more and more difficult to go on ones haunches and the western commode become more appealing.  However, breaking the Indian toilet and replacing it with a western one can be a costly and time consuming process.  While the best course of action is to bite the bullet and make the change, if budget and time are constrained, there are multiple other options in the form of Indian to western converters.

Option A:  A simple converter that can be placed on top of the existing Indian commode.  Not the most elegant solution, but an effective stop gap arrangement.  Could cost as little as Rs. 900.

Option B:  A height adjustable powder coated or chrome plated western commode with pail that is clean and effective and easy to wash and maintain.  Several variants are available and cost anywhere between Rs. 1500 to Rs. 4000.  You can buy it here.

4.   Install grab bars and railings.

The next issue faced by senior people is support when sitting or getting up from the toilet seat.  Many times, the walls around the toilet are tiles and smooth offering no assistance to the elderly by way of something to hold on to.  At other times, the walls themselves are too far away from the closet to be of any assistance.  Many western closets are also very low making it very difficult for people with weak knees when sitting down and getting up.  There are a few simple devices that can make life easy under such circumstances.

A.  A toilet raiser.  This is a small hard-plastic device that sits on top of the commode and increases the overall height of the commode by 8cm to 13cm.  It can be easily removed and washed after use or completely removed when not in use.  Such a toilet raiser will put you back by about Rs. 1500 – much cheaper than ripping out the low commode and replacing it with a taller one!  Click here to buy.

B.  Grab bars.  These are stainless steel bars that you can affix to the walls around the toilet bowl.  When installed at the right height, they can provide additional support allowing people to use their hands and upper torso to take the weight off their knees when getting up or sitting down.  Would cost you between Rs. 500 to Rs. 1500 to install a pair of grab bars.  Click here to buy.

C. Toilet safety railings. In some bathrooms, the walls may be too far away from the toilet bowl and hence having grab bars conveniently placed may not be an option.  Under such circumstances, the best option is to go for a toilet safety railing. It requires no wall and can be fixed to the toilet bowl itself with just a couple of screws (the provision for such screws is already available on most of the common toilet bowls to accommodate the toilet lid.  So you can easily fix these railings yourself without having to call a plumber or a carpenter.  Will cost you about Rs. 2500 – Rs. 3000.

5. Install a health faucet.

Many Indian bathrooms have a tap close to the floor with a tiny bucket to assist in washing oneself. To use this, a person has to bend down and straighten many times in the process of washing oneself.  A health faucet is a good option that makes the cleaning process efficient, thorough and easy.  A health faucet is a tube connected to a tap at one end with a hand-held nozzle at the other end.  The nozzle can be pressed to release water and it can also be used to regulate the pressure of the water jet.  Will cost about Rs. 500 – Rs. 1500 to buy one.

6. Get a shower chair and a hand shower installed.

Having a bath, especially with hot water can be tiring for the elderly.  A shower chair and a hand shower can allow people to have a leisurely bath while seated. The shower chair shown here is a very light weight hard plastic and aluminium chair that is easy to carry and wash.  Its shape also provides access to different parts of the body so bathing a patient also becomes easy.  The chair is also height adjustable and costs about Rs. 2000.

Elderly healthcare – Lessons from the UK

Elderly health care in UKAnother article on elder care caught my eye this morning.  It was a talk by aptly named Dr. Andrew Elder on elderly healthcare and learning from UK what not to do!

The expert in geriatric medicine from Edinburgh was delivering the 10th M V Arunachalam endowment lecture on healthcare, “80 not out – challenges of the silver innings.”

He said that just one of India’s 206 medical colleges, Madras Medical College, had a full-time geriatric MD programme. More undergraduate and PG programmes in geriatric studies were required and if this was not improved upon, it would affect quality delivery of healthcare. Presently, 7% of the total population in India was above the age of 65. This was expected to swell to 16% of the total population by 2050.

To read more about it, go to the times of India article titled Learn from UK’s mistakes on elderly healthcare: Expert.