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Aeroplane Ear :How to prevent it

By Dr.Amrita Basu(MBBS,MS) on December 25, 2017 27

Do you fly a lot? Does your ear pain in the aeroplane ? Do you have severe ear pain even after Flying? Can you prevent It?

The Good news:
Yes you can prevent it.

When my little girl was 1 year old we traveled to Jaipur by plane. Among many travel worries, I was especially thinking about ways to keep her awake and ear pain-free while traveling. I knew all the basics but it was still a challenge. So that’s when I decided to write a post for all of you mommies who travel by plane with children. I think when we know why things happen we are much more effective at preventing unwanted events and prevention of airplane ear runs top of my list during air travel.

What you will find here
What is this condition?
Why do your ears get blocked in an Aeroplane?
Who is more likely to get Aeroplane Ear?
What can you do during the flight to prevent blocked ear?
How can you prevent very young children from getting airplane ear?
How can you unblock your ears after the Flight?
When should you visit a Doctor?

What is Aeroplane Ear?

Pain in the ear, popping ear, blocked ear during air travel is the most common medical problem faced by flyers. Airplane ear is the better-known name for Barotitis media or Aerotitis media. Airplane ear or Barotitis media is the condition where there occurs damage to the ear due to difficulty in adjustment of the air pressure between Middle ear and External ear.

Why do your ears get blocked in an Aeroplane?

I have to go into a bit of physics for a proper explanation. Please excuse the science Lecture! As you know according to Boyle’s Law : The pressure and the volume of an enclosed mass o gas are inversely proportional. When the plane rises in the air, there is a progressive decrease in air/atmospheric pressure. Basically at 18,000 ft above sea level, the air pressure is half that at sea level.During the rise through the atmosphere , as the pressure falls ,a particular mass of air in an elastic structure expands .Similarly during descent, the air contracts and the volume of cash decreases.

So what happens in the ear during Flying?

Imagine your ear is made up of 3 rooms.The outermost part of the ear which connects the entryway with the other rooms is the external ear.This is the part involving your ear canal. The ear drum separates your external ear from the middle ear, where the small bones (malleus, incus, stapes), which help transmit sound live.The ear drum is somewhat flexible and can move with change in volume of air in the middle ear. Two windows oval window (covered by stapes footplate) and round window (covered by round window membrane) connect your middle ear and the inner ear.

The inner ear has your hearing and balance apparatus It’s called the labyrinth. A tube connects your middle ear with the part of your oral cavity behind the nose (nasopharynx) .It’s called the Eustachian tube.Easily the most important structure which helps keep up the normal air volume inside your middle ear. It’s through your Eustachian tube that air enters or exits to equalise air pressure between outside atmosphere and your middle ear.

What happens during Ascent?
Air pressure outside falls. Middle ear pressure falls. Air in your middle ear expands (following Boyle law) This excess air pushes the tympanic membrane outwards to its natural limit.This is normally followed by escape of air through your Eustachian tube. Movement of the ear drum may be restricted due to scarring (previous infection).This may cause ear pain during ascent.

What happens during Descent?
Air pressure outside rises. Middle ear pressure rises. Air in your middle contracts and volume decreases (Boyle law). The ear drum moves inwards. (retraction). The opening of your Eustachian tube must be opened to allow air from the nasopharynx to enter and adjust the volume.The Eustachian tube will open with swallowing movement. If this mechanism fails (if you fall asleep, or have a cold), or is delayed, the increasing pressure difference closes the naspharyngeal end of Eustachian tube.When the pressure difference is more than 90 mm,Hg, your tubal dilator muscles are unable to open the Eustachian tube and it stays locked.The ear then feels blocked.

Barotrauma occurs during flying due to:
Very rapid air pressure changes.Sudden ascent/descent. 2) Blocked Eustachian tube.

It may also occur in:

Divers
Hyperbaric oxygen chamber
Decompression and compression chambers

Who is more likely to get Aeroplane Ear?
Anybody who has some nasal or Nasopharyngeal problem which blocks the Eustachian tube.
Acute infection in the nose.
Chronic infection in the nose
Rhinosinusitis
Nasal allergy
Vasomotor Rhinitis
Malformation of nose
Nasopharyngeal tumour.
Sleeping during ascent or descent
Small narrow Eustachian tube; infants toddlers.

How will you know whether you are developing airplane ear?
Symptoms ( most common)
Discomfort in the ear
Ear pain

Ear pain while flying is a common complaint.Image courtesy marine @freedigitalphotos.net

Muffled hearing
Blocked ear/fullness of ear
Severe complaints
Excruciating pain in ear
Severely blocked ear
Ringing, buzzing sound in ear (Tinnitus)
Severe Hearing loss
Spinning sensation (Vertigo)
Bleeding from ear

When to see a doctor?

