My Weight:Growing Up and Getting It Right.

Puberty and Growth:

One of the problems of growing up in a modern society is that of weight. Most teenagers (boys and girls) would want to get it right but cannot stay off the junk foods and sugary beverages being offered all around them with all kinds of sophisticated advertising.

“What is the right weight for my height?” is a common question both boys and girls often ask. This question is easy to answer in the case of adults who have stopped “growing” in the sense that their bony epiphyses (the growing end of long bones of the body) has fused and can no longer enable elongation (growth).

With teenagers, this question is more difficult and complex to answer. Why? This is because not all teens have the same body type or develop at the same time or rate. People have different body types and even among people with the same height and age, some are more muscular or more developed than others; so there’s no single number that is the right weight for everyone. However, it is possible to find out if you are in a healthy weight range for your height.

Teens normally go through a period of faster growth and the rate of growth varies in various individuals even though they may be of same height and age. At attainment of Puberty, the body begins making hormones that bring about physical changes like faster muscle growth (especially in boys) and spurts in height and weight gain in both sexes. Once these changes begin, they continue for several years. The average person can grow as much as 10 to 12 inches (25cm to 30cm) during puberty before he or she reaches full adult height.

Most boys and girls gain weight more rapidly during these pubertal years, as the amount of fat, muscle and bone in their body’s changes. All these new weight gain can be perfectly o.k. – as long as body fat, muscle and bone are in the right proportion. Some kids attain puberty early (some by age 8) while some are late starters (as late as 14years); because of this, two teens of the same height and age can have different weights and it is perfectly normal to feel self conscious about weight during adolescence.

Your BMI (Body Mass Index):

Doctors have developed a way to help figure out if a person is in the healthy weight range for his or her weight. It is called Body Mass Index (BMI) and is a measure of body weight based on a person’s weight and height. It is calculated as a person’s weight in Kilograms (Kg) or pounds (lbs) divided by the square of his or her height in meters (m) or feet (ft). (Kg/m2 or lb/ft2). For example, an adult weighing 70kg with a height of 1.75m has a BMI of 70/1.75(2) = 22.9. This adjusts crudely for differences in body habitus, and provides the usual definition of obesity (See Fig.1).

Fig.1    BMI Categories

Severely Underweight                                   BMI        <16.5

Underweight                             16.5<           BMI        <18.5

Normal                                      18.5<           BMI        <25.0

Overweight                                25.0<           BMI        <30.0

Obese Class I                             30.0<           BMI        <35.0

Obese Class II                            35.0<           BMI        <40.0

Obese Class III                            40.0<          BMI

* Classification of the World Health Organization (WHO) and International Obesity Task Force.

Figuring out the BMI is a little more complicated for teens than it is for adults (because of the puberty phase). BMI charts for teens use percentile lines to help individuals compare their BMIs’ with those of a very large group of people of same age and gender. Different BMI charts exist for boys and girls under the age of 20.

A teen’s BMI number is plotted on the chart for their age and gender. Some teens’ especially those who go through puberty on a later time schedule, may feel too skinny. The good news is that their growth, development, and weight gain almost always catch up to other teens their age later on.

A teen whose BMI is at the 50^th percentile is close to the average of the age group. A teen whose weight falls between the 85^th and 95^th percentile is considered overweight because 85% to 95% of the age group has a lower BMI, while a teen above the 95^th percentile is considered obese. A teen below the 5^th percentile is considered underweight because 95% of the age group has a higher BMI.

What is my BMI saying?

Although BMI can be a good indicator of a person’s body fat, it does not always tell the full story of a person’s weight situation. A person can have a high BMI because he or she has a large frame or a lot of muscle (like a bodybuilder or an athlete) instead of excess fat. Similarly, a small person with a small frame may have a normal BMI but still have too much body fat. It is always advisable to allow your BMI to be calculated for you by your health-care provider (your family doctor or school nurse) to help you analyze its meaning and detect whether you are predisposed to becoming overweight in future from your health history.

Some people think of weight as a looks issue, but it is far more serious than just your appearance. Teens who are overweight run the risk of developing health problems such as sugar diabetes, high blood pressure, and heart disease later on in life as an adult.

If you think you are gaining too much weight or are too skinny, your family doctor should be able to help you decide, whether this is normal for you or whether you really have a weight problem, since he has a record of your medical history and has measured your height and weight over time.

List of possible things that can affect your weight:

(A)Heredity

       

      (B)Increasing Energy Intake from:-

(i)Increase portion sizes

(ii)Increase snacking and loss of regular meals

(iii)Increase intake of energy dense foods (mainly fat)

(iv)Increase Affluence

      

      (C)Decreasing Energy expenditure from:-

      (i)Increase car ownership

      (ii)Decrease walking to school/Work

      (iii)Increase Automation; decrease manual labor

      (iv)Decrease sporting activities in schools

      (v)Increase in time spent on video games and watching T.V.

