Health News and Information

It usually starts as a mild respiratory infection, similar to any one of a number of viral respiratory infections but, within 48 hours, the condition worsens, the temperature rises considerably, a dry cough develops and there may be confusion if the brain is affected.

Many other organs throughout the body are involved.

The diagnosis is difficult to make, and the germ is hard to isolate.

It may be that the true diagnosis is not established for several weeks after the onset of the infection, by which time the patient has usually recovered.

A high degree of suspicion is more likely to lead to early diagnosis or certainly to the correct treatment being instituted while proof of the diagnosis is being pursued.

This germ does not respond to penicillin, and is also poorly controlled by many antibiotics. Erythromycin appears to be the preferred drug but this may need to be continued over at least two weeks.

Any of a number of types of pneumonia can mimic Legionnaires’ disease.

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How does the law stand with regard to a person refusing permission for a blood transfusion?

Such a problem usually arises when the patient is a member of the Jehovah’s Witnesses, whose beliefs do not allow the acceptance of a transfusion of blood or its derivatives even when it may be necessary to save life.

In recent years the Medical Journal of Australia published an editorial written by a barrister on how the law regarded the question.

Any adult has the right to make a decision about what treatment he will or will not have, and the doctor treating him must accept this. If the doctor cannot offer proper treatment under those terms, then he can refuse to continue with the case and ask the patient to consult another practitioner.

The patient and the doctor have rights and obligations and, given goodwill on both sides, no conflict should arise.

The doctor is required by law, usually common law rather than any set statute, to use due care and skill in dealing with his patients.

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What can I do to prevent endometriosis? Although endometriosis is rarely life-threatening, it affects life on two very critical levels—well-being and fertility. Women are often surprised by the differences they can make in ending the misery of endometriosis.

Taking charge of the disease involves change. There is no getting away from it. it requires a real willingness to invest in yourself and alter some daily routines and ways of thinking about the disease, as follows.

• Build a support system. This begins with finding a doctor who understands endometriosis and how it has affected you in particular. There is no use in convincing skeptical practitioners that you are suffering from a real condition if they persist in believing that your symptoms are psychosomatic.

Discuss your condition with family members and friends in a calm and tactual manner. Explain what you have learned about the disease and why you are feeling the way you do. Severe menstrual camping attributed to prostaglandin levels, painful intercourse, and mood swings due to hormone fluctuations are real factors ha die disease. Now that your loved ones know it’s not “in your head,” ask for their help in getting you through any especially difficult time. If you feel you need pyschological counseling either alone or in ramify therapy to help sort out your feelings shout the impact of the condition on you and on others, seek help now.

The “career woman’s disease” touches the lives of millions of women who must deal with their condition and continue to work efficiently. This can be a problem. Many employers are not interested in hearing that employees suffer from chronic disorders such as endometriosis. As with sufferers of PMS, women with endometriosis may be assumed to be overly self-indulgent during menstruation. It has been estimated that 140 million work hours are lost each year to the symptoms of endometriosis, a fact that the business world cannot ignore.

Yet, they do. Now it is up to you. Your wisest strategy is to be consistently reasonable at work and prudent about whom you inform of your condition. Although your impulse may be to educate your employers and coworkers, many of whom may have the disease or know others who might, not everyone may be sympathetic to you. They are two schools of thought about discussing this disease and its effect on women, and doing so on the job. Some avoid public disclosure, feeling it is best to be discreet. They are concerned that knowledge of their condition may he used against them, that is, used as a reason to bold them hack from greater responsibility and promotions.

Other women fed that having endometriosis is not a stigmatizing factor and that a calm, honest, and educational approach will not hinder their career advancement. These women are bolder about their approach to the disease. They may disseminate information about endometriosis, or post notices of discussion groups to alert women to what they can do for themselves and for others, too. Knowing they do not have to keep silent about their condition and finding even one other woman at work who shares their problem gives them a psychological boost and an important sense of supportiveness. The action you do or do not take at work will depend entirely on the kind of job you have and the general tone of your workplace. You will know best what to do in this case.

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Both hair and nails are derived from the epidermis, and both consist of the same dead tissue—the protein, keratin. Because of their derivation from the epidermis it is not surprising that diseases affecting the skin may affect the hair and nails as well. In addition, there are a number of disorders which are peculiar to the hair (including the scalp) and nails.

