A Simple Guide to Cerebral aneurysm

A Simple Guide to Cerebral aneurysm

---------------------------------------------

What is Cerebral aneurysm?

-----------------------------------

A cerebral aneurysm is an abnormal ballooning of a section of a blood vessel in the brain.

What is the causes of cerebral aneurysm?

--------------------------------------------------

Cerebral aneurysms occur when there is a weakened area in the wall of a blood vessel in the brain.

1.They may occur as a congenital (before birth) defect or may develop later in life.

About 5% of the population has some form of aneurysm in the brain.

2.Trauma and infection, which can injure the blood vessel wall, can cause such aneurysms.

What are the Symptoms of cerebral aneurysm?

---------------------------------------------------------

Cerebral aneurysm usually cause no symptoms until they rupture and cause bleeding into the brain.

Often, an aneurysm is found when a CT scan or MRI is performed for another reason. If the unruptured swollen aneurysm presses on the brain , it can cause the following symptoms:
1.Headaches

2.Eye pain

3.Neck pain

4.Double vision

5.Loss of vision

Symptoms of an aneurysm that have ruptured are:
1.Sudden occurrence of a severe headache (often described as "worst headache of my life")

2.Headaches with nausea or vomiting

3.Stiff neck

4.Muscle weakness, difficulty moving any part of the body

5.Numbness or decreased sensation in any part of the body

6.Vision changes like blurring of vision,double vision

7.Eyelid drooping

8.Confusion,

9. Sudden onset of irritability, impulsivity, or poor temper control

10.Slow, sluggish movement

11.Speech impairment

12.Seizures

A ruptured aneurysm is a medical emergency.

What are the investigations done in cerebral aneurysm?

------------------------------------------------------------------

The following tests may be used to diagnose cerebral aneurysm:

1.CT scan of the head can identify bleeding and usually locate the aneurysm.

2.MRI of the head may be an alternative to a CT scan but may be as good at showing bleeding in the brain.

3.Cerebral angiography or spiral CT scan angiography of the head is used to pinpoint the location and size of the aneurysm.

4.cerebrospinal fluid examination via a spinal tap may confirm bleeding.

5.EEG (electroencephalogram) should be performed if there are seizures.

What is the Treatment of cerebral aneurysm?

--------------------------------------------------------

Symptoms often do not appear until bleeding of a cerebral aneurysm occurs.

A ruptured cerebral aneurysm is an emergency condition.

The goal of treatment is to prevent further bleeding.

Lowering of blood pressure can decrease the risk of further bleeding.

Neurosurgery is the primary treatment for cerebral aneurysm.

The base of the aneurysm is closed off with clamps or sutures.

Special coils or stents can be placed into the aneurysm through the arteries to prevent rupture.
A blood clot then forms in the aneurysm and prevents further bleeding. This is considered a less invasive approach than brain surgery. It is regarded as the best form of treatment.

If surgery is not feasible because of the location or size of the aneurysm or the condition of the person, medical treatment is:

1.restricting activity (often complete bedrest is advised),

2.treating symptoms such as headache,

3.controlling blood pressure, and

4.prescribing of antiseizure medications.

After the aneurysm is repaired, prevention of stroke due to blood vessel spasm is necessary. This may include intravenous fluids, certain medications, and controlling the blood pressure.

What is the Prognosis of cerebral aneurysm?

-----------------------------------------------------

The prognosis depends on the severity of the condition.
Ruptured cerebral aneurysms are often serious.

In severe cases, about 25% of people die within 1 day, and another 25% die within about 3 months. Of those who survive, more than half will have some sort of permanent disability.

In small leaks of ruptured cerebral aneurysm, early treatment of the condition can be very effective with little loss of neurological deficit.

Unruptured aneurysms can be treated very effectively before causing problems.

The decision to repair an unruptured cerebral aneurysm is based on the size and location of the aneurysm, and the patient's age and general health.

What are the Possible Complications of cerebral aneurysm?

----------------------------------------------------------------------
1.Subarachnoid hemorrhage

2.Stroke

3.Seizures, epilepsy

4.Paralysis of any part of the body

5.Permanent loss of sensation of any part of the face or body

6.Other neurologic deficits (such as vision changes, loss of speech ability, cognitive decline)

What is the Prevention of cerebral aneurysm?

---------------------------------------------------------

There is no known way to prevent the formation of a cerebral aneurysm because most of them are congenital.

If sudden or severe headache occurs, particularly if you also have nausea, vomiting, seizures, or any other neurological symptoms, early admission to hospital and appropriate investigation can detect an unruptured aneurym or one which has just started to bleed.

Treatment can be initiated and prognosis is good.

A Simple Guide to Genital Herpes

A Simple Guide to Genital Herpes
----------------------------------------
What is Genital Herpes?
-----------------------------

Genital herpes is a sexually transmitted disease caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2).
Most genital herpes is caused by HSV-2.
Incubation peroid is 14 days to several weeks.

What are the symptoms of Genital Herpes?
--------------------------------------------------

Most infected patients do not have any signs or symptoms from Genital herpes infection.
In the male, small blisters occur on the penis glans and on both of the scrotums.
If the urethra is involved. there may be discharge and pain on urination.

In the female, there may be one or more blisters on or around the genitals or rectum. The blisters normally break, leaving painful ulcers which may take two to four weeks to heal.

Typically, recurrence of the blisters may appear weeks or months after the first and is usually less severe and shorter than the first outbreak.

The infection can stay in the body indefinitely with the number of outbreaks decreasing over a period of years.

How is Genital Herpes spread?
-------------------------------------

Genital herpes is usaully a sexually transmitted disease.
Genital HSV-2 infection is more common in women (25%) than in men (20%).
This may be due to male-to-female transmissions.

HSV-1 and HSV-2 viruses can be found in and released from the blisters and ulcers that the viruses cause.
They also are released between outbreaks from skin that does not appear to be broken or to have a sore.
Transmission can occur from an infected partner who does not have a visible sore and may not know that he or she is infected.