Aeroplane ear:when to see a doctor.Image courtesy David Castillo Dominic @freedigitalphotos.net
If you have any of the severe problems.Or if the symptoms persist even after …..hours “check..

What will your doctor See?
An ENT surgeon may do an otoscopic examinations to see your ear drum.

Signs on otoscopy:

Invaginated/retracted ear drum
Congested ear drum
Solitary or multiple blood filled blisters on your ear drum
Haemotympanum
Signs of serous otitis media
Ruptured ear drum, with blood clot.
Otoendoscopy may also be done where you will also be able to see these findings along with your doctor.

Are there any long term complications ?

Rarely the ringing sound in ear or tinnitus may be permanent.

If inner ear barotrauma occurs hearing loss may not improve

What other tests can you do?

Pure tone audiometry: to check your hearing and rule out inner ear barotrauma Tympanometry:To check the air pressure in the middle ear.and find out if there is any fluid.

Aeroplane ear:How to prevent it during flights

Don’t fall asleep during flying, specially during ascent or descent.
Avoid flying if you are having a severe cold.If emergency then use a Nasal decongestant spray just before takeoff and landing.Also take a decongestant orally, before getting on the .Dont use over the counter sprays .They may cause even more problem in the long run.
Take plenty of chewing gum so that you can actively help in Eustachian tube opening during flight.The chewing and swallowing movement helps to open Eustachian tube.
Try Valsalva maneuvre.This is a pressure equalizing technique which helps to pop the ear.You can try this if repeated swallowing and yawning doesn’t help.
Pinch your nostril, take a mouthful of air,close your mouth and try to gently direct the air into the back of your nose.Imagine you are trying to blow your nose gently. You should feel a pressure buildup.But do not let the air out.If you hear a pop you will know the ear is unblocked.You can also close your nose and mouth and try swallowing .Donot try to do all this if you feel pain in ear.

What can young children do to prevent aeroplane ear?

Very young children have difficulty during fflying.Often you will find them irritable crabby , pulling at their ears and may also cry incessantly. This is because the Eustachian tube in infants and very young children are not mature enough to handle the extreme change in pressure.

How to prevent Aeroplane ear in young children.Image courtesy Jeffrey Betts at MMT

But you can help them too.
Dont let them fall asleep.
Play with them.
Carry a few pacifiers so that the suck and swallow reflex constantly works.
Talk to your baby doctor whether a decongestant oral medicine is advice able for your child.
A plain saline nasal drop given just before take off and landing helps to increase the swallowing movement and equalise pressure effectively.

What can you do to unblock the ear post flight?

Continue the Valsalva maneuvre/pressure equalizing technique
Normally it’s self healing and gets better within a few hours to few days.
If symptoms are uncomfortable and persists , or the ear doesn’t pop you should visit a doctor specialised in ear diseases
If your nose is blocked , avoid forceful nose blowing and take steam through your nose.This helps to relieve nasal congestion and open up the Eustachian tube.

What your doctor may advice?

Nasal spray; decongestants/steroids
Oral decongestants
Oral antihistamines
Non steroidal anti inflammatory drugs for relieving pain
Once medication have improved Eustachian tube function Valsalva maneuver helps to force open the blocked tube.Surgery is rarely needed.

If fluid in the middle ear persists even after 3 months myringotomy (incision in the ear drum) is done to drain the fluid.

If the perforation in ear drum does not improve after 3 months tympanoplasty to repair the eardrum may be needed. I hope next time you are flying you will be carrying some chewing gum or hard candy with you.

Write to me at dramrita@healthwealthbridge.com or comment below to let me know how your ears fared this time.

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Disclaimer:The purpose of this article is for educational purpose and should not be taken as professional medical advice.When in doubt always visit your doctor.

Lead Poisoning : What you can do

By Dr.Amrita Basu(MBBS,MS) on December 25, 2017 19

Lead poisoning

The problem.… Lead is a naturally occurring element of the earth.It is not biodegradable. It goes on accumulating, wherever it is deposited .

LEAD POISONING :protect your children

This post is a bit long you can go through this content list and jump to any section.

Shocking Statistics

Lead poisoning sources

How is lead metabolised?

Systemic effect of lead

Symptoms of lead toxicity

Management of toxic effect of lead poisoning

Action plan: what you can do

Take home message

Lead can stay, in the soil, air, water your homes for years. It can enter your body through food , water, air..it can even be absorbed through your skin. Lead has zero need in the body.

There is no known level of lead that is needed by your body and studies show that any amount of lead is potentially Dangerous! Lead is a known xenobiotic element.

Continuously accumulating lead over years can poison generations of children and adults. All social economic and geographical boundaries are crossed by the poisoning effects of lead.

Due to its widespread usage in various industries , chronic lead poisoning is a very real public health hazard, specially in developing countries like our motherland. Lead is still widely used in most house paints used in India and is one of the very important source of exposure .

