Dr Pankaj Jalan is an American Board Certified Neurologist and the director of medical services at Norvic International Hospital. Dealing with diseases of the brain, spine, muscles, and nerves, Dr Jalan has seen all kinds of disorders and he spoke to The Week about some basic health issues that we should all be aware of.
Headache
Headache is a very broad disorder. There are many categories of headaches of which migraine and tension type headaches are the most common ones. I see around twenty to thirty patients for migraine everyday. It is an episodic headache that is usually genetic and starts at the age of 10 to 12. It is usually one sided but it can be both sided too. It includes throbbing pain in the head and makes the patient sensitive to light and sound so much so that some may even suffer from vomiting episodes while under a migraine attack. It is a very disabling headache that takes a whole day, or even two to three days for some, to fade away.
There is always a trigger for migraine which can include the person’s food habit, poor sleeping habit, intake of caffeine in the form of tea, coffee and chocolates or even cheese and curd. Most people in Nepal tend to buy over the counter medicines for headache. However, the painkillers might end up making it worse. It’s always best to consult a doctor to determine the kind and cause of the headache you suffer from.
Chepang students go to school barefoot in freezing cold
Back pain
A US based company did a survey that has determined that back pain is the number one disease in Nepal. One of the main reasons is because we tend to use two wheelers in bumpy roads that lead to lower back problems. Also, Nepalis, especially women, watch a lot of TV, and that way end up sitting in positions where there posture isn’t correct. Back pain can also move towards the legs making it worse. You should always keep you back and neck straight. After 20 years of age, the body starts degenerating and people who do a lot of work bending down are more likely to have a slipped disc. However, back pain is a lifestyle related disease that can be avoided to a large extent with good posture.
Dementia
The frequency of dementia, especially Alzheimer’s disease, in Nepal and the USA is the same. However, the difference is that people in the States take immediate action whereas people here chalk it up to old age and don’t seek help. Even if a person is a hundred years old, he should remember everything perfectly. If he doesn’t remember things there is something wrong with him and he needs immediate help. This is one of the most frustrating diseases not because the person starts forgetting things but because there is no treatment and there is nothing much you can do about it apart from watch. People with dementia need a lot of care and support and with way the society has been constructed these days socially, with their busy lifestyle, people aren’t able to provide the support system they need. Another major setback for this disease in the country is that there is so proper healthcare provider. In the States, with the amount of specialized care needed for this disease, there are old age homes that people can go to. Here the lack of specialized caregivers makes things harder.
Nobody knows why this disease occurs but we know that it is the price we pay for living longer. If someone in your family has started forgetting things, especially after the age of 55, you should consult a neurologist to determine whether he or she is suffering from dementia. Early diagnosis won’t enable the doctor to cure the disease, but it will enable them to delay the rate at which it progresses.
Epilepsy
With the lack of good data in the country, it is hard to keep track of the numbers of cases of any diseases to compare whether it rising or not. However, the numbers of epilepsy cases have been on the rise and are very common in Nepal, India and Southeast Asia compared to the western countries. There are many reasons for epilepsy. Some are due to birth complications and some are due tumor or head injuries.
The most common one we see is due to tapeworm infestation. Neurocysticercosis (NCC) occurs when you accidentally ingest the eggs, which is very easy to do in Kathmandu because all the food items are sold on the roadside. If the food is consumed without washing it properly, the eggs enter the bloodstream through the stomach and reach the brain where it irritates it and causes seizures. It can attack people of any age group and usually takes two to three years of medication to get cured. Then there is the added expense of MRI and other tests without even mentioning the psychological trauma of knowing that something is living in your brain.
However, it is avoidable. It is important to know that this happens only due to vegetables that aren’t washed properly. The tapeworm infestation that happens because of pork is advanced enough in its lifecycle that it becomes a worm and can’t pass into the bloodstream. So avoid raw food and salads in restaurants and other places where you cannot see how the food is cleaned or if you cannot clean it yourself. The trend selling and buying groceries at supermarkets is catching on and that might help eliminate NCC because these items are washed before packaging.
Stroke
Stroke patients are the most commonly seen patients in a neurologist’s emergency room. Smoking and drinking both increase the chances of stroke in a person. In the last 10 years there have been many advances to help stroke patients. TPA is a blood thinner that will help you not get a paralysis if you reach the hospital on time. However, it is hard to use in Nepal because not only is it expensive, people don’t come to the hospital on time. For the TPA to work, you need to come to the hospital within three to four hours of the onset of symptoms. If you or anyone you know has a sudden onset of weakness in any part of the body, slurring of speech or facial distortion, make sure to go to the ER immediately.