HSV-1 can also cause genital herpes.
It however causes more infections of the mouth and lips, so-called "cold sores."
HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person who has HSV-1 infection.
Genital HSV-1 outbreaks does not recur as often as genital HSV-2 outbreaks.

How do you diagnose Genital Herpes?
--------------------------------------------

The signs and symptoms of HSV-2 infection may be none to obvious.
Doctors can diagnose genital herpes by visual examination if the outbreak is typical and by taking a sample from the sores and testing it in a laboratory.
HSV infections can be difficult to diagnose between outbreaks.

The best way to confirm the presence of Genital herpes is to do a blood test for HSV1 and HSV2 viruses. The results however may not 100% accurate.
Most people infected with genital herpes do not know of their infection.

Once the virus is transmitted, an outbreak usually occurs within two weeks and the sores typically heal within two to four weeks.
During the primary episode, signs and symptoms may include a second episode of sores and sometimes fever and swollen glands.
Most individuals with HSV-2 infection do not have sores, or the sores may be so mild that they do not even notice.

Most people diagnosed with a first episode of genital herpes can expect to have several symptomatic recurrences within a year.
Usually these recurrences decrease in frequency.

What is the treatment of Genital Herpes?
-------------------------------------------------

There is no treatment that can cure herpes but antiviral medications like acyclovir can shorten and prevent outbreaks during the period of time the person takes the medication.
In addition the medications can reduce transmission to partners.

How do you prevent Genital Herpes?
-------------------------------------------

1.abstainance from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected from genital herpes.

2.protection using a latex condom during sexual contact. However since a condom may not cover all infected areas, even correct and consistent use of latex condoms cannot guarantee protection from genital herpes.

3.Persons with herpes should abstain from sexual activity with uninfected partners.
This is a very important moral responsibility.
Sex partners of infected persons should be advised that they may become infected.

Sex partners can seek testing to determine if they are infected with HSV.
A positive HSV-2 blood test most likely indicates a genital herpes infection.

What are the Complications of Genital herpes?
--------------------------------------------------------

1.In some cases, genital herpes can cause recurrent painful genital sores in many adults.

2.Herpes infection can be severe in people with suppressed immune systems eg. HIV.

3.psychological distress may occur in people who know they are infected because the herpes is not curable.

4.genital HSV can cause potentially fatal infections in babies.
If a woman has active genital herpes at delivery, a cesarean delivery is usually performed.
Infection of a baby from a woman with herpes infection fortunately is rare.

5.Herpes may play a role in the spread of HIV the virus that causes AIDS. Herpes can make people more susceptible to HIV infection, and it can make HIV-infected individuals more infectious to others.

A Simple Guide to Hepatitis A

A Simple Guide to Hepatitis A
-----------------------------------

What is Hepatitis A?
-------------------------

Hepatitis A is a acute inflammatory infection of the liver which is caused by the hepatitis A virus(HAV).

How is Hepatitis A virus spread?
--------------------------------------

The virus is excreted in faeces and transmitted through contaminated food and water. Eating shellfish, cockle shells, prawns or crabs taken from sewage-contaminated water is a common means of contracting hepatitis A.
It can also be acquired by close contact with individuals infected with the virus.
HAV causes the liver to become enlarged, inflamed and tender resulting in all the symptoms of hepatitis.
There is no chronic (long-term) infection.

What are the Symptoms of Hepatitis A?
----------------------------------------------

A person is infectious for 2-3 weeks before he or she experiences symptoms:
1.fever and joint pains

2.jaundice

3.fatigue

4.loss of appetite

5.nausea and vomiting

6.abdominal pain

7.pale coloured stools and dark urine

8.itchy skin due to irritation by the bilirubin.

During the first week of the illness he feels very sick and weak.
As the condition improves, the patient generally feels better after the first week but may requires to rest at home for 6 weeks to avoid damage to the liver.

How is the diagnosis of Hepatitis A made?
-------------------------------------------------

A blood test is the best way to diagnose hepatitis A.
His hepatitis antigens are raised at the early stage but as his condition improves the antibodies become positive.

His liver function tests are also done to assess the damage to the liver.
Usually the serum bilirubin is high, liver enzymes or tramsaminase, alkaline phosphatase are raised in the acute stage of illness.
As the condition improves, these tests gradually returned to normal.

What is the Treatment of Hepatitis A?
---------------------------------------------

There are no medicines for treatment of Hepatitis A except for symptomatic treatment of symptoms.
1.Rest in bed

2.multivitamins especially vitamin B to improve the function of the liver

3.Lots of fluids

4.carbohydrate diet

5.Anti-itch creams and lotions to stop itch

Recovery is usual with very rare cases going on to cirrhosis of the liver.

What is the Prevention of Hepatitis A?
---------------------------------------------

Hepatitis A vaccination is the best protection.
It is usually given in 2 doses within 1 year.

Immune globulin can be given for short-term protection.
It is given before and within 2 weeks after coming in contact with hepatitis A virus.

The vaccine is recommended for travellers travelling to developing countries and people with chronic liver disease.

Always practice good food hygiene.
Avoid food like seafood which may be contaminated by unhygienic water.

Always wash your hands with soap and water after using the toilet, before preparing and eating food.

Recovery is usual within 6 weeks.

What is the difference between Hepatitis A and Hepatitis B?
----------------------------------------------------------------------

Hepatitis A is spread through eating food contaminated with the HAV virus.
Examples include partially cooked shellfish (oysters, clams) or in situations where there is poor hygiene (food/drink/utensils contaminated with an infected person's faeces).
Most people suffer an acute episode and upon recovery have immunity to Hepatitis A.

Hepatitis B is spread by contact with blood or body/fluids of an infected person (including a carrier) or from a carrier mother to her newborn during childbirth.
Hepatitis B infection can lead to hepatitis carrier stage or chronic hepatitis which can results in liver cirrhosis or cancer.

A Simple Guide to Hepatitis B

A Simple Guide to Hepatitis B
------------------------------------

What is Hepatitis B?-
-------------------------
Hepatitis B is a serious chronic inflammatory liver disease caused by a virus which is called hepatitis B virus (HBV).

