Waiting for Monsoon

Somewhere between the Andaman sea and the gulf of Thailand, she floated on the pretend sanctuary of calm bays. Waves swept her north and south, sometimes dragging her towards the depth of the ocean then returning her back to the sunbathing sand. She didn't mind either. She soaked up the rays that cured her of all malice and heartaches, her tears rolled down adding salt to the ocean before it reached her ears. Her hair wet and dark, added colour to the aquamarine.

But the ocean would change forms just when she became most comfortable and could almost give water a form other than flowing. The ocean would get vicious on her for trying to put him in a box and like an old jealous lover would try to drown her down to the bottom. She would worry and forget to breathe; her feet couldn't find the ground so she would swim back to the shore.

On the shore everyone seemed calm, unaware of the ocean's whereabouts, unaware of her drowning and floating. She wasn't invisible yet the sight of her fit in so seamlessly with the surroundings that it made it hard for all to distinguish her from the seashells and puffy white clouds. She would plop herself down on a bed of sand lighter than the colour of her skin and read Bengali novels not written for her.

Waiting for monsoon and sipping on coconut water she craved the taste of old music. But they were all gone. Some stolen and other voluntarily wiped out of her system. Thinking about the lack of music in her life, she stared at the sun and thought about the speed of light. Memorized numbers from childhood appeared in her mind. 8 minutes and 20 seconds, that's how long it takes for light to travel from the sun to the earth. She thought about all that could happen in 8 minutes and 20 seconds. Like how many babies might be conceived around the world, and how many bricks could be stacked to make homes for them. And how many couples might fight and make up or break up and how many calories would be lost doing so.

She tried to jot down numbers. She knew she couldn't be proven wrong as the answers were mostly unknown, so whatever she wrote down on the sand next to each of her questions were the right answers. So she did; she wrote down all that she could estimate in amounts on the wet sand. Little crabs crawled up on the rounded middles of eights and kissed and made out. Jellyfishes preferred the nests of the loopy sixes. By the end of it, she forgot what stood for which and why she wanted to figure out answers for her nonsensical train of thought.

But nothing mattered because she knew the numbers would float away eventually; the ocean would bully the sand and wipe everything clean. So she made a one with her body and lied next to all the freshly written numbers, the answers to almost all unknowns.

After a few hundred 8 minutes and 20 seconds the monsoon finally arrived and settled it all. Raindrops drew fat round zeros all over the sand and the ocean erasing away all other numbers. Leaving her with all the same answers, circular imprints and bubbles to believe in.

Dear doctor,
Beside oral hygiene, what are other preventive measures that should be taken to prevent gingivitis? Please give me a suggestion.
-Mohammad Rajja, Nepal

Dear Mr. Rajja,
Nice to have a letter all the way from Nepal!
Gum disease is a chronic bacterial infection that affects the gums and the bone supporting the teeth and if left untreated, can lead to tooth loss. It can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colourless film that constantly forms on your teeth) causes the gums to become inflamed. At the intermediate stage of gum disease (gingivitis), the gum becomes red, swollen and bleeds easily. Gingivitis is reversible with professional treatment and good oral home care.

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissues and bones are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

Causes of gum disease
The main cause of gum disease is bacterial plaque, a sticky, colourless film that constantly forms on your teeth. However, factors like the following also affect the health of your gums.

Smoking/tobacco use
As you probably already know, tobacco use is linked with many serious illnesses such as cancer, diseases of the heart and the lungs, as well as numerous other health problems. What you may not know is that tobacco users also are at increased risk for gum diseases

Genetics Research proves that up to 30 percent of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease.

Pregnancy and puberty
As a woman, you know that your health needs are unique. You know that brushing and flossing daily, a healthy diet and regular exercise are all important to help you stay in shape. You also know that at specific times in your life, you need to take extra care of yourself; times when you mature and change, for example, puberty or menopause, and times when you have special health needs, such as menstruation or pregnancy.

During these particular times, your body experiences hormonal changes. These changes can affect many of the tissues in your body, including your gums. Your gums can become sensitive, and at times react strongly to the hormonal fluctuations. This may make you more susceptible to gum disease. Additionally, recent studies suggest that pregnant women with gum disease are seven times more likely to deliver preterm, low birth weight babies.

Stress
As you probably already know, stress is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. What you may not know is that stress also is a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases.

Medications
Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can affect your oral health. Just as you notify your pharmacist and other health care providers of all medicines you are taking and if any changes in your overall health occur, you should, furthermore, inform your dental care provider.

