Better to act young than to look young

[email protected] (New York Times )
October 7, 2013

Young_than_to_look_youngJane E Brody, Oct 7: At a party I recently attended, a woman in her 60s proudly announced that her periodic facial treatments “have made me look 10 years younger.” A man of similar vintage said he was considering “facial tucks” to raise his sagging jowls.

Some days it seems everyone I meet is afraid of getting old - or at least of looking as old as they are. Occasionally, I see women who have had so many face lifts that they can barely move their lips when they talk, let alone smile.

Business is booming in the anti-aging market. Plastic surgeons who specialise in lifts, tucks and fillers barely noticed the recent recession. Cosmetics with anti-ageing properties fly off the shelf, and new concoctions appear almost weekly.

I admit to supporting the multi-billion dollar skin care industry with my long use of night creams, as well as a slew of daytime lotions that purport to “smooth out” aging skin while protecting it with sunscreen. I also colour my hair, which in its natural state is now about 80 per cent gray.

But I draw the line at injectable fillers and muscle relaxants, face lifts and tummy tucks. I’ll do everything I can to stay out of an operating room. My anti-aging measures, if and when they are needed, will be limited to cataract removal, a hearing aid and glasses for driving.

I wear clothes that suit my personality and activities, not necessarily my age. Shorts and tank tops anchor my summer wardrobe. And I wear colours near my face that are right for my skin tone, avoiding those (like yellow) that are unflattering. Still, cosmetic fixes go only so far to counter the effects of time.

True youthfulness - or, I should say, appearing younger than your age - is much more than skin-deep. Research has shown that youthfulness must come from within.

In one study, a team at Case Western Reserve University in Cleveland analyzed the facial photographs of 186 pairs of identical twins, determining which sibling looked older and why. Factors that contributed to looking older included smoking, sun exposure, stress and depression (or the use of antidepressants), the researchers reported. Other studies have linked depression to higher levels of inflammatory markers and oxidative stress, which can accelerate aging.

The team also found that among those younger than 40, a woman with a heavier body looked older than her leaner twin, but in subjects older than 40, a higher body mass index was associated with a more youthful appearance. Fat fills out wrinkles and makes the face - and presumably other parts of the body - look younger. But there’s a limit to its benefits: obesity is associated with more rapid biological aging.

Another study published last year by researchers at Brigham and Women’s Hospital in Boston found a biological link between stress and accelerated aging. Dr. Olivia I. Okereke and colleagues examined the chromosomes of 5,243 women ages 42 to 69 participating in the Nurses’ Health Study. They found that women with phobic anxiety - irrational fears of anything from social situations to spiders - had shorter telomeres on their chromosomes.

Telomeres are DNA-protein complexes on the ends of chromosomes that are considered biological markers of aging. Shortened telomeres are thought to underlie many of the adverse health effects of aging, and perhaps even to contribute to looking older than one’s years.

Lifestyle changes

A pilot study published online by The Lancet Oncology last month underscored the benefits of limiting stress. Dr. Dean Ornish and colleagues at the Preventive Medicine Research Institute and the University of California, San Francisco, tested the effects of lifestyle changes on the length of telomeres.

Ten men were asked to make changes that included adopting a whole-foods plant-based diet, moderate exercise, stress management techniques (like yoga and meditation), and seeking greater intimacy and social support. After five years, changes in the length of their telomeres were compared with those among 25 men who were not asked to make such changes.

In the men who made lifestyle changes, telomere length increased by an average of 10 per cent; the more changes the men made, the greater the increase in length. But telomere length decreased in the control group by an average of 3 per cent.

Still, youthfulness is not just a question of biology. People are perceived to be younger than their years if they smile and laugh a lot (be proud of those laugh lines!) and are generally cheerful and upbeat, the kind of people who smile at strangers and wish them a good day.

I occasionally pass an older couple who walk together three times a week. With their dour expressions and grudging acknowledgment of my “good morning,” I thought they were in their mid-90s. So one day I asked, only to learn that she was 80 and he was 83.

It also helps to pursue personal and professional activities you enjoy as you get older. My role models include the actress Estelle Parsons, who continues to perform on stage (and can do yoga headstands) at 85, and Dame Judi Dench, 78, who stars in movies despite having to learn her lines orally because macular degeneration has caused her vision to deteriorate.

My dear friend Margaret Shryer, 86, starred in a documentary about age discrimination and performed a one-woman show she wrote at a theater festival in Minneapolis this summer. Another friend, the award-winning broadcaster Lucy Jarvis, cane in hand at 96, still travels abroad to make television documentaries.

To my mind, it is far better to act young than to look young. Of course, it helps to be physically fit.

Too often, those who spend liberally to counter the superficial signs of age neglect their bodies below the neck and become physically old before their time. Muscle tissue inevitably declines with age, but much can be done to minimize and even reverse a loss of strength.

Try using free weights or resistance machines. If these don’t appeal, lift cans of soup (better for lifting than consuming) and continue to do chores that require strength, like digging in the garden or carrying groceries.