What are the Symptoms of Hepatitis B?
----------------------------------------------

Most of the time a person with HBV infection has no symptoms at all.
Older people are more likely to have symptoms.

If you have symptoms, they might include :
1.jaundice (yellowing of the skin and white of eye)

2.dark coloured urine

3.pale stools

4.prolonged tiredness

5.nausea and vomiting.

6.loss of appetite

7.abdominal pain

8.fever and joint pains

How is the diagnosis of Hepatitis made?
-----------------------------------------------

A blood test is the only way to diagnose hepatitis B.
You may be infected with HBV and may even spread it to others without knowing it.

HBV can be spread from an infected mother to her infant during birth.
To prevent spread of HBV from infected mothers to their infants, every woman should have her blood tested for hepatitis B surface antigen (HBsAg) during each pregnancy.

What is the treatment of Hepatitis B?
-------------------------------------------

There are no medications available for recently acquired (acute) HBV infection. There are antiviral drugs eg interferon which may be able to treat chronic HBV infection.

Who is at risk of getting Hepatitis B?
-------------------------------------------

For those who has never been immunised or do not have antibodies from having a previous Hepatitis B infection, you are at risk of Hepatitis B infection.

The Hepatitis B virus is is not spread through food or water, sharing eating utensils, breastfeeding, hugging, coughing, sneezing, or skin contact.

HBV is spread by exposure to infected blood from skin puncture or contact with mucous membranes.

It is spread by:
1.sexual contact with an infected person

2.an infected mother to her newborn during childbirth

3.a Hepatitis B infected person's blood during blood transfusion

4.sharing of injection needles among drug abusers

5.accidental cuts to the skin by a nail clipper, shaving blade or other instruments that are contaminated with a Hepatitis B infected person's blood

6.contact with an infected person's saliva or blood through cuts or sores in the mouth or skin. Kissing by itself do not spread HBV unless there is a cut in the lips.

7.during acupuncture, body or ear piercing and tattooing if the needles used are contaminated with Hepatitis B infected person's blood

8.have a job that involves contact with human blood or body fluids

What is the best prevention for Hepatitis B?
----------------------------------------------------

Hepatitis B vaccine is the best prevention against hepatitis B.
If you do not have antibodies from a previous infection and if you are not a Hepatitis B carrier, you can get vaccinated against Hepatitis B and protect yourself from its complications.
Hepatitis B vaccine is recommended for all infants, for children and adolescents who were not vaccinated as infants, and for all unvaccinated adults who are at risk for HBV infection as well as any adult who wants to be protected against HBV infection.
The vaccine is safe.
It is also extremely effective provided you complete all 3 doses:
1st dose - at the appointed date
2nd dose - 1 month after the 1st dose
3rd dose - 5 months after the 2nd dose
A booster vaccination may be necessary after 5 years if the blood test showed a drop in immunity.

Infants born to infected mothers need to get hepatitis B vaccine and another shot call HBIG (hepatitis B immune globulin) soon after birth to prevent infection.

Besides vaccination, other ways to prevent transmission of HBV are:
1.avoid multiple sexual partners; keep to one sexual partner

2.Latex condoms, when used consistently and correctly, may reduce the risk of sexually transmitted HBV transmission.

3.Do not inject illegal drugs. Never share needles, syringes or drugs.

4.Do not share personal items like razors, toothbrushes or any other instruments that may cause tears to the skin and hence spread of any blood borne infection.

5.seek reliable operators for ear or body piercing, tattooing or acupuncture.

What happens if I am a Hepatitis B carrier?
--------------------------------------------------

A simple blood test can tell if you are a carrier, are immune or need immunisation.
If you are found to be a carrier, then:
1.you will need to see your doctor every 6 months to a year for tests to check your liver function and blood alpha-foetoprotein which is a cancer marker for liver cancer

2.your immediate family members should go for blood tests.
They should get immunised if they are not immune.
If they are carriers too, they should go for regular follow up with the doctor.

3.you should take precautions to prevent the spread of hepatitis B to your family and loved ones

4.you should avoid smoking and drinking alcohol as they may further increase the risk of damage to your liver

5.inform your doctor and dentist that you are a carrier

6.do not donate blood, organs or sperm

7.know the symptoms and signs of the various complications and see your doctor at once if you experience any of them.

What are the Complications of Hepatitis B ?
---------------------------------------------------

Hepatitis B can lead to complications like:
1.acute hepatitis (episode of liver inflammation)

2.chronic hepatitis (permanent liver inflammation)

3.liver cirrhosis (permanent scarring and hardening of the liver)

4.liver failure (liver is unable to function,
resulting in toxins accumulating in body)

5.liver cancer

Those who recover completely from Hepatitis B infection become immune to the disease.
1 in 10 people who get infected with the virus become carriers who then carries the Hepatitis B virus permanently in his body.

Hepatitis B carriers seldom show any symptoms but they can:

1.spread the disease to others
2.develop serious liver complications such as those mentioned above.

About 15%-25% of people with chronic HBV infection die prematurely from these complications.

A Simple Guide to Hand, Foot & Mouth Disease

A Simple Guide to Hand, Foot and Mouth Disease
----------------------------------------------------------

What is Hand, Foot and Mouth Disease?
-----------------------------------------------

Hand, Foot and Mouth Disease (HFMD) is an infectious disease usually occurring in children which causes ulcers in the mouth and maculopapular rashes(sometimes blisters) on the palms of the hands and soles of the feet.
Because of the locations of the lesions, the illness is thus called Hand, Foot and Mouth Disease.

What causes Hand, Foot and Mouth Disease?
--------------------------------------------------

Hand, Foot and Mouth Disease is caused by the Coxsackie virus and Enterovirus 71.
Of the 2 viruses the enterovirus is more dangerous with some fatalities in severe cases.
Fatalities are usually due to complications involving the heart and nervous system.
It is usually a mild illness with the rash healing in 5 to 7 days.

How is Hand, Foot and Mouth Disease spread?
----------------------------------------------------

HFMD is usually spread through the direct contact with the nasal discharge, saliva, faeces and fluid from the rash of an infected person.

Both adults and children can be affected.

Young children below five years are more prone to the infection.