Pregnant women and children are at most risk from exposure to this metal. The controversy regarding high proportion of lead in Maggi noodles has brought into focus the the need for more awareness and stricter regulatory measures. Nestle,and it’s counterpart in India are world renowned companies, with long history of quality products.

If they , can’t keep a check on their products, I wonder about the quality of any packaged food ! There are more than enough, environmental sources of lead exposure without food items contributing to the chronic poisoning.

Individual , government and the corporate sector all need to work together to stop poisoning ourselves… because nobody’s safe. In the meantime educating yourself to keep you and your family healthy shouldn’t be delayed!

Shocking Statistics

According to CDC data , there are 4 million households in USA ,where children are being exposed to high levels of lead . Lead poisoning is the number one environmental disease affecting children in developing countries.

Lead poisoning is a serious health hazard.Having lead as a component in paint can harm your health as well as that of children. The seriousness of the long term health hazards make lead paint a painful death in dusguise — Lead poisoning is a serious health hazard.Having lead as a component in paint can harm your health as well as that of children. The seriousness of the long term health hazards make lead paint a painful death in disguise

Lead Poisoning Sources

How do you get lead Poisoning?

Leaded petrol

The majority of the countries have banned the sale & use of leaded petrol . Afghanistan, Myanmar, North Korea, Algeria , Yemen and Iran, 6 countries were still using leaded petrol as late as 2011(The LEAD group data).

Algeria and Iraq have promised to phase out its use of leaded petrol by 2015. Canada and USA were one of the first few countries to take up the difficult task of going against the petrol companies. Unfortunately India was one of those who still allowed leaded petrol till 2000, when good sense prevailed.

Tetra ethyl lead is an organic lead compound in petrol which has unimaginable notoriety and was responsible for decreased IQ and development of antisocial behaviour traits in children. It’s a blessing that the world woke up and stopped the use of this poison.

Lead smelting
coal combustion

Lead paints

Paint companies unfortunately have questionable standards in self regulation of lead levels in paint. In countries were strict legislation is absent in this matter we find shockingly high lead levels in paint. USA &UK have banned lead usage in paints for painting homes.

But many countries including India, still don’t have adequate legal infrastructure to check & control lead levels in house paints. The major culprits are often small and medium sized paint companies of the unorganised sector. Yellow,green, red and white paints generally have lead pigments.

Lead containing pipes,
Lead based solder in water pipes
Batteries
Ceramics ; improperly glazed
Plastics
Food can soldering
Drinking water systems

Cosmetic and folk remedies

lead poisoning sources

Environmental exposure to paint, demolition of lead painted houses, bridges, stained glass, contaminated herbal remedies, candies, are some of the very common sources of chronic lead exposure. Top

Industries with high level

of lead usage include:

Automobile
Paint
Ceramics
Plastic

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How is Lead metabolised?

Absorption:

Ingestion Inhalation Dermally (organic lead)

Distribution of lead

in the body

Blood:

95% to 99% of lead may be stored in the red blood cells. You really need to measure your blood level of lead ( not serum) which helps to find out recent exposure .

Soft tissue:

Extensive storage with half life of 30 days.

Bone storage:

Upto 15% of exposure dose may be stored in the bones. An astounding 20 years is the half life of lead in bones.Bone lead levels shows the cumulative exposure of this ubiquitous element over several years.

Excretion:

Mainly in urine May also appear in other bodily fluids including breast milk.

Systemic Effects of Lead

Effects of lead poisoning in humans are manifold All the imp systems of the body may be affected.

Most seriously affected systems are:

Nervous system Hematopoietic system(Blood) Renal system(Kidneys) Hepatic system(liver)

What are the Symptoms?

Children are the most affected as their developing nervous system absorbs a larger amount of lead.

Children

Common nonspecific symptoms

Children appear inattentive, hyperactive or decreased activity, temperamental, irritable delayed developmental milestones, language delay.

Studies done by CDC have shown that even with low blood levels ( 3-4 microgram per decilitre) of lead the long term effect on cognition, learning abilities of children , is significant.

Symptoms needing urgent attention

Loss of appetite,
nausea,
vomiting,
abdominal pain
Sleepiness,
ethargy,
ataxia,
headache,
stupor ,coma.

Adults

Nonspecific

Mood swings,
irritability,
Sleep disorders
Altered sex drive,
headache,
depression,
even constipation

Though all these have a multitude of causes , chronic lead poisoning may have to be ruled out.

Acute high dose exposure symptoms include:

wrist drop,
Foot drop,
delirium
, hallucinations,

Both children and adults may present with neuropsychiatric problems,impaired cognition, learning difficulties, and antisocial behaviour. Top

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Management

Treatment
Prevention
Public health education and awareness

Treatment;

What blood levels of lead need Treatment?

