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COMMON PROBLEMS IN MULTI-INFARCT DEMENTIA: EMOTIONS AND INCONTINENCE

admin — Thu, 16 Sep 2010 17:21:27 +0000

Emotions

We try to control our emotions and expression of them both consciously (one tries not to laugh at someone in the same room who is wearing a hideous hat) and unconsciously (I always cry during the last few minutes of the film The Color Purple even though I’m trying not to). A stroke can effectively bring one’s emotions nearer the surface, lessening any control so that some sufferers cry or more rarely laugh at inappropriate times. The control system seems to be damaged. This is known as emotional lability and ranges from the person crying when a certain subject is mentioned to bursting into tears whenever they try to speak. In its severe form it is obviously very disabling both in terms of rehabilitation and socially. There is good evidence that one of the anti-depressants – amitryptiline – in a dose too low for it to be having an anti-depressant effect is helpful. I have used it many times with good success.

Incontinence

Incontinence of urine (more rarely of faeces) can occur after a single stroke but is more common as multiple strokes lead to a confused state. The condition is often associated with more marked physical disability, making toileting difficult, and also because the nervous control of the bladder may be damaged making the achievement of continence difficult. Though one tries to avoid them, one may have to use some form of incontinent pad or consider the use of a urinary catheter when both the physical and mental results of multiple strokes are advanced.

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PERMANENT CORRECTION OF NEARSIGHTEDNESS: STORY OF MELONY CARSON

admin — Thu, 16 Sep 2010 17:19:21 +0000

Appearing about twenty years younger than her present age of 46, Melony Carson of New York City does everything possible to remain youthful and beautiful. She is tall and willowy, uses cosmetics like an artist, and has long, naturally platinum-blond hair.

Melony can’t wear contact lenses comfortably because of an acute sensitivity reaction to them, and she disdains using eyeglasses because she believes they make her seem old and ugly. But corrective lenses or other vision aids are a necessity for the woman inasmuch as she is exceedingly nearsighted. If Melony tries to go without help from visual aids, she just can’t make out the details of anything in her surroundings. Her vision in each eye is only 20/400 or less. Despite her not wanting to, spectacles or some other corrective aids are devices she must wear at her job as a legal secretary and receptionist.

Greeting clients and other visitors for her attorney employer has the woman repeatedly removing her eyeglasses. She does this for two reasons: for sight and for vanity. Wearing a correction for myopia is an obstacle to her recognizing anything at close range. The woman can’t make out the features of office visitors’ faces so that she must take off the spectacles. In turn, Melony would never allow someone to check out her looks while she is wearing eyeglasses, especially if that someone is a handsome man, so off come the visual aids as soon as the outside door opens. Of course, she hated even the idea of resorting to bifocals.

In June 1984, Ms. Carson brought her eye problems to her ophthalmologist. Her doctor suggested that the eye surgery known as radial keratotomy (RK), today’s fastest growing advance in eye care since contact lenses, be carried out. It was the ophthalmologist’s concept, tailored to this woman’s visual, psychological, occupational, and social needs, that he performs the surgery on only one of her eyes. In this way, she could have distance vision with lens correction from the operated eye, and still use the unoperated for near work, again without correction.

Of course, the eye surgeon explained, “It will take considerable practice to coordinate your eyes in order to be able to use them alternately, as you desire.” Melony Carson was strongly motivated to give the procedure a try. Radial keratotomy for the left eye was scheduled the next week, and Melony’s eye coordination practice continued for a month, thereafter.

The concept worked quite well. RK for one eye has totally satisfied both her visual and vanity needs. As far as vision is concerned, Melony Carson will remain 26 years old forever.

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YOUR CHILD’S HEALTH: AMBIVALENCE ABOUT THE SEPARATION

admin — Thu, 21 May 2009 07:02:59 +0000

Although the first separations occur when the baby is first put down to sleep, it is not until the age of 7-9 months that the baby begins to become truly upset when separated from the primary care-giver. This then continues and may intensify during the early toddler period, depending on the particular context and circumstances. The child may become distressed whenever confronted with a new separation situation — when left with a grandparent or relative, a new babysitter, when beginning daycare, kindergarten or school, and so on.