What are the Symptoms of Hand, Foot and Mouth Disease?
------------------------------------------------------------------

The symptoms usually start after a prodromal peroid of 3 days with:

1.fever

2.sore throat

3.ulcers in the throat, mouth and tongue

4.rash with vesicles (small blisters-- 3-7 mm) on hands, feet and buttock area.
The rash are typically on the palm side of the hands, the sole side of the feet and very characteristic (maculopapular then vesicle) in appearance.

5.loss of appetite

6.headache and bodyaches in the older child or adult

What is the Treatment of Hand, Foot and Mouth Disease?
-------------------------------------------------------------------

There is no specific cure for an viral infection other than symptomatic relief of symptoms.

Antibiotics is not effective and is not indicated.
Paracetamol can given to treat fever.

Drinking lots of water and fluids is important even though sometimes swallowing may be painful.
More fluid is required when a fever is present.

Rinsing of mouth with salt water may soothe the pain of mouth ulcers.

A soft or liquid diet should be given rather than solid food.

Avoid sour fruits or their juices which can cause pain to the mouth ulcers.

Rest and adequate sleep is also important in the child's recovery.

Parents should also be alert to any change in their child's normal behaviour, e.g. irritation and sleepiness.
Should they refuse to eat or drink, have persistent vomiting or drowsiness, parents should bring their child immediately to hospital.

What is the Prevention for Hand, Foot and Mouth Disease?
--------------------------------------------------------------------

All infected children should be kept away from crowded public places (such as schools, preschools, play groups, markets and public transport).

All family members should follow good hygiene practices, including frequent hand washing, to limit the spread of the infection.

A Single Attack usually gives lifelong Immunity!

A Simple Guide to Fever

A Simple Guide to Fever
-----------------------------

What is Fever?
-----------------

A person's normal body temperature is 37.0 degrees Celsius.
Once above this, it is classified as a fever.
Fever is a symptom not an illness.

What is the cause of Fever?
---------------------------------

A Person's body temperature can be influenced by factors such as
1. infection,

2. metabolic rate and

3.environmental temperature.

When any infection entered the body and localised in a part of the body such as the throat ,intestine, nose, urinary tract etc, it does not cause any fever, only symptoms such as sore throat, diarrhoea, nasal discharge or frequent passing of urine.

However once the germ(whether bacteria,virus or parasite) enter the blood stream from the infected area, the body responses immediately by raising the body temperature.
The raising of the body temperature is the body's way of trying to kill the germ by heating the environment which the germ is trying to survive.

High fevers (above 39 degrees Celsius) however can also damage the body especially the brain.
It can cause seizures in children below the age of five (febrile fits).

Toxins from bacteria and viruses released into the bloodstream can cause chills and shivering in between or sometimes during temperature spikes.

What are the Symptoms of Fever?
----------------------------------------

1. Headache

2. Bodyaches

3. Chills

4. Shivering

5. Giddiness

6. Loss of appetite

What is the Treatment of Fever?
--------------------------------------

Fever is the body's natural response to a infection, increase in the temperature of the environment and increased metabolic rate.

If the fever is mild (<37.5)and no other problems are present, no medical treatment is necessary.
Just drink more water and rest.

Sponging or bathing in a tub of tepid water can help to reduce the fever. Evaporation of the water cools the skin and thereby reduces body temperature.

Give the person a correct amount of paracetamol which helps to bring down the temperature.

You should see a doctor:
1.If a child of less than 6 months old has a fever.

2.If a fever of more than 39 Degree Celsius cannot be brought down by paracetamol and sponging.

3.If fever lasts for more than 5 days.

4.If there is associated stiff neck and vomiting

5.If there is drowsiness or loss of consciousness

Once the cause of the fever is found and eliminated, the body temperature will reduce spontaneously back to normal.

A Simple Guide to Headache

A Simple Guide to Headache

---------------------------------

What is Headache?

----------------------

Headache is a very common complaint, not an illness.

It literally means pain in the head.

What are the Common Types of Headaches?

--------------------------------------------------

Tension headache:

-----------------

as defined by the International Headache Society is characterised by:

1.bilateral location

2.pressing/tightening (non-pulsating) quality

3. mild to moderate in intensity

4. not aggravated by routine physical activity like walking or climbing stairs.

It is the most common headache and may be associated with contractions of head and neck muscles due to physical or mental stress. The headache is made worse by changes in the environment, drugs, or factors unique to the individual.

It can also be classified into 2 side types:

episodic (<>

chronic (> 14 days a month on average and <>

Treatment can be divided into:

pharmaceutical

non pharmaceutical

Pharmaceutial:

can be divided into acute and prophylactic.

In acute treament simple painkillers is usually effective.

In prophylactive treatment,antidepressants like amitriptyline usually help in the prevention of tension headache.

Medicines should always be given at low doses and titrated up to therapeutic doses to minimise side effects.

Non-pharmaceutical:
1. rest

2. removal of aggravating factors.

3. relaxation exercises

Migraine:

-----------

is defined as a heavy throbbing pain usually over one side of the scalp, forehead and about the eye, caused by abnormally dilated blood vessels.

Migraine may be accompanied by nausea, vomiting or sensitivity to loud noises or bright lights.

It is also triggered by certain factors unique to the individual such as:

1.menstruation,

2.alcohol,

3.anxiety,

4.loud noises,

5.bright lights

A validated 3 items questionaire covering

1. disability

2. nausea

3. sensitivity to lights

should given to every patient to screen the severity of the migraine.

Treatment again is divided into:

phamaceutical

non-pharmaceutical.

Pharmacetical:

can be divided into acute and prophylactic.

In acute treament simple painkillers like paracetamol is usually effective in mild cases.

Non-steroidal anti-inflamatory drugs should be tried if paracetamol fails.

If NSAIDs are ineffective then migraine-specific drugs like triptans or ergotamine which act to constrict blood vessel should be tried.

In some cases anti-emetic drugs like stemetil to prevent vomiting is given together with the migraine medication.