Dandruff is the commonest condition of the scalp for which treatment is sought. It is not however a disease. It is simply a physiological state which has been elevated to the status of a ‘disease’ solely on cosmetic grounds. Basically dandruff consists of normal, dead skin cells which have been shed only to become trapped among the hairs of the scalp or in the oily sebum film. It is most common after puberty and is absent on the bald scalp. If it occurs in excess, it may appear in other hair-bearing areas and is then called seborrhoeic dermatitis. Occasionally psoriasis is mistaken for severe dandruff, and so if what appears to be dandruff does not respond to simple measures, a doctor should be consulted. Dandruff is not an infection, nor has it any relationship with hair loss. Usually dandruff may be satisfactorily controlled by the use of shampoos containing tar, selenium disulphide, or zinc pyrithione, all of which act by reducing the rate of normal skin shedding (turnover rate). Sometimes salicylic acid or corticosteroid creams are required intermittently to control the condition. From the plethora of proprietary preparations sold over the counter it is obvious that dandruff concerns people, and that there is no one preparation which suits all sufferers.

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The modem focus of eating plans for sustainable fat loss is a decrease in total dietary fat and an increase in the proportion of complex carbohydrates, followed in importance by a decrease in total energy intake. When assessing diet plans, these basic criteria need to be kept in mind. It is also important for health professionals providing advice to those seeking fat loss to know just how this is best achieved and to have an understanding of how popular diet plans manipulate the facts. The following is a review of some general diet plans.

Very low-energy diets. These are often available through clinics, where the diet supervisor (usually someone untrained in nutrition) provides some monitoring designed by a medical practitioner. These diets usually provide a formula feed of less than 800kcal/day, which is less than the usual range needed for the resting metabolic rates of most adults. The physiological effects of these diets are less than for fasting, but still carry risks and require medical supervision. The low-carbohydrate content of the formula stimulates the production of ketones which are thought to be responsible for the appetite suppression experienced. The hunger is intense upon reinstating carbohydrate in the diet. These diets should only be administered to morbidly obese people fulfilling strict selection criteria and within the context of a long term management plan.

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If you picture the uterus as an organ that is essentially static in the abdomen, think again. The combination of elastic tissue and muscle in the supporting ligaments of the uterus is organised to enable rapid adjustment to the altered position and size of its neighbouring organs, the bladder, bowel and vagina. When the bladder or rectum is full, the uterus moves accordingly. In addition, the uterus lifts out of the way with the entry of the penis into the vagina during sexual intercourse. In this position, the uterus may contract during orgasm. When a woman lies on her back, the uterus hugs the rear of the pelvis; if she rolls onto her stomach, it moves towards her belly button; and when she stands, the uterus drops down a centimetre or two, a movement that is accentuated if she has a prolapse and the ligaments do not provide strong support for the uterus.

Displacement of the uterus also occurs if there is a lump or growth in a neighbouring organ. For example, a lump in the vagina pushes the uterus upwards. On the other hand, if there is a growth in the bowel the uterus is pushed forwards, and in the bladder, backwards. The uterus is also able to rotate around the point where the cervix meets the rest of the body. A forwards rotation is called anteversion, and a backwards rotation, retroversion. Some women find these movements uncomfortable if they occur during sexual activity or when a doctor is examining their uterus to see if its ability to move is restricted in any way. In most cases women are largely unaware of these movements, although they may account for some of the pelvic ‘twinges’ or abdominal pain that is sometimes experienced.

For the uterus to contract successfully—which occurs during menstrual bleeds, childbirth and, in perhaps a third of women, during orgasm — the muscle tissue of the uterus and of the surrounding ligaments must work harmoniously. Women do not have conscious control over these contractions; this is exercised by nerves and hormones. Some aspects of uterine function are under dual control of both hormones and nerves, while others are influenced mainly by one or the other.

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Another possible explanation of why we need to sleep is perhaps a psychological one. When we are sleeping, we all dream. Dreaming has a restorative function. We act out and experience some of our frustrations and anger during dreams. When we wake up the next morning, we have forgotten our dreams. This forgetting is important, as it allows us to forget our frustration and anger at the same time. Dreams are like a psychological filter, filtering out the worries that accumulate during the day. Sleep laboratories have demonstrated that when we are dreaming all the big muscles of the body are totally relaxed. This may be the only time that the body muscles are ever completely relaxed.

Another recent discovery in dream study is the occurrence of a male erection, which is discussed in chapter 8 on Sex and Dreams. It has been observed that whenever a man dreams his penis is erect, no matter what sort of dream he is having. This dream erection occurs in all age groups and this to be important for the proper development of the penis. Hence, at least for men, dreams are very important.