Clenching or grinding your teeth
Has anyone ever told you that you grind your teeth at night? Is your jaw sore from clenching your teeth when you're taking a test or solving a problem at work? Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and could speed up the rate at which these periodontal tissues are destroyed.

Diabetes
Diabetes is a disease that causes altered levels of sugar in the blood. Diabetes develops from either a deficiency in insulin production (a hormone that is the key component in the body's ability to use blood sugars) or the body's inability to use insulin correctly. If you are diabetic, you are at higher risk of developing infections, including periodontal diseases. These infections can impair the ability to process and/or utilise insulin, which may cause your diabetes to be more difficult to control and your infections to be more severe than a non-diabetic.

Poor nutrition
A diet low in important nutrients can compromise the body's immune system and make it harder for the body to fight off infection which ultimately causes gum disease.
Failure to have professional scaling (cleaning)
Dental scaling should be done every year.

Dear Doctor,
I am thirty-two years of age. I am faced with an unusual problem. As a child I had the habit of regularly wetting the bed. In adulthood, whenever I am tensed due to work or family problem, I wet my bed. Once I get over the cause of my anxiety, I regain control. However, this is causing much shame and severely affecting my marital life. I am even ashamed to discuss the problem face-to-face with a doctor. Please help.
- Troubled

Thanks for trusting me with a sensitive issue like this. This is surely not an easy topic to discuss as adults.

Majority of children with nocturnal Enuresis (night time bed wetting) grow out of it with age, only 0.5 to 2.3 percent cases unfortunately continue to suffer in their adulthood.

From your description it appears to me as a case of secondary enuresis where a child or adult starts wetting bed after staying dry for at least 6-12 months at a stretch. As you have indicated stress feelings can precipitate secondary enuresis leading to a vicious cycle between enuresis and stress.

Enuresis damages a person by lowering the self-esteem and inflicting pathological shame. This happens more when highly critical and non-compassionate people surround one. If your marriage is on the rocks because of your bed wetting condition, then the stress is not going to go away unless you free yourself from this environment or your spouse becomes more co-operative or you learn better stress management techniques (both cognitive and behavioural methods) to handle the negative emotional baggage that follows the condition.

Most bed-wetting is the outcome of a developmental delay where the neuronal circuits, responsible for carrying sensations of a full bladder to and from the assigned brain centres, are underdeveloped. This leads to impaired bladder control. Sometimes a strong family history reveals a genetic predisposition.

Medical research has been successful in identifying the faulty genes linked to this clinical condition. Symptom management instead of cure seems to be a better choice in cases where the underlying factor is mostly genetic. It is also helpful to go through a complete medical investigation to exclude any abnormalities in the urinary tract or bladder muscle tone. Sometimes chronic urinary infection can also be a contributory factor, which is a treatable condition.

Some anecdotal evidences show a connection between unusual deep sleep and bed-wetting; others report bad toilet training as a possible contributor.

Simple measures such as evacuating the bladder before going to bed, restricting fluid intake at night time, waking up in the middle of night to empty bladder or using a specially made alarm system that starts ringing as soon as the bed starts wetting are often found helpful in reducing the number of accidents.

Research also shows that an abnormality in anti-diuretic hormone (ADH) production at nighttime can lead to nocturnal enuresis. The normal upsurge of ADH production at nighttime is associated with less urinary output by kidneys. Children above 6-7years of age usually secrete enough ADH to keep themselves dry throughout the night. Synthetic ADH preparations can be used to combat the situation if blood level shows a deficiency. However, judicious use of medicine is essential in avoiding side effects and complications.

Tricycle antidepressants are commonly used medications for symptom management. They work both on bladder retention capacity as well as on anxiety and depression levels that tend to come in the same package.

You have mentioned that you are tensed due to work or family problems. Therapy or counselling sessions might be helpful to equip you better in handling those situations. Your feelings of shame around this issue need to be further explored. In my opinion, shame is a useless emotion in this scenario, which can only drag you further down.

Enuresis is most likely to be an organic condition without affecting emotional maturity and intellectual capacity. As a responsible adult, if you are reaching out for help to correct the condition instead of allowing this condition to rob your dignity, if you are acting responsibly (doing personal extra laundry, having a separate bed and maintaining hygiene etc.), then I don't think you have a reason to be ashamed.

This is not something that you have asked for or have any control over; accept it as a medical condition and not as a personal failure. Save this shame for people who fail to have any compassion at all for others who are less fortunate than them.