In prophylactic treatment, the goals are to:

1. reduce frequency,severity and duration

2.improve function and reduce disability

3.improve responsiveness to treatment of acute attacks

Medicines used include:

betablockers

Calcium channel blockers

Serotonin receptor antagonists

Antidressants

Anticonvulsants

Angiotensin blockers

NSAIDs

Non-pharmaceuticals:

1.resting in a cool, dark and quiet room.

2.relaxation exercises

3.Solving the triggering factors also help.

4.Oestogen containing oral cotraceptives should avoided in menstrual migraine.

During pregnancy or lactation treatment should be non-pharmaceutical when possible. If necessary paracetamol is the safest drug for women during pregnancy or lactation.

Cluster headaches

----------------------

is defined as pain which occurs in runs with tearing pain over the forehead or behind the eye(s) with flushing of the face.

There are aura of stars,flashing lights etc associated with this headache.

The cause is beleived to be due to histamine release from ingestion of certain foods like cheese, seafood,alcohol etc.

It is more common in males.

Treatment is by

1.strong painkillers

2.avoidance of food triggers

3.rest.

What are Secondary headaches?

---------------------------------------

Secondary headaches refer to headaches associated with a known medical illness.

It is diagnosed by its close relation to a disorder that is known to cause headache.

The headache improves or disappear after successful treatment or spontaneous resolution of the causative illness.
1.Sinus headaches:

----------------------

are due to acute sinus inflammation attacks.

Pain is over the frontal forehead and the upper cheeks.

It may be associated with fever and heavy mucus production.

Treatment is by

1.antibiotics for the sinus infection,

2.antihistamines to reduce mucus production

3.painkillers

4.rest.

2.Referred headaches:

---------------------------

these are caused by by referred pain from disorders of structures around the head. Common ones are

1. earaches,

2. toothache causing pain over an entire part of the face and

3. temporomandibular joint dysfunction from mechanical pain from the jaw joint.

4. temporal arteritis, a rare inflammatory blood vessel condition causing persistent headache at the temporal artery. There is possible complication of blindness secondary to anterior ischemic optic neuropathy. The headache usually resolves or improves with 3 days of high dose steroid treatment.

3.Meningitis / Encephalitis headaches:

---------------------------------------------

caused by infection of the brain tissue (encephalitis) or the membranes surrounding the brain (meningitis).

Headache is the most common symptom. The pain is diffuse and progressive with fever, a painful stiff neck and other symptoms such as drowsiness, seizures and neurological problems including weakness and numbness.

This type of headache needs immediate hospital treatment.

4.Cerebrovascular Accidents (haemorrhagic stroke):

-------------------------------------------------------------

a stroke happens when a blood vessel in the brain is blocked or bursts.

Bleeding in the brain causes a sudden severe headache.

There is also associated loss of consciousness and other neurological signs such as weakness, numbness and seizures.

This type of headache needs immediate hospital treatment.

5.Brain Tumour:

------------------

is rare and causes a gradual headache lasting for weeks.

It is localised and associated with nausea, vomiting, loss of appetite and loss of weight.

It is worse in the morning and aggravated by coughing or leaning forward.

By the time neurological symptoms appear such as seizures, numbness, weakness or blindness, the brain tumour has already grown to an advanced stage.

Treatment includes surgery, chemotherapy or radiotherapy.

6. Other causes of secondary headaches are:

a.post traumatic headache following a head injury

b.whiplash injury

c.cerebral venous thrombosis

d. idiopathic intracranial hypertension

e. hydrocephalus

f. sleep apnea

g.cardiac cephalgia

h.acute glaucoma

Simple Treatment of Headache

-------------------------------------

Consume a painkiller.

Lie down in a dark, quiet room.

Use muscle relaxation techniques or a gentle massage.

For tension headaches, try a warm bath.

For migraines, put an ice bag or cold towel on your temple.

If the headache do not improve, go for a complete investigation of the headache.

What are the investigations done in Headache?

-------------------------------------------------------

You should be investigated for your headache if the headache has:

1. associated fever and and change in mental state.

2. numbness of part of the body or with paralysis.

3. associated fits.

4. sudden onset of severe headache

5. lasted for more than a day even after taking painkillers.

6. increased headache frequency.

7. appeared different from your usual type

8. been precipitated by coughing,sneezing,bending

9. associated with stiff neck and vomiting

10.appeared for the first time in middle age

Common tests:

Blood tests - for infections,raised ESR, bleeding disease

MRI of brain- to exclude brain tumours, bleeding in the brain

Lumbar puncture - used only if there is suspected infection of brain or meninges

A Simple Guide to Depression

A Simple Guide to Depression
-----------------------------------

What is Depression?
------------------------

Depression is a very common mental ilness with an alteration of mood which exceeds normal sadness.

How common is Depression?
----------------------------------

Everyone has felt sad at one time or another.
It may be due to a disappointment, frustration or losing someone.
But time heals, the mood lifts and people continue to get on with their lives.
In some people, depression can be so severe that it dominates their lives, preventing them from living their lives as they used to.
Depression of this degree is a medical illness and needs treatment.

What Are The Types Of Depression?
------------------------------------------

1.Major depression is manifested by a combination of symptoms that affect our work, interests and feelings towards family and friends.
These disabling episodes can occur twice or several times in a lifetime.

2.Dysthymia is a less severe type of depression.
People with dysthymia have long-term depressive symptoms and it prevents them from functioning at an optimal level.

What Are The Causes Of Depression?
--------------------------------------------

1.hereditary or genetic factors in the transmission of depressive disorders.
In some families, major depression seems to occur generation after generation.

2.biological component in depression.
It may be associated with having too little or too much chemicals in the brain.

3. medications have mood altering properties.
Some medication act by altering the biochemical imbalances in the brain causing depression.

4. Life events such as loss of a job, retirement, divorce, death of a loved one or moving to a new house can precipitate a depressive illness.

5.Social circumstances also play a part.
If we are alone, have few or no friends, suffer from a chronic illness, then we may be more vulnerable to depression.

6. People with life threatening or long-term physical illness such as cancer, stroke, arthritis or heart disease are also more vulnerable to depression.

7. Personality may also play a part in depression. Some of us are more vulnerable than others because of the individual make-up or early life experiences.