Whole blood lead levels (BLL) needs to be checked. CDC has some guidelines for treatment of lead exposure.

More than 70 microgram per decilitre of BLL is a medical emergency, even without neurological symptoms.

BLL greater than or equal to 45 micrograms per decilitre needs treatment. New guidelines of CDC indicate all children with blood lead levels greater than 5micrograms per decilitre need evaluation and active management.

Dietary guidelines

Lead is responsible for oxidative stress in the body.There occurs increased generation of free radicals due to oxidation of cellular proteins,DNA, RNA, which may even cause cancer. Antioxidants in the diet can help prevent lead toxicity (Garcia and Gonzalez 2008)

Flavonoids , the natural polyphenols: present

in fruits, vegetables , tea.

Vitamins B, C, E : Important to fight

the toxic effects of lead.The dietary sources of these antioxidants can be found here

Alphalipoic acids : synthesised by the

body in small amounts, present in carrots, spinach,beet, potatoes, red meat are an important group of dietary antioxidant.

Garlic : Allicin is its active agent

which is responsible for the odour and medicinal property (Sharma et Al 2010).The disease fighting property of garlic is well known.

Curcumin : This is the principal active

component of turmeric with anti -inflammatory and antioxidant property.Along with chelating agents like DMSA, Curcumin has shown promise, regarding treatment of lead induced oxidative stress in rats( Saxena &Flora 2006)

Medicines

Symptomatic, highly exposed people :

Mainstay of treatment is chelation. The sulfhydryl group in chelating agents, bind the free lead in the blood and help in removing it from our body through the kidneys and liver.

As the blood levels of lead decreases the body stores of lead like in the bones become mobilised and there may occur rise in blood lead levels with toxicity including encephalopathy .

Chelation is to be done , definitely under a doctor’s supervision.

Oral agents include: DMSA (Succimer), and oral penicillamine. If acutely toxic, hospitalization with intravenous or intramuscular chelation with edentate calcium disodium (CaEDTA) may be needed. Dimercaprol is added to prevent encephalopathy.

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Action Plan:What you can do?

1) Stop the exposure: The most important thing about heavy metal poisoning is to stop the chronic exposure through various sources.

2) Get tested A simple blood test will help you decide regarding treatment. Definitely check whether the lab,can test for low blood levels of lead.

3) Decrease dietary fat. A high fat diet increases the rate of absorption of lead.

4)Increase dietary fibres This helps to decrease absorption of lead.

5) Correct dietary deficiency of iron

6)Prevent and treat osteoporosis. Correct dietary deficiency of calcium Osteoporosis causes mobilization of bone stores of lead and may precipitate acute symptoms. 600 IU vitamin D3 is adequate for prevention. We need a minimum of 1000mg of calcium as daily requirement for our nutritional needs. Treatment of osteoporosis needs much higher doses, of both vitamin D and calcium.

7) Increase dietary sources of Vitamin B, Vitamin C , Vitamin E and other dietary antioxidants Vitamin C is a naturally occurring weak chelating agent. Upto 1000mg of Vitamin C may be taken per day.

8) Avoid flaking paint in the house.

9) Regularly clean surfaces and children’s play area . Children’s typical hand to mouth habits are responsible for a large percentage of environmental exposure to lead from lead contaminated dust.

10) Avoid using lead containing cosmetics. Many leading brands have high amount of lead in their products and price has little to do with it.Research the product well before buying and definitely never forget to remove makeup at night

11) Open shoes outside the front door. If this not possible keep your shoe rack, mudroom close to the entryway to prevent mud tracking indoors. Outdoor soil is a very common source of lead indoors.

12) Choose lead free paint to paint your home. Nerolac in India offers lead free paint options.

13) In India you can contact InSLAR ,for testing a product for lead in their lab .

Indian Society for Lead Awareness & Research – InSLAR

inslar.org/

14)cOnly buy idols painted with Lead free paint or better yet buy

brass/silver idols.

Top

Along with treatment and prevention certain Public health strategies may be able to influence a larger population more effectively.

Public health strategies

Guidotti and Ragain (2007):

2 important strategies

1) Prohibition of setting up industries with lead close to habitable areas

2) Complete banning use of lead, where appropriate replacement is available. Top

Take home message

1)Get your blood tested for lead

2)Stop the exposure

3)Diet rich in vitamin,B,C,D,E, Calcium,iron,natural antioxidants 4)Make your home lead free

5)Use unleaded gasoline .

Children are the future.Unfortunately they are also most at risk.Make your homes safe, practice good housekeeping and above all educate yourself ,your family, your neighbours … anybody who will listen!

Your awareness will go a long way in making the authorities make the much needed changes.

Do you suffer from any of the effects of Lead poisoning? Have you ever tested your blood lead levels?