      (vi)Increase in Central Heating

What to do to reach and maintain a Healthy Weight:

Dieting is not the ideal way to go when you want to lose weight. This is because dieting creates a temporary eating pattern, hence you get temporary results, which leads to the fact that you gain back any lost weight when you return to your old habits.

The best way therefore, is for you to create a new normal for yourself. Weight loss is likely to be successfully maintained when you change your old habits, replacing old unhealthy ones with new, healthy habits or behaviors, such as:-

(a)Regular Exercise

This helps burn calories and builds muscle which makes you look fit and keeps your weight down. You can be easily motivated to exercise when you schedule it and always have fun doing it. Things like walking, jogging, cycling to school and other activities that increase your daily level of activity; to which you can add some strength exercise (like weight lifting) to help build your muscles. The more muscles you have, the more calories you burn even when not exercising.

(b)Reduce Screen Time:

The amount of time spent watching T.V., looking at the computer and playing video games is one major reason a lot of teens get less exercise in today’s modern world. Reduce recreational screen time to between 11/2 to 3hours per day.

(c)Portion Distortions:

Resist taking bigger portion sizes of your favorite foods for any reason. Choose smaller portions (or share restaurant portions) and go for water or low fat milk instead of sugary beverages like sodas, juices and sport drinks.

(d)Eat plenty of Fruits and Vegetables:

These give you (apart from vitamins and minerals) fiber necessary for good bowel motion.

(e)Don’t Skip Breakfast:

Your breakfast is what kick starts your metabolism for the day and gives you energy to do more during the course of the day. People who skip breakfast get very hungry during the day that they eat more later on and get more calories than needed, leading to weight gain eventually. It has been shown that people who skip breakfast end up having a higher BMI than people who eat breakfast.

To summarize it all, the keys to reaching and staying at a healthy weight, are regular exercise and good eating habits.

Author: Ola Suyee

SIMPLE WAYS TO OVERCOME STRESS: TIPS FOR EFFECTIVE MANAGEMENT 2

Eat right:

Eating a good balanced diet every day is very important to avoiding stress of body, soul and mind. Foods rich in vitamins like eggs, meat, legumes and vegetables rich in iron and other trace mineral elements like zinc, manganese etc. are all essential body building elements necessary for good physical, mental and emotional stability necessary for stress reduction. Where the raw food materials cannot be easily obtained for whatever reason then food supplements in form of tablets or caplets may be taken with the available food. But it is better if the raw food materials can be cooked and taken, instead of synthetic food supplements.

Get organized, so everything has its place:

Organizing yourself in terms of physical, mental and emotional components is very important to reducing stress. Dotting your ‘I’s and crossing your ‘T’s and putting square pegs in square holes and round pegs in round holes is very important. Also, try to do the right things at the right time, in the right way and in the right place. This brings peace of mind and a relaxed composure at all times.

Every day, find time to be alone:

This gives you opportunity to look at things in retrospect and possibly make corrections and adjustments. Also you get to appreciate the Almighty creator of the universe, life and living.

Make friends with happy, non-stressed people:

Like attracts like. When you associate with such people you learn from them and their non-stressed nature rubs on you easily.

Laugh:

Laughter is a good antidote for stress and engaging in activities that engineer laughter will bring relaxation and fun. So try and watch comedies and play games that make you laugh a lot. You will discover that your stress level falls significantly when you engage in these laughter-fun activities.

Laugh some more:

You cannot have too much of it and even if you do, it will be for the best.

Take your work seriously, but yourself not at all:

Learn to prioritize your work activities and leave your ‘work’ at the work place. Do not indulge in the habit of carrying work files home. Spend ‘quality time’ with your family every day except maybe when you are out of town. Make sure you engage your family members in fun activities that bring everyone joy and laughter. RELAX and be yourself.

Remember that the shortest bridge between despair and hope is often a good night’s sleep:

The benefits of good sleeping habits cannot be over emphasized. Make sure you apportion adequate time for sleep. If possible try and go to bed early on days when your work duties seem to have stressed you more than usual. If you are having regular sleep problems, you may need to see your physician for help.

Be kind to unkind people (they probably need it the most):

This is one of the attributes of good neighborliness and when practiced gives you peace of mind and relaxation most times.

K.Y.M.S. (Keep Your Mouth Shut). This single piece of advice can prevent an enormous amount of trouble:

This is very good advice and most times SILENCE is golden. If you must speak be careful about what you utter. Always choose your words carefully. In essence, be a good listener and less of a talkative. Heeding this advice will greatly reduce your tension, hence your stress.