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Dr G K Sudhakar Reddy
August 4,2020

Being overweight or obese is now recognised as a serious cause of ill health and disability. There is a significant positive association between orthopaedic disorders and the level of obesity causing pain, deformity and difficulty in walking.

Excess body weight accumulation increases pressure on joints, particularly the hips, knees and ankles.

Here are a few type of  arthritis:

Osteoarthritis

It is a condition of damage/ wear and tear of the joint lining or cartilage. Obesity triggers this by loading excessive weight on the weight bearing joints like the knee and the hip. 

Knee Osteoarthritis

This is the most common arthritis especially in the Indian subcontinent.

While walking, an individual exerts 3 to 6 times pressure that of the body weight on the weight-bearing knee joint, which means in an obese with excess body weight, larger forces are exerted, which lead to higher risk of deterioration of cartilage.

In addition, there are excessive fat tissues that produce hormones and other factors that affect the joint cartilage metabolism and cause inflammation of the joints giving rise to joint pathology.  Leptin is one of the hormones causing knee osteoarthritis. 

Hip osteoarthritis

The force exerted across the hip is 3 times that of body weight. Hip osteoarthritis is caused by factors such as joint injury, increasing age and being overweight.    

Hand osteoarthritis

The observation that obese individual has a higher risk in having hand osteoarthritis has led to a hypothesis that the metabolic effect produced by fat tissue is the underlying factor. 

Osteoporosis

It is a progressive bone condition of decrease in bone mass and density (Bone Mineral Density or BMD) which can lead to an increased risk of fracture. Recent research suggests that obesity may accelerate bone loss. It is the amount of muscle mass which is seen in an active person, which accounts for bone strengthening effects and not due to the fat seen in a heavy person.

Low back pain

Low back pain from degenerative disc disease of the lumbar spine is one of the most disabling conditions in the community and overweight and obesity have the strongest association with seeking care for low back pain.

Managing Hip and Knee Osteoarthritis

Life style changes

If one is overweight, try to lose weight by doing more physical activity and eating a healthier diet. Regular exercise keeps you active and mobile and builds up muscle, thereby strengthening the joints and can improve symptoms. 

Pain Killers

Painkillers help with pain and stiffness for short term. They don’t affect the arthritis itself and won’t repair the damage to your joint. Creams and gels can be applied directly onto painful joints.

Nutritional Supplements

Glucosamine and chondroitin are nutritional supplements. Animal studies have found that glucosamine can both delay the breakdown of and repair damaged cartilage. However, there is insufficient evidence to support the use of glucosamine in humans and one can expect only a mild-to-moderate reduction in pain

Joint injections

If pain from osteoarthritis is severe joint steroid injections are injected into the joints that can reduces swelling and pain. The injections can start working within a day or so and may improve pain for several weeks or months. 

Hyaluronic acid injections, which help to lubricate your knee joint also give short term relief. In early stages. Stem cell treatment or cartilage regeneration procedures are being tried in young people with small defects, however it is still experimental and lacks long term evidence.

Surgery

May be recommended if you have severe pain or mobility problems.

Arthroscopy

If one has frequent painful locking/stiffening episodes especially in the knee joint, an operation to wash out loose fragments of bone and other tissue as joint can be performed by a minimally invasive key hole procedure called Arthroscopy.

Arthrodesis

If hip or knee replacement is not suitable, especially in young people who do heavy manual work, one can consider an operation known as an arthrodesis, which fuses your joint in a permanent position. This means that your joint will be stronger and much less painful, although you will no longer be able to move it.

Osteotomy

In young, active people in whom a knee joint replacement would fail due to excessive use one can consider an operation called an osteotomy. This involves adding or removing a small section of bone either above or below your knee joint.  This helps realign your knee so your weight is no longer focused on the damaged part of your knee. An osteotomy can relieve your symptoms of osteoarthritis, although you may still need knee replacement surgery eventually as you grow old

Joint replacement surgery

Joint replacement therapy is most commonly carried out to replace hip and knee joints. It involves replacing a damaged, worn or diseased joint with an artificial joint made of special plastics and metal.

For most people, a replacement hip or knee will last for at least 20 years, especially if it is cared for properly and not put under too much strain.

Dr G K Sudhakar Reddy is a Sr Consultant Orthopaedic Surgeon at Citizens Speciality Hospitals, Hyderabad

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Agencies
May 18,2020

China, where the novel coronavirus originated, has reported 111 cases since beginning of May, which shows the infection rate has dipped, and 3 deaths since April 27, according to the WHO. A Shanghai-based Noida doctor says China is close to winning the battle against COVID-19, and the combination of zinc, hydroxychloroquine (HCQ) and antibiotic azithromycin has been able to save the lives of coronavirus patients.

Speaking to media persons, Dr Sanjeev Choubey, Medical Director Internal Medicine at St. Michael Hospital said this combination has been adopted as a line of treatment for patients infected with coronavirus, and as a result patients are recovering, decreasing their need for intensive care.

