Saturday, November 22, 2014

Stop Journeying towards fatigability

Stop Journeying towards fatigability

Prof G R Mohan
MD (H0m) P G Dip (Env Stud)

Beware of false knowledge; it is more dangerous than ignorance-George Bernard Shaw

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.

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
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.    
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
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.
Evidenced  based Case : is available at homoeocure with

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,
7) N Arlappa, N Balakrishna, A Laxmaiah, GNV Brahmam, prevalence of anaemia among rural pre-school children of Maharashtra, India,
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 - TIMIDITY - public; about appearing in
GENERALS - ANEMIA - nutritional disturbance, from
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.
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