Parents should expect the child to be distressed at these times — this is perfectly normal. In most instances, if properly handled, the distress will quickly dissipate and will become less frequent and less intense as the child becomes more familiar with the new surroundings, and more comfortable with his new care-givers, and as he becomes more confident with experience that the parent will indeed return.

The situation is often made worse by the parents’ own ambivalence about the separation. The mother and/or father may have all sorts of mixed feelings about leaving their child — ambivalence about a child growing up too quickly, anxiety about the child’s safety and so on — that are transmitted to the child. While such feelings are only too normal and often understandable, they may develop into an overprotective attitude towards the child which serves to hinder his development. This may also manifest itself in other ways, such as a reluctance to set consistent limits, and so on. Ultimately this may lead to a child who is reluctant to participate fully in the various experiences of life, who is overdependent on adults, and who reacts to any anxiety or stress by turning these feelings inwards so they are expressed as somatic symptoms such as abdominal pain, sleep problems and nightmares, and headaches.

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HEALTH SCREENING – SPECIFIC SYMPTOMS

admin — Fri, 15 May 2009 09:12:51 +0000

All of this may be reassuring to the person who undergoes the testing and then gets a clean bill of health. But recently this mass screening of healthy people has come under criticism. The problem may be that not enough positive findings turn up, except where expected, to justify the whole procedure in terms of money and manpower.

Where a patient has specific symptoms for which a doctor cannot find enough evidence to make a diagnosis, he should carry out specific tests, usually one or two at a time, to find out what is going on. Ordering a whole battery of tests may save time but often means many are ordered unnecessarily and this may be expensive.

The Australian Medical Association has recently reaffirmed its policy that multiphasic health screening of healthy persons should not attract a subsidy from the Government or the health funds but the cost of it should be totally borne by the individual.

This opinion is not shared by all doctors and some are wholeheartedly in favor of screening of healthy people and believe early disease may thus be detected before symptoms make themselves known.

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MISCARRIAGE – INTRODUCTION

admin — Fri, 15 May 2009 07:20:53 +0000

A miscarriage or spontaneous abortion is almost as common as a normal birth. Most miscarriages occur in the first three months of the pregnancy.

Those that occur in the second trimester or between three to six months, usually are due to dilatation or opening of the cervix or neck of the womb.

This may happen as the result of a previous injury to the muscles of the cervix, during childbirth, or from stretching of these muscles during a curette or induced abortion.

If trouble is recognised early, or as a preventive measure with a subsequent pregnancy, a firm suture or stitch can be put in the cervix early in the pregnancy, and this may enable the pregnancy to continue to full term.

Why should a woman miscarry?

Unfortunately, in most instances, we doctors just do not know the reason, although some doctors tell their patients it’s nature’s way of ensuring that most babies born are normal — thereby assuming that a pregnancy that miscarried is abnormal.

This probably is just speculation.

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BABY AND CHILDHOOD RESPIRATORY DISORDERS: PLEURISY

admin — Fri, 08 May 2009 08:38:38 +0000

Pleurisy is the condition when the pleura (the thin outer membrane that encases the lungs as they sit in the thoracic cage) is inflamed. It is often associated with a respiratory infection, maybe with a sudden onset. It may be accompanied with a cough; and with each cough, there is often a very sharp stabbing pain in the chest. Pains may also occur in the shoulders and in the abdomen, depending on the part of the pleura affected. Often breathing movements are reduced, for it may be painful to breathe in and out with any depth. There may be an elevated temperature.

In years past, this was common with tuberculosis, and fluid or pus would frequently collect between the lungs and the lung cage.

This was called effusion and empyema. This is seldom seen today, particularly as tuberculosis is far less common.

Treatment

Medical attention as early as practical is recommended with symptoms of this nature. Antibiotics are usually extremely quick and effective in killing the germs. A large range of organisms may be responsible, but many are amenable to treatment, and often a rapid cure is readily forthcoming.