Write to me at dramrita@healthwealthbridge.com

(Disclaimer: this article is meant to educate and cannot be a replacement for a doctor’s consultation.

Reference:

1)Harrison’s Principles of Internal Medicine 2)CDC lead poisoning 3)The George Foundation 4)Toxicity of lead: A review with recent updates Gagan Flora, Deepesh Gupta, and Archana Tiwari

Interdiscip Toxicol. 2012 Jun; 5(2): 47–58.

Published online 2012 Jun.

5)Determination of free α-lipoic acid in foodstuffs

Durrani AI, Schwartz H, Nagl M, Sontag G.

by HPLC coupled with CEAD and

ESI-MS. Fd Chem. 2010;120:1143–1148.

6) Environmental occurrence, health effects

and management of lead

poisoning.

Flora SJS, Flora G, Saxena G

In: José S. C, José S, editors. Lead. Amsterdam:

Elsevier Science B.V.; 2006. pp. 158–228.

7) Protecting children from toxic

exposure: three strategies.

Guidotti TL, Ragain L.

Pediatr Clin North Am.2007;54:227–235.

8)Can antioxidants be beneficial in the treatment of lead poisoning? Gurer H, Ercal N Free Radic Biol Med. 2000;29:927–945.

9) The effect of oral administration of Allium sativum extracts on lead nitrate induced toxicity in male mice. Sharma V, Sharma A, Kansal L. Fd Chem Toxicol. 2010;48:928–936.

10). Changes in brain biogenic amines and haem biosynthesis and their response to combined administration of succimers and Centella asiatica in lead poisoned rats. Saxena G, Flora SJ J Pharm Pharmacol.2006;58:547–559.

11) Nutritional antioxidants mechanisms of action, analyses of activities and medical applications.Vaya J, Aviram M. Curr Med Chem-Immunol Endo Metabolic Agents. 2000;1:99–117.

12) Toxic effects of perinatal lead exposure on the brain of rats: Involvement of oxidative stress and the beneficial role of antioxidants. Garcia MTA, Gonzalez ELM. Fd Chem Toxicol. 2008;46:2089–2093.

13) Fruits and vegetables:Nature’s multivitamins

14 https://pubmed.ncbi.nlm.nih.gov/15764522/

15)Why Lead Poisoning May be Causing Your Health Problems

16 90% of paint samples tested contain lead above permissible limits in India: Study

17 https://www.researchgate.net/publication/23414139_Lead_content_in_household_paints_in_India

18 The brighter the worse’: Lead content of commercially available solvent-based paints intended for residential use in Pakistan

19 Evaluation of blood lead among painters of buildings and cars

15 Startling Realizations this Year:Letter of an Optimist Mommy to the Universe

By Dr.Amrita Basu(MBBS,MS) on December 25, 2017 1

The year that was.The memories I have.The lessons I learned, the friends I made, and the goodbyes that happened.15 startling realizations this year not random. They happened because I survived.

It was a year like never before. Sounds cliched, but I finally grew up I think. The stress is on I think.

But in the last few days of this year, as I look back, I have a sense of finality, of closure.

I am grateful to God for always giving me the tools to prop my soul up.

Sometimes you need those bandages and sellotapes to hold you together. You can call them books, habits, people, relationships, or chocolates. But the truth is they help!

15 Startling Realizations this Year

1)I think learning to breathe deeply and count to 100 and sometimes 1000 is helping me stay calm. There is news about attacks by terrorists everywhere, sometimes you just want to stop thinking. Let’s have a motto and stick to it people.

My motto:

[bctt tweet=”Evil will not win!” username=”misra_amrita”]

That’s a promise from a mother! You can beat us but we will not die. You can attack us but we will not cry. We will just become stronger till your hand breaks trying to beat us down.

2)Glass ceilings the truth about them

They are there.Everywhere.In Government offices and a Corporate corner office with a view.You will face them everywhere. But every time you think you are being skipped for the man behind you, remember, we will reach the top glass ceilings or not. Break them one at a time and always believe you have millions of women waiting to hear your story. So every time you struggle. Breathe and put on that lipstick. It will help I guarantee.

3)Walking and being healthy

One year back I was going through a rough patch and couldn’t seem to calm down, till I started using my trusted treadmill aggressively. By aggressive I mean it’s my walking desk and writing companion. Sounds weird and how can you run and write? I don’t. I walk and w r ite. I am slow, but I persist. I have seen that the only way for me to persist and get the results I want, is by doing what I enjoy. When I clubbed writing with walking, it stopped being a chore.

4)If you stop having sugar in your tea or coffee it will make a difference to what you eat throughout the day . You stop craving those cakes, cookies, and chocolates. It’s always easier to control what you eat even while traveling when it’s a good habit.