Very often, a combination of genetic, psychological and environmental factors is involved in the onset of depression.

The good news is that whatever the cause, depression is treatable.

What are the Symptoms Of Depression?
----------------------------------------------

Certain characteristic symptoms can give you or your family a clue that you are depressed:

1.Depressed mood

2.lethargy and fatigue

3.loss of interest and enjoyment in life

4.lack of drive or motivation that makes even simple tasks or decisions difficult or impossible

5.loss of concentration

6.Loss of self confidence, avoiding people

7.Sleeplessness or excessive sleeping

8.Agitation or restlessness

9.ideas of being useless, inadequate, helpless or hopeless

10.Feeling guilty or worthless

11.Loss or gain in appetite, libido with loss or gain in weight

12.Thoughts of suicide;

These symptoms are very common in depression.
It is much better admitted to friends or relatives than to keep them hidden.

How is Depression Treated?
---------------------------------

Reassurance and support is most important in treatment of depression.

Recognition of suicide risk must be remembered when treating a depressed person.

Treatment for depression is well established.
Majority up to 90% of people with major depression have fairly good treatment outcome.

Treatment consists of
drug (antidepressant medication) and
non-drug therapy.
Usually, a combined treatment is best:
1.medication to gain relatively quick relief and
2.psychotherapy to learn more effective ways to deal with life stresses.

Antidepressant Medication
---------------------------------

All antidepressant medications are equally effective but they have different side effects.
The most often used antidepressants include tricyclics, monoamine oxidase inhibitors, lithium and selective serotonin inhibitors (SSRI).

Antidepressant medications do not begin working the day you take them but your mood will improve after one to two weeks.
However, you may notice some improvement on the first day, especially in your sleep and feeling less tense and anxious.

The medications are compatible with painkillers, antibiotics and contraceptives. However, you should avoid alcohol as the medication and alcohol combined can make you too drowsy.
Do not stop the medication once you start to feel better as you may relapse into depression again.
You should discuss this with your doctor and let him advise you when to stop.
Antidepressants like all drugs have some side effects, though these are usually mild and tend to wear off as treatment goes on.

The common side effects and their remedies are:
Dry mouth - drink more water
Constipation - eat more fruits, cereals, prunes and vegetables
Drowsiness - this will pass soon; do not drive or operate heavy machinery if feeling sedated Dizziness - rise from bed or chair slowly

Some side effects with the newer medications:
Headache - this will usually go away
Nausea and stomach discomfort - transient; take medication with food
Nervousness and insomnia - these may occur during the first few weeks, reducing the dose will usually resolve them.

Non Drug Therapy
-----------------------
Psychotherapy
Psychotherapy involves talking things through with a trained counselor or therapist.
Talking to someone who can really listen and understand you without passing judgement can be a tremendous relief.
You learn how to solve problems and cope with life stresses better.

Exercise
Exercise not only improves your health but it also gives you a sense of accomplishment. Endorphins ('feel good' hormones) are released during exercise and this can elevate your mood.

Relaxation Therapy
This involves deep breathing exercises and progressive muscle relaxation.

Support Groups
Support groups offer fellowship and you get to hear first hand accounts of how others with depression, like you, have learnt to cope.
There is also a psychoeducation group which help you learn about the depressive illness and methods of coping.

Electroconvulsive Theraphy (ECT)
ECT is only indicated for those with severe depression who have not responded to treatment or are highly suicidal.
It involves giving a light general anaesthetic and an electric current is passed through the brain for a few seconds. The whole procedure takes only about 15 minutes and the patient is only aware of having gone to sleep.

How Can You Prevent Depression ?
-----------------------------------------

1.try to talk to close friends about bad news

2. Be realistic about your goals. Do not aim too high. Set priorities and do what you can.

3. Do something - get out of the house for a walk or some exercise.
While you may not be able to work, it is always good to try to keep up with some light activities such as housework.
This will help take your mind off those painful feelings.

4. Eat a good balanced diet, even though you may not feel like eating.

5. Resist the temptation to drown your sorrows with alcohol.
Alcohol can depresses the mood, so while it may give you immediate relief by making you forget your problems, this is very temporary and you may end up more depressed.
It is also bad for your liver and general physical health.

6. Remind yourself that you are suffering from depression, something that many other people have gone through, and that you will eventually come out of it, as they do

7.Remember your appointments to see the doctor , take your medicine regularly and do not be afraid to ask for help from your friends and support groups.

A Simple Guide to Epilepsy

A Simple Guide to Epilepsy
--------------------------------

What is epilepsy?
---------------------

Epilepsy is a neurological disorder which occurs when the brain malfunctions due to sudden abnormal electrical discharge of brain cells.
If all the brain cells discharge abnormal signals at once, the epileptic fit is called a generalised fit or grand mal.
If only part of the brain is involved in discharging abnormal signals, the fit is called a partial epileptic fit.
Epilepsy is diagnosed only when there are repeated episodes of epileptic fits.

What are the types of epilepsy?
-------------------------------------

Epileptic Seizures may vary from the briefest lapses of attention(trance) or muscle jerks to severe and prolonged convulsions.
They may also vary from less than one a year to several per day.
Seizures are classified :

1.Partial or focal seizures
These seizures arise from an electric discharge of one or more localised areas of the brain regardless of whether the seizure is secondarily generalized.
They may or may not affect consciousness.
Partial seizures begin in a localized area of the brain, but then may spread to the whole brain causing a generalized seizure.

2.Generalized seizures
Generalised electrical discharge involves the whole brain.
It may cause loss of consciousness and/or muscle convulsions or stiffness.
They include what used to be known as grand mal convulsion and also the brief petit mal absence of consciousness.

3.Status epilepticus
This is a condition in which a person has very frequent seizures without recovery of consciousness between each episode.
This is a dangerous condition and if not treated may lead to brain damage or death.

What are the causes of Epilepsy?
---------------------------------------

In 70% of cases the cause is unknown.
In such cases, the theory most commonly accepted is that this epilepsy is the result of an imbalance of certain chemicals in the brain (especially chemical messengers known as neurotransmitters) causing them to have a low convulsive threshold.
Epilepsy of unknown or genetic origin are present in children and adolescents.

