Stop
Journeying towards fatigability
Prof G R Mohan
MD (H0m) P G Dip (Env
Stud)
www.drgrmohan.com
Key
Words : fatigue, nutritional anaemia, iron deficiency anaemia
Introduction
:
Fatigue called exhaustion, tiredness, languidness, languor, lassitude,
and listlessness) is a subjective feeling of tiredness which is
distinct from weakness, and has a gradual onset. Unlike weakness, fatigue can
be reduced by periods of rest.
Fatigue has physical or mental causes. Physical fatigue is the transient
inability of a muscle to maintain optimal physical
performance, and is made more severe by intense physical exercise. Mental
fatigue is a transient decrease in maximal cognitive performance resulting from
prolonged periods of cognitive activity. It can manifest sleepiness, lethargy, or directed
attention fatigue. [4] A
tendency to get tired or lose strength. 1
One of the common causes of fatigability is
nutritional anaemia; chronic
fatigue is a symptom of many diseases and conditions. Like Autoimmune diseases, anaemia and hemochromatosis, drug abuse, mood disorder, malnutrition, diabetes mellitus and hypothyroidism, Fibromyalgia, Sleep deprivation, Lyme disease, Liver failure and in
malignant conditions 1
Fatigability is a common problem in students, employees,
home makers. Due fatigability day to day work
performance is hampered like poor turnout of targeted work, absenting from work,
bunking college and schools, poor scoring in examinations, ECT. Fatigability is grossly neglected
condition However, we are educated we
compromise with our health problems more so with fatigability by seeing a T V
advertisement, buying glucose pack consuming it for months together without any
result, on a day when blood examination
is done, seeing haemoglobin levels one open the eyes , even some
percentage of people still neglect. Commonly symptoms of anaemia are overlooked.
Epidemiology:
Nutritional anaemia is very much
prevalent and largely undiagnosed among students in the Professional
Institutes. Nutritional anaemia is a disease syndrome caused by malnutrition..
It has been defined by WHOM as “a condition in which the haemoglobin content of
the blood is lower than normal as a result of a deficiency of one or more
essential nutrients, regardless of the cause of such deficiency”. By far the
most frequent cause of nutritional anaemia is iron deficiency, and less
frequently foliates or vitamin B12.Various socio-demographic characteristics
like age, sex, social class, dietary habits, and infections are the etiological
factors for nutritional anaemia 3.
Anaemia is a global public health problem affecting
both developing and developed countries. In 2002, iron deficiency anaemia (IDA)
was considered to be among the most important contributing factors to the
global burden of disease. Anaemia is an indicator of both poor nutrition and
poor health 4.
Global prevalence of anaemia in (preschool aged children is
47.4%, in pregnant women is 41.8%, in non-pregnant women is 30.2 %,) 818
million women worldwide (both pregnant and non-pregnant) and young children
suffer from anaemia and over half of these, approximately 520 million, live in
Asia.5
In one cross sectional study on study conducted in a medical
college show the following results, the study was about
100 Medical students, 32.0% students were anaemic, out of which 44.0% were
girls and 20.0% boys. 25.0% students had mild anaemia. The majority (81.8%) of
anaemic students was undernourished as per their Body Mass Index 6 According to one study conducted by Arlappa, N Balakrishna in Maharashtra, 59.2 % of the
rural pre-school children of Maharashtra were anaemic. 2, 6, 7
Causes:
The following are the causes a) Poor
dietary intake, b) poor bioavailability of iron
in the diet consumed c) and
increased requirements of iron d) malabsorption leads to poor iron
absorption e) any Blood loss from Any
orifice of the body, ( Gastrointestinal
blood loss. Bleeding from gums and oral cavity, Bleeding piles .Bleeding from
the genito-urinary tract, in females Menorrhagia, and ante partum and
postpartum haemorrhages.