Author: Ola Suyee    

SIMPLE WAYS TO OVERCOME STRESS: TIPS FOR EFFECTIVE MANAGEMENT - PART 1

SIMPLE WAYS TO OVERCOME STRESS: TIPS FOR EFFECTIVE MANAGEMENT - PART 1

Going to bed on time:

This is one of the most important areas of living that needs to be properly attended to if one is to overcome stress. Taking a light beverage coco drink an hour or more before retiring to bed could help ‘deepen’ your sleep. Engaging in relaxing activity like watching telly, playing games, reading etc., just before going to bed could also be helpful in ensuring you have a sound sleep. Generally, things that bring you joy and make you happy should be done before going to bed at all times. NEVER GO TO BED ANGRY, QUARRELING OR HAVING NEGATIVE THOUGHTS. You are likely to have a disturbed sleep and possibly, nightmares which, on waking up will certainly lead to a stressful and unfulfilled day.

Get up on time, so you can start the day unrushed:

When you go to bed on time you are also likely to get up on time to organize your day, dot your Is’ and cross your Ts’ before engaging the days duties in earnest.

Delegate tasks to capable hands:

You must learn the art of delegating duties/tasks to capable hands and make sure each one gives you adequate feedback or progress report regularly till the task is successfully completed. Trying to do everything by yourself and be everywhere at the same time, only leads to serious stress and poor results. Essentially, this is a sign of poor managerial skill and bad leadership quality. Try as much as possible to avoid overloading yourself with work. Make effective use of your subordinates and where you do not have subordinates, then learn to prioritize your duties; executing the most important ones’  first.

Simplify and unclutter your life:

Make sure you set attainable goals for yourself, and prioritize your tasks. This will help simplify things and get you properly organized both in your thinking and in your actions. An organized life makes living, simple and beautiful and is the panacea for success.

Take one day at a time:

Learn not to rush things or be too eager about doing things. Just take things in their stride as they come along. Do not worry about tomorrow. Let tomorrow take care of itself.

Separate worries from concerns:

This is another area where prioritizing becomes very useful. You should find solution to your worries before your concerns. Once you have been able to identify those areas of worry as different from those giving you concern, set in motion machinery to bring visible change and solutions to the worrisome areas while the areas of concern also get some reasonable attention for improvement. It should be a continuous evaluation process. 

Get enough exercise:

Subjecting your body to a certain amount of controlled stress through exercise helps to keep you balanced, relaxed and fit to take on each day and its challenges with ease and certainty for success.I assure you, nothing can replace a good workout in the gym or at home, in your house. Make sure you devout at least 30 to 40 minutes every day to a good workout routine that makes you sweat and burn some calories.

Author: Ola Suyee

 

Diarrhoea and Vomiting (D&V) – Some Common Causative Agents and Their Management (Part 3)

Diarrhoea and Vomiting (D&V) – Some Common Causative Agents and Their Management (Part 3)

Antibiotic Associated Diarrhoea (Clostridium difficile Infection):

A history of any antibiotic therapy in the 6weeks prior to the onset of diarrhoea can be related to the finding of Clostridium difficile or its toxins in the stool.

This is a potent cause of diarrhoea and can produce life threatening pseudomembranous colitis.

This diagnosis is common in the elderly and treated often with metronidazole (Flagyl) for 10days.

Vancomycin may be used where the organism is unresponsive to metronidazole.

Cholera:

Aetiology & Epidemiology:

Cholera is caused by Vibrio cholera, a bacterium. Serotype 01 causes acute watery diarrhoea plus vomiting.

Following its origin in the Gangs valley, devastating epidemics have occurred, especially during large religious festivals.

Pandemics have spread worldwide.

The 7^th pandemic due to the El Tor biotype began in 1961 and spread via the Middle East to become endemic in Africa.

In 1990 it surfaced in Peru and spread throughout South and Central America.

Since August 2000, there has been a massive outbreak in South Africa.

The El Tor biotype is more resistant than the classical vibrio and can cause prolonged carriage in about 5% of infections.

A new classical toxigenic strain, serotype 0139, established itself in Bangladesh in 1992 and started a new pandemic.

Mode of Infection/Transmission:

The infection spreads via the stools and vomitus of symptomatic individuals or through the much larger number of subclinical cases (asymptomatic carriers).

Transmission is through infected drinking water, foods contaminated by flies or through the hands of carriers.

The vibrio microorganism survives for up to 2weeks in fresh water and 8weeks in salt water.

Signs and Symptoms (Clinical Features):

Severe diarrhoea starts all of a sudden without abdominal pain or colic and is soon followed by torrential vomiting.

After evacuation of normal gut faecal contents typical “rice water” stools follow consisting of clear fluid with flecks of mucous.