In the remaining cases, the causes can be found and some may be treated.

1. Brain infection can cause epilepsy at any age. Neurocysticercosis cysts on the brain caused by tapeworm infection, malaria and meningitis are common causes.

2. Febrile illness of any kind can trigger seizures in young children.
Some 3% of children who have febrile convulsions go on to develop epilepsy in later life.

3. Stroke may damage brain cells resulting in seizures.

4. Trauma and head injury may also damage brain cells resulting in seizures.

Certain flashing lights (discos, television, video games etc.), over-breathing, over-hydration, loss of sleep, and/or emotional and physical stress, may stimulate seizures.
Although these are not causes of epilepsy, they may affect the timing and frequency of seizures.

Who are at risk of Epilepsy?
---------------------------------

It occurs in men and women and can begin at any age, but is most frequently diagnosed in infancy, childhood, adolescence and old age.

What are the Symptoms of Epilepsy?
-------------------------------------------

Symptoms varies depending on the part of the brain which is functioning abnormally.

Generalised Fits
--------------------
There are several types of generalised fits.
In the classical Grand mal fit:
1.there is a sudden loss of consciousness and the person fall to the ground.
2.The eyes may roll up.
3.There is body stiffening and convulsions.
4.The tongue may be bitten during the fit
5.The urine may passed out due to loss of bladder control.
6.After the fit the body relaxes and the patient may fall into a sleep for several hours.

In the generalised Petit Mal Fit:
1. There may be a sudden absence of movement or sudden interruption of speech for a few minutes
2. This is followed by the patient picking up the speech or movement where he last stopped.
3. It can be dangerous especially while driving or doing dangerous work which require continous movements.

Partial or focal Fit
----------------------

Just as in generalised fits, there are also many types of partial fits.
In a partial fit , there may be changes to the way the person looks at things, feels, smells or taste.
In other cases there may be staring and unusual movement like hand rubbing etc.

What are the investigation for Epilepsy?
-----------------------------------------------

All suspected epileptic cases should undergo the following tests:

1. blood tests - for chemicals imbalance or poisoning
2. MRI of brain (or CAT Scan of the brain) to detect any any abnormal focal area of the brain
3. EEG of brain (which measures the brain electrical waves)

What is the Treatment of Epilepsy?
-----------------------------------------

It has been shown that 70% of newly diagnosed children and adults with epilepsy can be successfully treated (i.e, their seizures can be completely controlled for several years) with anti-epileptic drugs.
After 2-5 years of successful treatment, drugs can be withdrawn in about 70% of children and 60% of adults without relapses.

Modern drugs used for epilepsy are:
phenytoin
carbamazepine
sodium valproate

Some 30% of people may not respond to drug therapy.
A factor which leads to worse prognosis is the presence of an underlying brain disease.

Partial seizures, especially if associated with a brain disease, are more difficult to control than generalized seizures.
Surgery may be considered when the epilepsy or the brain disease poses a danger to life.

Secondary seizures- not epilepsy- such as those related to an acute, short-lasting brain disease, may run a self-limiting course.
A significant proportion of people may develop established epilepsy.

What are the complications of Epilepsy?
------------------------------------------------

Epilepsy can be associated with an increased risk of mortality.
Death may be related to:
1.An underlying brain disease, such as a tumour or infection;

2.Seizures in dangerous circumstances, leading to drowning, burns or head injury

3.Status epilepticus;

4.Sudden and unexplained causes, or a possible respiratory or cardio-respiratory arrest during a seizure;

5.Suicide.

How do you prevent another Epilepsy Fit?
--------------------------------------------------

The patient must do the following:
1. take his anti-epileptic medicine exactly as prescribed, avoid stopping his medicine or altering the dosage of medicine.

2. strive for a healthy lifestyle with balanced diet, regular exercise and effective stress management.

3. limit the intake of alcohol

4. get adequate sleep and rest as lack of sleep can trigger a fit

5. avoid operation of heavy machinery

6. carry a card stating his condition and medicines.
This will be helpful in an emergency.

How to help a person having a Epilepsy Fit?
---------------------------------------------------

As a person having an epileptic fit may be unconscious or drowsy, you should :
1.keep the person safe from injury - protect him from falling to the ground, remove any sharp objects near the drowsy epileptic person

2. do not place any object in his mouth - this may cause injury like chipped teeth or even a broken jaw

3. put him in a prone position with the mouth sideways to avoid any blockage of his airway - may sure that he is able to breathe properly

4. Call an ambulance if the fit lasts more than 5 minutes, or if there is repeated seizures, or if the person is pregnant or has diabetes

A Simple Guide to Acne

A Simple Guide to Acne
----------------------------

What is Acne?
-----------------

Acne is a skin condition which is characterised by papules, pustules and inflamed sebaceous oil glands.
It typically occurs on the face, neck, upper back, chest, or shoulders where the concentration of these glands are normally located.

What is the cause of Acne?
--------------------------------

It is a disease caused by the overactivity of the skin's sebaceous glands which are located at the base of the hair follicles.
Sebaceous glands produce an oily moisturising secretion (sebum)which helps to wax the hair growing from the hair follicle.

The sebum then empties into the skin's hair follicles which cover most of the body. Normally tiny skin cells shed so that new skin can replace the ones on the surfaces. When the shedding of such cells is abnormal, the opening of the hair follicle can be blocked. The result is a accumulation of sebum in the follicle which can easily become infected.

Bacteria Infection of the accumulated sebum produce pus and toxins which then resulted in a infected swollen gland or infected pimple.
The infected pimples if severe may result in scars.

What are the Symptoms of Acne?
---------------------------------------

The severity of symptoms depends on the individual.
Acne usually occurs during puberty when the production of male hormone in teenagers both male & female are higher.

1.Small bumps which appear under the skin and have no opening are known as whiteheads.

2.Dark spots with plugged pores in the centre are blackheads.

3.Persistent, recurrent red spots or swellings on the skin, filled with pus, are pustules.