5)I completed three years of blogging. That makes life very interesting. There’s a saying you need to have 10,000 hours of learning a craft before you are good at it . Good or not I understand the concept. It’s about sweat . Nothing succeeds like success and success is 99%perspiration!

6)I want my daughter to be strong and kind. The rest God will help me with. Oh also financially independent. That is something I want her to be. If I could make syrup and feed her this thought it would be infinitely useful. Unfortunately, there are no shortcuts to parenting. I have to do this the long way, one story at a time.

7)Husbands are to be chosen carefully. Yes, I have felt this from the time I started reading Mills and Boons. After being with my best friend for 15 years and being married for 9 and a half I realized in life you need a friend and a game worth playing. If parents help you stand up and walk, your spouse sees you grow wiser more beautiful, or crankier. If they don’t love your flaws it’s not easy.

[bctt tweet=”In life, you need a friend and a game worth playing ” username=”misra_amrita”]

Love the flaws the cracks the shortcomings and the person.If you are a good friend you will have a good friend too!

8)Some kindnesses can never be repayed.They may be disguised and you may miss them when you were helped. But when your life changes and the veil lifts a lot can be revealed .Wait, introspect, and think of all the epople who have been kind to you even once .When you remember kindness and feel thankful you send positive energy toward your well-wisher. That’s a good thing right?

9)Don’t stop yourself from starting a garden. Rental?No problem.Apartment?No problem. Traveling no problem.I have solutions for all .

Get succulents. They don’t need much water and can tolerate any kind of neglect.
Get a vertical garden with inbuilt watering and nutrition synced to your mobile. Yes you can have it in India too.
Talk to your nursery owner to babysit your plants.
Help your neighbors start a community garden and keep your potted plants there when traveling.

10)Life will give you lemons and you can make lemonade, cheesecake, pickle just about anything. Lemons are great. You will get exactly what you want just don’t forget writing to the universe about it.

11)Thankfulness.I have written 53 thankfulness posts last year and plan to find more ways to be thankful this year How did this help me?

You are what you practice. What you focus on grows. It’s better to focus on the good and the blessings it will help attract more of the good stuff.

12)What will be will be?

Then why should you even try? You must try. Sometimes the Universe says

That will be which you will!

Tricky right? This is where persistence always helps. I never give up until the river changes its course or I reach the shore. Whichever comes first.Good or bad this is still my favourite part of me !

13)I love lipsticks and that’s a good thing.A few months back on a decluttering spree my hubby threw away plenty of my makeup stuff. Good thing as it was beyond expiry date. The best part I got to buy new lipsticks to try . You really can’t have enough lipstick ever.Get rid of clutter and junk to make a place for new good things.

14)When I was a young girl festival were bittersweet Not going into the deep end I would say they made me stronger even if they didn’t give me happy memories.

With my child, I take every opportunity to create memories, every moment of every day.I tell her my stories and want her to understand that taller, stronger, and sharper is what all girls have to be!Because sometimes being born is the blessings.Everything else can go downhill after that. Will you act or react?Will you take it lying it down, or get up and fight?That is the question!

With cases of child abuse being reported from every nook and cranny, one wonders what happened to people’s fear of karma. Does karma not exist or is this the biggest game that the universe plays with all the nonbelievers and evil doers.

This false sense of get away with anything? It is false right? When these people look into the mirror, they know. Their family knows and there is always a higher court not necessarily in this life. Those destined for eternal suffering repeat their mistakes.

[bctt tweet=”Those who repent and make amends get blessed.” username=”misra_amrita”]

Be strong. Strength is something you will need, to battle this.

15)Don’t be cynical, be wise. Life events have a way of making you bitter, distrusting and less of a believer. But that’s exactly when you need to believe.Pray , believe and have faith. It will be okay.

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Feeding your preschooler:Ultimate guide

By Dr.Amrita Basu(MBBS,MS) on December 24, 2017 2

My daughter is 4 and a half years old. Meal times nowadays are more fun and relaxed than before.But it’s still not a breeze.

As a mother, I have learned that there really is no simple single solution to feeding your child. It’s a challenge, which you have to win.

I practically learned to cook so I could feed my child! My mom and sis are super awesome cooks.So growing up,I only went to the kitchen to clean up.That was my delegated chore.

Even during college when I went to Delhi for my post grads I had a limited set of recipies under my belt, which I used to recycle every other week.

But to feed a child you constantly have to reinvent and innovate.It has to be healthy, tasty, fresh, appropriate for age, etc, etc.These were top tip from my Hubby!

The most difficult time for me was when I started weaning her. That’ definitely, topic for a book!

(If you have just started weaning your child write to me drabhijit@healthwealthbridgeand. com I will send you all the do’s and don’t.)

The next milestone for feeding is when your baby is a preschooler.

Is your child a Preschooler?

Does every mealtime seem to be totally uphill ?