Classical cholera produces enormous loss of body fluids and electrolytes leading to intense dehydration with muscular cramps. Shock and oliguria develop but mental alertness remains.

Death from acute circulatory failure may occur rapidly unless fluids and electrolytes are replaced quickly. This is why the disease is more dangerous in children.

Improvement however is rapid with proper treatment.

It is to be noted however, that majority of infections cause mild illness, with slight diarrhoea and vomiting.

Occasionally, a very intense illness “cholera sicca” occurs, with massive loss of fluids into dilated bowel, killing the patient before typical gastrointestinal symptoms appear.

Diagnosis:

Clinical diagnosis is easy during an epidemic.

At other times, diagnosis is confirmed bacteriologically from rectal or stool swab cultures.

*Cholera is a notifiable disease under international health regulations.

Treatment/Management:

Quick, early restoration of the circulation by replacement of water and electrolytes is very important and is the key to survival.

Early intervention improves the prognosis.

Oral rehydration solution (ORS) is effective and safe where vomiting has been controlled by initial intravenous fluid therapy.

The addition of resistant starch to ORS reduces faecal fluid loss and shortens the duration of diarrhoea in adolescents and adults.

Total fluid requirements may exceed 50litres over a period of 2–5days. Ringer lactate is the best fluid for intravenous replacement.

Careful attention to fluid balance is especially important in children and they are prone to low blood sugar (hypoglycaemia) during the illness.

3-5days treatment with Tetracycline, or Doxycycline or Ciprofloxacin in adults and children helps to reduce the duration of excretion of vibrio and the total volume of fluids needed for replacement.

*Children should not be given Tetracycline because of discolouration of their dentition.

Prevention:

-         Strict personal hygiene

-         Clean drinking water (pipe borne or boiled)

-         Proper food hygiene to deny flies access.

-         Parental and oral vaccines provide limited protection (6months at most)

-         In epidemics, mass single dose vaccination and treatment with Tetracycline are valuable.

-         Public education, control of water sources and population movement are very important.

-         Disinfection of discharges and soiled clothing.

-         Meticulous hand washing by medical personnel reduces danger of spread.

Author: Ola Suyee

Diarrhoea and Vomiting (D&V) – Some Common Causative Agents and Their Management (Part 2)

Diarrhoea and Vomiting (D&V) – Some Common Causative Agents and Their Management (Part 2)

Travellers Diarrhoea (TD): 

This is classically defined as passage of three or more unformed stools within a 24 hour period during or shortly after a period of foreign travel.

It is frequently encountered by individuals travelling to developing countries.

Aetiology:

Most common cause of TD is the ingestion of faecally contaminated food or water.

A number of bacterial, viral, and parasitic organisms can cause TD, but the majority of cases are associated with bacteria, particularly the pathogen enterotoxigenic Escherichia coli (ETEC).

Here is a list of the most common causes of TD:

(1)  Enterotoxigenic E.coli

(2)  Shigellosis spp.

(3)  Camphylobacter jejuni

(4)  Salmonella spp.

(5)  Pleisonias Shigelloides

(6)  Non-Cholera Vibrio spp.

(7)  Aeromonas spp.

Pathogenesis: 

The organisms produce either a heat-labile or a heat-stable enterotoxin, causing marked secretory diarrhea and vomiting after 1- 2 days incubation.

Treatment: 

(a) If diarrhea is associated with severe dehydration, intravenous fluid and electrolyte replacement is indicated.

This is of particular importance in the case of diarrhea associated with Vibrio.

(b) Antibiotics: These can be used to limit the duration of symptoms and prophylaxis may help to prevent the disease.

(c) In most cases the illness is usually mild and self-limiting after 3 – 4days. Most important supportive treatment is fluid and electrolyte replacement; either orally (if there is no vomiting) or intravenously if there is.

Campylobacter jejuni:

Aetiology and Pathogenesis:

This infection is basically a zoonosis (a disease of animals that may secondarily be transmitted to man). The organism inhabits the gut of cattle and poultry, the commonest source of infection being chicken or contaminated milk.

There is also an association with pet puppies.

Campylobacter infection is now the most common cause of bacterial gastroenteritis in the U.K., even though most of the cases are sporadic.

The incubation period is 2–5days.

Clinical Features & Treatment:

Severe colicky abdominal pain which mimics surgical pathology at times ensues and is followed by nausea, vomiting and quite significant diarrhoea which may become blood stained as the illness progresses.

Majority of Campylobacter infections affect fit, young adults and are self-limiting after 4-7 days.

10-20% will have prolonged symptomatology warranting treatment with antibiotics such as ciprofloxacin or a macrolide, while another 1% of cases will develop bacteraemia and distant foci of infection.

Author: Ola Suyee