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This is one of the most common causes of anxiety in women of childbearing age. The unmarried woman who has let herself be led into a foolish sexual experience without proper contraceptive precautions inevitably experiences severe tension. Her anxiety is often sufficient to inhibit her next menstrual period. She sees this as proof that her worst fears are confirmed, and desperation and self-loathing may easily drive her into precipitate action.

The married woman who fears pregnancy usually says that she does so because it would be financially embarrassing or would interfere too much with her social life. However, on close questioning it frequently turns out that there is much more to it than this, and that the fear is really based on a deep-seated fear of childbirth which developed when she was a girl as a result of foolish talk on the part of her mother or elder sister. That this fear is in fact neurotic is shown by the fact that these women are in no way reassured by completely adequate contraceptive measures, and their intimate life with their husband leaves them cold and in constant tension.

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People with recurrent depressions can be divided into unipolar and bipolar categories. Those with recurrent unipolar depressions suffer only from periods of low mood, separated from one another by normal periods. In contrast, those with bipolar depression experience periods of exaggerated energy and activation as well as depressions. During their activated periods, known as manic or hypomanic (less than manic) episodes, these individuals need less sleep, think and talk more quickly and are more sped-up than normal. Sometimes they are elated but at other times quite irritable and angry, especially when they feel blocked, frustrated or thwarted by those around them, who appear to them to be moving at a snail’s pace. The question here is whether a bipolar person can safely use St John’s Wort during a period of depression.

Unfortunately there are as yet no published studies on the use of St John’s Wort in the treatment of bipolar depressions. We do, however, know two important facts about the treatment of bipolar depression with other anti-depressants: (1) All anti-depressants that work in the treatment of unipolar depression also work for bipolar depression; and (2) All anti-depressants are capable of inducing hypomanic or manic episodes in patients with bipolar depression. Based on these observations, I would expect St John’s Wort to be an effective anti-depressant in bipolar depressions. I would also caution anyone with a tendency to develop hypomanic or manic symptoms to be sure to use the herbal antidepressant only under the close supervision of a doctor, and on no account to experiment with its use on your own. In addition, in most bipolar patients it is customary to use a mood stabilizer such as lithium carbonate or valproic acid before adding an antidepressant, to guard against the development of a hypomanic or manic episode. For those of you who are wondering why one should be so careful to prevent the development of a hypomanic or manic episode, I should mention that they can be extremely disruptive and destructive to a person’s life. Even though a mild hypomanic episode may not be harmful, when the process reaches its extremes it can cause the breakup of a marriage, the loss of a job, serious financial reversals and physical injury to the affected person.

I should emphasize that, to my knowledge, there has not been a single report to date of a manic episode induced by St John’s Wort and that there is no greater reason to be concerned about the herbal remedy in this regard than about any other effective anti-depressant. Even so, it is good to be aware of the potential risk, especially if you have a history of hypomania or mania. One of my patients who has experienced recurrent depressions and mild hypomanias in the past is on a maintenance dose of lithium carbonate to stabilize his moods. When he developed a mild depression I started him on 600 mg of St John’s Wort per day. A week later he rang me to say that he was feeling ‘too good’ and waking up in the early hours of the morning. I interpreted this as possible evidence of hypomania and suggested that he cut back to 300 mg a day, which turned out to be just the right amount for him. Once you are aware of the possibility that hypomania can develop with the use of any anti-depressant, you are forewarned

and better able to deal with the symptoms should they arise.

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The pathways of chemical metabolism in the newborn are very unstable and vast changes in the serum concentrations of various substances can occur. A blood glucose concentration sufficiently low (hypoglycaemia) to cause seizures, for example, cannot be induced in older children or adults by starvation, or indeed by any means other than the injection of insulin. However, severe hypoglycaemia resulting in seizures may be seen in the newborn, particularly in premature infants, or in babies born to diabetic mothers.

Seizures due to a low serum calcium are also fairly frequent in the newborn period. One cause is early feeding with cow’s milk, which is very rich in phosphates, and which results in increased renal excretion of calcium and subsequent low levels of calcium in the blood.

In later stages of life, other acquired metabolic disorders may cause seizures. Chronic renal failure used to be one of the more common causes, but dialysis and successful transplantation of kidneys has reduced the frequency of seizures due to this cause.

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