Mealtime=Battlefield? Fussy eating? Picking at food, pushing food away, tantrums during eating ? You need a solution now. Don’t lose your temper, it will just make the problem worse.

Eating healthy starts from home

I have a solution ….

Ultimate tips for feeding fussy Preschoolers.

1) Make meal times family time. Have fun at meals.Eat together as a family. Include food from all food groups so that your child gets curious and wants to taste them.

The more you enjoy your own meals as a family , more likely your child will learn to look forward to her meals and enjoy them more. Eating all meals together may not be possible. Try to have at least your breakfast and dinner together!

2) Cook tasty healthy food one item on your plate easy to share with your child. Offer food from your plate.When child sees you eating different types of food , he/she will be more wiling to try new food items.

3) Maintain a daily chart of what your toddler eats.The calorie count will help you decide on further dietary needs. Rotate and change food items you give for meals and snacks. Just like you, your baby will like variety in her meals. The biggest reason for food refusal is often boredom with the food she is offered.

4) Avoid sweets, chocolates , fries, chips and fast food before meals These foods cause satiety but doesn’t fulfill your child’s nutritional needs. Fun food like these should be offered as positive reinforcement or bribe. If your child has her meal without tantrums then she may be given a small treat.

5) Make it a rule to make your child try at least 1 new item of food everyday. This way she will have variety , as well as a balanced diet.

6) Make a pact with your child At each meal your child must try a food atleast 5 times before he/she can decide to not, have that food. By that time you should be able to make her have a fair amount ! Then allow her to have one item of his/her choice.

7) Feed your child when he /she is hungry. Children eat better when they are hungry,. Give them the new food item ,as the first food to try .Hunger will make them more likely to eat the new food. Definitely avoid snacks too close to mealtimes.

8) Cook with your child at least show her the veggies, fruits, cereals which are needed to make her meals. Ask him/her to help you make the preparations.Being involved in the process often make them more likely to try these food willingly!

Some other articles which offer deeper insights:

5 Best Wipes for Baby: Everything you want to Know!

10 Reasons Mother Sparsh has the best baby wash for sensitive skin

6 Best Baby Oil for Baby massage in India

10 Best Natural Baby Lotion for Babies in India

Best Baby Laundry detergent

Baby face creams I love

Baby bottle cleaners

How much should my preschooler eat?

Why is feeding your preschooler such a Big deal?

You know that your child needs energy to play.They also need the right amount and right type of nutrition for growth. But as a preschooler they have one more challenge… They have to Learn!

As a mother you will not only be building her body for a healthy life , but also be responsible for providing her with the right equipment to make learning fun and easy.

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So what should your preschooler

Eat?

They can be offered the same food as the family. Offer them variety, but not too many choices at the same time.

Experiment with different, consistency, cooking methods for cereals, pulses, vegetables. Ideally their daily food intake should include food from all groups.

Cereals, vegetables, fruits, proteins including animal proteins,milk all are needed for the complete physical and mental development.

Meal plan Guideline

Cereals: Rice, roti, bread, oats

Proteins: fish/lean meat/eggs/chicken Beans, peas, various dal Milk group: milk, yoghurt, cheese

Fat: butter, oil, ghee .

You must also read

Healthy eating what young children need

You should be careful with food that may cause choking.

Slippery food like grapes.Its better to cut them up.Large pieces of meat/poultry.
Small hard food:nuts/seed/popcorn/raw carrots raisins
. Sticky food like peanut butter.
Always make small pieces of food. Watch while your child eats.

What food may cause Food Allergies?

Common food includes milk, eggs, peanuts, other nuts, soybean, wheat, fish, shellfish. If you feel your child may be allergic to certain food definitely talk to your doctor.

Symptoms of food allergy:

Cramps pain in abdomen, bloating, flatulence, altered stool, itchy rash.

Special tips for picky eaters

Offer them 1 new food at a time.

The new food should be offered at the start of a meal, when child is hungry.

Every mealtime should have 1 food

that your child loves+whatever the family is having.

Make food recognizable ,mashed

formless food may not be to everyone’s liking.

Might like only 1 food group.

Offer incentive to try others.

Other posts in the Childhood obesity series :

If baby is a picky eater blame yourself:Healthy eating habits in children (part 1)

Picky eater : When you need to worry(part 2)

Childhood obesity :The control is in your hand(part 3)

Childhood obesity : Healthy eating habits & You (part 5)

What are good healthy snacks for your preschooler?

Crackers, toast, air popped popcorn, vegetables cut Into cubes air fried/grilled with a dip. Cut up fresh fruits, home-made curd, grilled paneer, milk plain/flavoured, custard with fruits, pudding, hard boiled eggs.