Plenty of fluids, bed rest for a few days, linctuses for coughs, analgesics and antipyretics for pain relief, and to reduce elevated temperatures, may be given as necessary. Paracetamol elixir for children under the age of six years is effective in the latter case, or paracetamol or aspirin tablets for those in the 6-12 age group. Dosage varies with age—check the label, which usually lists the dose for each age. Check the details given earlier for the common cold, for the advice is similar.

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BABY AND CHILDHOOD ILLNESSES: AGGRESSIVE BEHAVIOUR

admin — Fri, 08 May 2009 08:29:20 +0000

Even a young baby may get upset and fly into a rage, but this is usually not very apparent. Excessive restraint, often by parents in a passive manner, may be the triggering factor as the child gets older. Persistent nagging and coercion and forcing the child by all manner of unfair prohibitions can initiate an aggressive attitude. Some may resist passively, by being negative. But others will actively fight back in an aggressive active manner. Youngsters soon find this also becomes an excellent way of attracting attention. Boys tend to show aggression more than girls, because they are socially conditioned to do so. Excessive restraint and discipline, often alternating with overindulgence, are likely causes.

Treatment

It is often possible to modify the aggressive response. Give the child the opportunity to let off steam on a regular basis. It is fruitless to try to coop a child up at all times and force acceptance of every rigid restriction you suggest. It will not work in the long term.

Make opportunities where your child’s energies and frustrations can be redirected. Hobbies offer unlimited scope for this, especially those you know the child will do well. Success usually breeds success, and pride of achievement is a good way to get rid of pent-up emotions; it also dissipates energy extremely well. Punishment, sometimes essential, is not the cure in most cases. It will only tend to worsen the situation and make an aggressive bully an even worse one.

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PELVIC FLOOR MUSCLE

admin — Wed, 29 Apr 2009 09:56:04 +0000

This sling or hammock of muscle stretches from the pubic bone to the coccyx (tailbone), forming the floor of the pelvic area and supporting the bladder, rectum and (in women) the vagina and uterus.

When this muscle gets too slack and flabby as you get older or after childbirth, your pelvic organs can sag (prolapse) and you might experience problems such as stress incontinence (leaking of urine if you laugh or cough — see Bladder) and constipation. If the vagina becomes loose and weak it can lead to less sensation during sexual intercourse, and it may allow the bladder to sagdownwards, creating an increased risk of urinary infection.

Whatever age you are, you can tone up your pelvic floor muscles with simple exercises, sometimes called Kegel exercises, which you can do anywhere — in the office, on the phone, in a movie, waiting for a bus — wherever. No one will notice a thing. First get the feeling of which muscles they are, by concentrating on trying to stop the flow intermittently when urinating. You may not be able to do this completely, but the aim at this stage is just to feel the pelvic floor muscles working.

Once you can identify the muscles, you’re ready to start exercising. Tighten up the whole pelvic floor and hold for around three seconds, then relax for three seconds. Repeat five or six times. You should try and do at least 10 sets of these exercises a day — preferably more like 20. But don’t do too much too fast — work up to it gradually.

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CHILDREN’S HEALTH: CONJUNCTIVITIS

admin — Tue, 28 Apr 2009 09:27:58 +0000

Conjunctivitis, or pinkeye, is an infection of the transparent membrane (conjunctiva) that covers the white of the eye and lines the inside of the eyelids.

Conjunctivitis is highly contagious. It is spread by contact with discharge from the eye or by contact with objects (hands, facecloths, toys, handkerchiefs) that have touched the infected eyes or that the child with conjunctivitis has handled. Symptoms of conjunctivitis may develop within one to three days after contact with the infection. Conjunctivitis usually spreads quickly to the other eye.

Conjunctivitis may exist alone. It may also develop as a complication of sore throat, tonsillitis, earache, or sinusitis.

Signs and symptoms

Conjunctivitis causes redness of the entire white of the eye. There is a buildup of yellow pus. The eyelids may swell and redden. There is a burning sensation in the eye. Vision is always normal, and light rarely bothers the eye.