A woman loses about 500 mg of iron with each pregnancy. Menstrual losses
are highly variable, ranging from 10 to 250 mL (4-100 mg of iron) per period, an
adult male absorbs and loses about 1 mg of iron from a diet containing 10-20 mg
daily. Children who drink more than 16 to
24 ounces of cow's milk per day also have a higher risk of Iron deficiency
anaemia, because cow's milk can interfere
with iron absorption and irritate the lining of the intestines, leading to
blood loss. Each gram of haemoglobin contains 3.47 mg of iron; thus, each mL of
blood lost from the body (haemoglobin 15 g/dL) results in a loss of 0.5 mg of
iron.
Symptoms
Initially, anaemia goes unnoticed in majority of people. But
symptoms increase as anaemia worsens, Fatigue , a feeling of laziness, dizziness, pain in head,
tinnitus, diminished vision a vague
feeling that one is not well ; difficult or laboured breathing, Poor concentration, Palpitations, irregular,
forceful beating of the heart, Sensitivity to cold temperatures, Cold intolerance, Pica is not a cause of iron deficiency anaemia;
pica is a symptom of iron deficiency anaemia i.e. craving for ice, chalk, dry rice etc ,
sufferer looks pale and life less Leg cramps on climbing stairs, Poor
educational performance, Reduced
resistance to infection, Altered behaviour, Dysphasia with solid foods (from
oesophageal webbing 8
The
following symptoms are less common, Tinnitus ,Dysphagia,Restless leg syndrome, Impaired growth in infants,
Spoon-shaped nails (koilonychia) A glossy tongue, with atrophy of the lingual
papillae, angular stomatitis Splenomegaly
Investigations:
Complete blood cell picture, Evolution of Iron
status is based on Haemoglobin concentration,
Serum iron, total iron-binding capacity , serum ferritin. and Reticulocyte counts (Reticulocyt0paenia occurs in
Nutritional deficiency Anemias,), Haemoglobin and haematocrit are all decreased in Iron Deficiency
Anaemia. MCV, MCH and MCHC are also decreased. The peripheral blood film shows
hypo chromic microcytic red cells, Serum iron is decreased, examination of the
stools for occult blood and helminthiasis is mandatory in all patients. 8
Homoeopathic perceptive:
Iron deficiency anaemia is an easily treated disorder with an excellent
outcome, but ignorance is becoming hurdle.
However, we educate about the
importance of a balanced diet, people they have their own reservation about
diet, per capita income is less purching capacity to buy nutritious food items
becoming difficult, small group interaction was conducted in a medical
institute revelled that 95% are not consummating nutritious iron rich food.
hand full people buy the costly anihaemtics which are prescribed by health care
persons, but they do not consume due intolerance, oral iron in small percentage of people causes nausea, epigastria
discomfort, vomiting, constipation and diarrhoea.,
The only options left is giving the indicated homeopathic remedy on the basis
of the totality of symptoms and suggesting a balanced iron rich food. But still
people avoid advised diet due to various reasons. In Homoeopathy Ferum Phos 3x,
Lecithin 3x and Vanadium 3x helped majority of people not in people who wants
to live with Anaemia. According to
Hahnemann a classification of diseases Anaemia comes under pseudo chronic
disease,
Lecithin is
important in the vital processes of plant and animal organisms. It is prepared
from the yolk of egg, phosphorus containing complex organic body. Lecithin has
a favourable influence upon the nutritive conditions and especially upon the
blood, hence its uses in anaemia and convalescence, neurasthenia and insomnia.
(Lotus) Tired, weak short of breath; loss of flesh symptoms of general
breakdown. (Patak)
Ferrum
Phos
3X: In pale, anaemic subjects with violent local congestions. Ferr-p. Increases
haemoglobin. Haemorrhages, bright from any orifice. Anaemia. Emaciation. Takes
cold easily. Inflammation of the soft parts. Bruised soreness, chest, shoulders
Vanadium
is a remedy in degenerative conditions of the liver and arteries. Anorexia and
symptoms of gastrointestinal irritation, albumen, casts and blood in urine.
Tremors, vertigo, hysteria and melancholia, Neuro-retinitis and blindness.