What is the line of treatment for COVID-19 patients, which also include asymptomatic patients?

The combination of zinc, hydroxychloroquine and antibiotic azithromycin has produced positive results, and it helped in the recovery of many COVID-19 patients. The combination -- Ascorbic Acid, B-complex, Zinc, Selenium, L-carnitine, Vitamin B-12 and Glutathione normal saline should be administered on patients twice a week for at least 6 weeks. This is COVID-19 treatment protocol for prophylaxis, and it implies both asymptomatic and symptomatic along with other medicine support.

Based on your experience on COVID-19 in China, after how many tests, is it safe to call a person coronavirus free?

The coronavirus should be performed at least 9 times, before terming a patient COVID-19 free. It is a standard in China. This procedure has worked in China and it will also work in India. Minimum five tests should be mandatory through RT-PCR.

Does coronavirus majorly attack the respiratory system or it could lead to organ failure too?

Line of treatment should not be just looking at the respiratory system, as the problem lies somewhere else. COVID-19 attacks many vital organs in the body. In China, a coronavirus patient died from a stroke. In the autopsy it was found that the innermost layer in the arteries was swollen. It was concluded that coronavirus had inflamed the layer of the arteries leading to clotting, which was a factor in generating a heart attack. Therefore, COVID-19 is not just a respiratory problem.

Amid the coronavirus pandemic, should autopsy be made mandatory in the case of unpredictable death or where reasons for death are not unknown?

Patients below 50 years, who die suddenly and the reasons are not known, then it should be mandatory to conduct the autopsy. After death, coronavirus is active in the body for five days, and it fades away on day 6. Therefore, if an autopsy is done then it will help in understanding this disease. In China, we have seen young COVID-19 patients, aged 22 and 28, succumbed to strokes.

Since the beginning of May, India has recorded more than 2,000 cases everyday in the first week, then it jumped past 3,000 mark in the second week. Finally, the tally is 4,987 on May 17. At 90,927 cases, has India progressed into community transmission or Stage3?

Yes, India has moved into Stage 3. The data suggests that 3,000 to 4,000 active COVID-19 cases, who are asymptomatic, are moving around and spreading the infection. The research has indicated that COVID-19 from an infected person spreads in 30 minutes to non-infected persons. The relaxation on the lockdown will certainly contribute to a high infection rate.

Do you think India has reached its peak in COVID-19 cases, or the sharp rise will continue till July end?

It seems India has already reached its peak and cases will begin to come down from June end or beginning of July first week. If social distancing norms are followed then certainly things can improve, but if not followed then it may get worse. High population density is a major contributor for the increase in cases. The government should continue to focus on finding hotspots, and urge people to follow the rules, eventually it is for people’s own benefit.

Has China won the battle against COVID-19?

It seems China has won the battle by not opening up Wuhan. The Chinese are following a COVID-19 patient’s engagement program, where the authorities continuously interact with people infected with the disease. The Government of India should reward people who follow the guidelines; it will help in setting up a positive trend in the society.

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Agencies
June 24,2020

New Delhi, Jun 24: Expanding the testing criterion for coronavirus, the Indian Council of Medical Research has said it should be made widely available to all symptomatic individuals across the country.

"Since test, track and treat' is the only way to prevent spread of infection and save lives, it is imperative that testing should be made widely available to all symptomatic individuals in every part of the country and contact tracing mechanisms for containment of infection are further strengthened," it said in an advisory on 'Newer Additional Strategies for COVID-19 Testing' on Tuesday.

In its revised testing strategy for COVID-19 issued on May 18, the Indian Council of Medical Research (ICMR) had advised testing for all symptomatic Influenza-like illness (ILI) among returnees and migrants within seven days of illness.

All hospitalised patients who develop ILI symptoms, symptomatic individuals living within hotspots or containment zones and healthcare and frontline workers involved in containment and mitigation of coronavirus were also advised testing.

The apex health research body has also advised authorities to enable all government and private hospitals, offices and public sector units to perform antibody-based COVID-19 testing for surveillance to help allay fears and anxiety of healthcare workers and office employees.

The earlier advisories on rapid antibody testing advisories had focused on areas reporting clusters (containment zones), large migration gatherings/evacuees centers and testing of symptomatic ILI individuals at facility level.

Besides, the ICMR on Tuesday also recommended deployment of rapid antigen detection tests for COVID-19 in combination with RT-PCR tests in all containment zones, all central and state government medical colleges and government hospitals, all private hospitals approved by the National Accreditation Board for Hospitals and Healthcare (NABH), all NABL-accredited and ICMR approved private labs, for COVID-19 testing.

All hospitals, laboratories and state governments intending to perform the point-of-care antigen tests need to register with ICMR to obtain the login credentials for data entry.

"ICMR advises all state governments, public and private institutions concerned to take required steps to scale up testing for COVID-19 by deploying combination of various tests as advised," the advisory added.

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