Conjunctivitis is different from other conditions that also cause reddened eyes. Eye allergies cause itching and tearing but never pain or pus. Viruses cause pain and tearing but no pus. Foreign bodies in the eye cause pain, sensitivity to light, and tearing, but no pus; redness caused by a foreign body usually appears in only one part of the white of the eye. Glaucoma causes pain, enlargement of the pupil, tearing, and sensitivity to light, but no pus. If your child has reddened eyes, remember to consider these other possible causes besides conjunctivitis.

Home care

If you suspect that your child has conjunctivitis, call your doctor. Your doctor may wish to see the child; however, if your description of the symptoms is detailed and accurate, the doctor may decide to prescribe antibiotic eye drops or ointment over the telephone.

Place the antibiotic eye drops or ointment into the eyes as frequently as directed. Treat both eyes even if only one eye seems to be affected. Continue treatment for 24 hours after the eyes appear normal. Since conjunctivitis is so contagious, isolate your child from other people. Watch other members of the family for possible symptoms.

Precautions

• With medication, the eyes should improve quickly-usually within 24 hours. If eyes don’t begin clearing in that time, call your doctor.

• If eye ointments are used, vision will be blurred for a few minutes after each application. Any other vision problems should be reported promptly to your doctor.

• Be certain to notify your doctor of any other signs of illness, such as a head cold, nasal discharge, sore throat, earache, fever, or sore glands. Conjunctivitis may be a complication of another disease.

Medical treatment

The doctor will carefully examine the outside and inside of the eyeball, including looking under the eyelids for hidden foreign bodies. Your doctor may stain the eyeball with special drops to look for injuries or ulcers (scratches on the surface of the eye). The doctor may also culture any discharge from the eye, nose, or throat. Antibiotics taken by mouth might be prescribed. If necessary, your doctor may consult an ophthalmologist (a specialist in eye diseases).

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EXTENDING AGE: MEDICAL TESTING FOR TWENTIES

admin — Thu, 23 Apr 2009 06:12:53 +0000

The problem with guys in their twenties, says Dr. Goldberg, is that they’re invincible. “Or at least they think they are,” he says. While it’s true that you’re less likely to have serious health problems at this younger stage in life, now is a great time to map out a lifestyle plan to help you prevent diseases in the future. You can also catch any potential problems, such as high blood pressure, in their infancy and stop them there, says Dr. Goldberg.

To head off future health woes, doctors recommend getting the following tests starting when you’re in your twenties.

History and physical: See your doctor for a history and physical every three years until you turn 40, suggests Dr. Goldberg. Then switch to every two years until you are 50, when you should start getting them annually. It’s here that your physician learns all about you and your family history: health problems dating back to childhood; any current medical conditions such as allergies, diseases, or medications; lifestyle factors, such as whether you drink or smoke; and any other pertinent information.

Blood pressure: Have your blood pressure checked every three years until you turn 40; then switch to every two years, says John Coulehan, M.D., professor of medicine and preventive medicine at the State University of New York at Stony Brook School of Medicine. “This might be one of the most important screenings you can have done,” Dr. Coulehan says. “There are absolutely no symptoms to high blood pressure. Untreated, it can lead to heart attack, stroke, kidney failure, and many other problems.” To refresh your memory, blood pressure is read in two numbers, the top number being systolic; the bottom, diastolic. Systolic pressure measures the force of blood flow at its peak. Diastolic measures blood pressure at its lowest point. A normal reading is around 120/80 millimeters of mercury. Consistent readings above 140/90 are high.

Blood count: Have your blood count done every three years, until you reach 40; then have it tested every two years, suggests Dr. Coulehan. This test measures the quality of your blood and the levels of three types of blood cells needed for optimum health: red cells, which carry oxygen; white cells, which fight infection; and platelets, which help with blood clotting. Low levels of red blood cells can be a sign of anemia, a major cause of fatigue.

Urinalysis: Have a urine test done every three years until you reach 40; then switch to every two years, says Dr. Goldberg. Give your doctor a paper cup with a small urine sample, and he can tell you how well your kidneys function, whether you’re drinking enough water, whether you have any kidney stones or prostate or urinary tract infections, and even if you have diabetes or some cancers.

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