Anaemia, emaciation. Cough dry, irritating and paroxysmal, sometimes with
haemorrhages. Irritation of nose, eyes and throat.. (Lotus) Murphy
If you fail to stop your journeying towards
fatigability you have to face following:
You suffer with severe anaemia and Severe
fatigue. you may be so tired that you can't complete everyday
tasks; you may be too exhausted to work or play. Impaired immune function is reported and
prone to infections, doctor visits will be more. increased risk for psychiatric disorders, The
intelligence quotients (IQs) of students will be low . An
estimation of haemoglobin should be done to assess the degree of anaemia. For men, anaemia is typically
defined as a haemoglobin level of less than 13.5 grams/100 ml and in women as haemoglobin of
less than 12.0 grams/100 ml. If the anaemia is “Severe”, 10 g/dl high doses
of iron or blood transfusion may be necessary. If haemoglobin is between 10-12
g/dl, the other interventions are like iron and folic acid rich diet,
supplementation and other strategies such as changing dietary habits, control
of parasites and nutrition Education.
References:
4) Worldwide prevalence of anaemia 1993–2005 WHO
Global Database on Anaemia. W H O
6) Rubeena
Bano, Nadeem Ahmad, B. C. Sharma, Ashok Agarwal, Nutritional
Anemia in the Medical Students, http://medind.nic.in/ice/t12/i1/icet12i1p16.pdf
7) N Arlappa, N Balakrishna, A Laxmaiah, GNV Brahmam,
prevalence of anaemia among rural pre-school children of Maharashtra, India, www.iapsmupuk.org
8) A P
I Text book Of Medicine,8th Edition,vol 2.
If U have a
“Magnetic Personality and still u can’t attract a giral/guy towards U,
It’s not your fault,
it just means that the girl /guy has Iron deficiency Anaemia “—by Namam
CASE:
Patient named Ms S, aged 19 years, Female, Intermediate student came with
following complaints ON 11-03-2014 came with following symptoms:
MIND – SADNESS
MIND - TIMIDITY - public; about appearing in
RECTUM - CONSTIPATION - chronic
FEMALE GENITALIA/SEX - MENSES - painful
GENERALS - ANEMIA - nutritional disturbance, from
GENERALS – WEAKNESS
HB % was 8,
ON repertorisation Plumbam Met 32/13, Lyco 29/13, Nux Vom 29/13
and Silicia 29/13.
ON 12TH March Plumbam Met 30C 5does was given
Rubrum for 15 days were given, there was not much improvement,
ON 28TH March Plumbam Met 200 C 5does was given Lacethine
3x four grains twice a day was given, Rubrum for 15 days were given,
12th April patient came weakness’ and
constipation were to some extent relived Rubrum 5 doses and LACETHINE 3X FOUR
GRAINS TWICE a was given,
20th June 2014 she came with same complaints, as I
enquired why she has not regular to collect medicines, she told me she
consulted a general physician, took allopathic medicines without any benefit. Haemoglobin
was 9 grams
Nux Vomica 200C, 5doses were given along with Lacethine 3X four
grains twice a day was given for 15 days.
21TH July she told me that she is feeling better
physically and mentally, but constipation was still persisting, Sulphur 200C, 3doses
were given along with Lecithin 3X four grains twice a was given for 15 days.
22nd Aug 2014 she came with complete Blood
picture report Haemoglobin was 10.4 grams.
Tuberculinum 1M, 1dose was given along with Lecithin 3X four
grains twice a day for 30 days.
27th Sept 2014 she has put on weight, feeling
better physically and mentally, Constipation was not totally relived, I advised
the patient to take opinion of Surgeon, surgeon opinion was rectal stricture.
Conclusion:
Lecithin is important in the vital processes of plant and
animal organisms.
It is prepared from the yolk of egg, a phosphorus containing
complex organic
Body. Lecithin has a favourable influence upon the nutritive
conditions and
Especially upon the blood, hence its uses in anaemia and
convalescence,
Neurasthenia and insomnia. (Lotus) Tired weak short of
breath; loss of flesh
Symptoms of general break down. ( Patak)
Article was published in first college day Souvenir 0n 07-11-2014