Take Away Message

So the top tips for making your preschooler eat well are:

Eat healthy as a family .
Plan your meals as well as snack.
Give your child enough time to eat.
Try to have quiet time before meals and snacks
Involve child in making food.
Try using child sized plates, cups, spoons etc.

I hope this guide helps you feed your preschooler. Bringing up your little one may be your most difficult lifetime project, but she/he will definitely be your most rewarding!!For more such articles check out my blog.

(This guide was compiled after discussion with Dr.Abhijit Misra, pediatrician, a.k.a my hubby)

Like this post, please share it.

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15 Gifts to Surprise Art Lovers

By Dr.Amrita Basu(MBBS,MS) on December 24, 2017 2

If you are reading this either you know someone who loves art or loves art yourself.I will tell you about 15 gifts to surprise art lovers. Gift ideas are plenty, but what if you need it for someone with very specific hobbies? My daughter loves doodling, painting, and creative drawing so much that we run out of paper on a regular basis. To keep her happy the only thing needed is I sit and draw with her.

That’s why I now have a set of Christmas gifts bookmarked for various occasions. The best part these can be given on other occasions too! Just tweak according to the event.

Here’s a list of 15 Gift Ideas to Surprise art lovers!

1)If you are an artist too, draw and frame an original by yourself and send it. Various online options have easy methods of doing this digitally.I am sure your friend will adore this idea.

2)Get your artwork on T-shirts, coffee mugs, notebook covers, diary. The limit here is just your budget.

3)Buy them doodle notebooks. Pocket-sized artbooks are great to carry around and they will love you for gifting them these. They need this all the time and can never have enough.

4)Brush pens. These are a lot of fun for people who try a lot of creative calligraphy. Make a hamper of different varieties and your friend will adore you.

5) Micron-tipped pens for the Mandala or Zentangle artist. You can never have too many of these gorgeous pens which make doodling a lot of fun. The fine work of these pens makes doodling a stress buster.

6)Easel stand and canvas. This is perfect for the budding artist. Encouragement and happiness together.

7)Coloured printer to print that gorgeous art. These now come at various price ranges. Go for an option that suits your budget. Portable Instant Mobile Photo Printer

8)Laminating machine to laminate and keep their artwork safe from moisture. Don’t laugh, it’s important to keep those treasures in good condition.

9)If they have a lot of artwork lying around why not help them open an Etsy shop in India online so that they can display their work and earn something extra. You never know right? It’s not difficult and can be life-changing.

10) Make a collage of their art and print a large poster which they can display at home. There’s something about a humongous poster that gives a boost!

11)A nice razai cover, printed with all their artworks or favorite artworks you could get your hands on

12)Mandala coloring books.

13)Oil paints, Watercolor kits, brushes. This is fun at any time and they will love this.Glasspaintingkit.This is super fun and your friend can discover a new surface of expression

15) Gift them a live masterclass with an artist they admire or gift them a skillshare graphic designing class .they may discover a new love and will thank you for this. The best part they can use it for a long time.

Other Gift Guides

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Gardener Daddy

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What should I feed my Child?

By Dr.Amrita Basu(MBBS,MS) on December 24, 2017 0

What should I feed my Child? This is
a question troubling all moms.

From the time child starts to have complementary feeds, the battle starts.The terrible twos make you wish there was a magic wand for making your baby eat the green!

What are your worries about your child’s Diet?

Is your child developing health food habits?

What they eat not only helps them grow but also makes it easier fir them to learn.

What you teach now will help them their entire lives.

Childhood malnutrition and obesity both have a long term effect.

The good news is both are preventable.

Let me know your queries, at dramrita@healthwealthbridge.com

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Want to consult me professionally?

Sharing is good Karma!

Lead poisoning

Shocking Statistics

Lead Poisoning Sources

Industries with high level

of lead usage include:

How is Lead metabolised?

Absorption:

Distribution of lead

in the body

Blood:

Soft tissue:

Bone storage:

Excretion:

Systemic Effects of Lead

Most seriously affected systems are:

What are the Symptoms?

Children

Common nonspecific symptoms

Symptoms needing urgent attention

Adults

Nonspecific

Acute high dose exposure symptoms include:

Management

Treatment;

Dietary guidelines

Medicines

Action Plan:What you can do?

Public health strategies

Take home message

Reference:

Sharing is good Karma!

15 Startling Realizations this Year

3)Walking and being healthy

Sharing is good Karma!

Ultimate tips for feeding fussy Preschoolers.

How much should my preschooler eat?

Why is feeding your preschooler such a Big deal?

So what should your preschooler

Eat?

Meal plan Guideline

You must also read

What food may cause Food Allergies?

Symptoms of food allergy:

Special tips for picky eaters

What are good healthy snacks for your preschooler?

Need more tips , subscribe to my Healthletter

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Sharing is good Karma!

Here’s a list of 15 Gift Ideas to Surprise art lovers!

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