4.Lumps under the skin which are inflamed and solid are nodules, or if fluid filled are cysts.

Often the acne become worse during stress or using oily cosmetics or hair creams.
In girls the acne may be aggravated during menses or during pregnancy

What is the Treatment of Acne?
-------------------------------------

Reassurance of worries about their looks in teenagers is very important because it reduces stress and the production of more male hormones.

Fresh air, enough rest and a healthy lifestyle will help physically and psychologically.

A small amount of sun exposure may also help acne problems because of drying effect on the oily skin.

Avoid touching the acne spots with dirty hands because of increased risk to infections.

Do not try to squeeze the pimples.

Patients with minimal symptoms:
1. simple healthy skin care can resolve the problem.
Oily skin can washed with simple soap and water.
Topical medications that help to dry up the oil and promote skin peeling can be applied on the skin. Such products may contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or tretinoin, or retinoic acid (Retin-A).

2.antibiotics (such as tetracycline or erythromycin) is prescribed if the skin lesions appear infected.
Topical antibiotics (applied to a localized area of the skin) such as clindamycin or erythromycin are also used to control infection.

3.New treatment with synthetic vitamin A analogues (isotretinoin, Accutane) have been shown to be beneficial in the treatment of severe acne.
This medication is not to be taken by pregnant women and sexually active adolescent females because of the danger of deformity to the foetus.

4. Sometime oestrogen therapy (Diane 35) on a short term may benefit girls with very severe acne and whose menses are not regular.

It is important to remember that every person who has gone through puberty has some form of acne and usually do not have any complications or bad scarring with the condition.

Prognosis is very good for 99% of cases.

A Simple Guide to Laceration

A Simple Guide to Laceration
-----------------------------------

What is a laceration?
-------------------------

A laceration is an injury to the skin and its underlying soft tissue when you are cut or hit by something.
A laceration is usually called a cut when the injury is caused by a sharp object breaking the skin. It may a clean cut without bleeding or if it damages the blood vessels in the skin, it can cause visible bleeding.
Lacerations can occur at any part of the body.
Healing time for a laceration depends on where it is on your body.
A laceration usually take longer to heal if it is over a joint such as the knee or elbow.

What are the signs and symptoms of a laceration?
----------------------------------------------------------

1.Lacerations may appear in all shapes and sizes.

2.It may look like a cut, tear, or gash.

3.The wound may hurt, bleed, bruise, or swell.

4.Lacerations may bleed a lot in areas of the skin which has a lot of blood vessels such as the scalp.

5.The wound may have edges that are close together, or gaping apart.

6.Sometimes there may be numbness around the wound due to a cut of the nerve endings.

7.Similarly there may be decreased movement in an area below the wound due to loss of nerve endings or tear of muscle fibres.

What are the complications arising from a laceration?
----------------------------------------------------------------

Even with proper treatment, a laceration can become infected:

1.Increased warmth to the area.

2.Redness or swelling to the area which becomes worse.

3.Pain in the area that increases over time.

4. pus or bad-smelling discharge from the wound.
Pus is milky and may be white, yellow, green, or brown.
It is the result of the white blood cells fighting the bacteria or virus.

Other complications may be:

1.the presence of foreign bodies

2.Injury to the bone( fracture)

3.Injury to the nerve

4.Injury to the blood vessels

5.Injury to muscles

What investigations may be necessary in Laceration?
--------------------------------------------------------------

If there is suspected foreign objects in your laceration, an x-ray may be required.

Foreign objects include things like metal, gravel, and glass.

If you have many wounds from a car accident, tests may include an ultrasound, a MRI, or a CT scan.

What is the treatment for a laceration?
----------------------------------------------

The doctor will want to
1.control the bleeding if your wound is bleeding a lot.

2.clean the wound with disinfectant.
This will remove dirt and other small objects and reduce the chance of infection.

3.look in the wound for foreign objects like dust, metal or glass splinters.

4.explore (probe) or close the wound under local anesthesia.
An anesthetic is a medicine which numbs the area so that there is no pain during the probe or surgery.

Closing the wound:
The laceration may need stitches, staples, other treatments to close the wound:
1.if it is deep or bleeds a lot.
2.if your wound is gaping open or
3.if the wound is in an area that moves a lot, such as the hands, feet, and joints.

Stitches also keep the wound from getting infected.
Stitches may decrease the amount of scarring.

If the wound is too old, it can not be stitched.
Some lacerations may heal better without stitches.

Special care:
Some lacerations need special care.
Laceration caused by bites from fish or marine life may need special medicines like antibiotics and antitoxins.
Antibiotics are not needed for most wounds.
Antibiotics are given if your wound has a high risk of infection.

If the laceration injure a bone, nerves, or blood vessels, there may be need for microsurgery to join the torn nerve or blood vessel.
A broken bone may also need to be treated conservatively or with surgery.

Tetanus injection:
Tetanus infection, or "lockjaw," can happen after any deep break in your skin. Tetanus can kill you. It is important for adults to get a tetanus shot at least every 10 years.
After an injury, a tetanus injection may be given if:
1. it has been longer than five years since your last one.
2.any wound that may have dirt or saliva in it.
3.Deep wounds also have a high risk for tetanus infection.

If necessary, tetanus injection should be given as soon as possible (within 72 hours of the injury).

What are the risks in the care of laceration?
---------------------------------------------------

A sharp object which passed through your clothing before cutting your skin may have caused small threads or bits of clothing to be pushed under your skin.
The risk of getting an infection is higher if there are foreign bodies in the wound.
Sometime even with the best care, there may still problems such as infection with your wound.
People who have diabetes have a higher chance of getting a serious infection in a wound.

A Simple Guide to a Bruise

A Simple Guide to a Bruise
-------------------------------

What is a bruise?
--------------------

A bruise is a bluish discolouration of the skin which occurs when tiny blood vessels are damaged or broken as the result of a heavy blow or fall.

The raised area of a bruise results from blood leaking from these injured blood vessels into the tissues.

A purplish, flat bruise that occurs when blood leaks out into the top layers of skin is referred to as an ecchymosis.

What are the causes of bruises?
-------------------------------------

Every person can get a bruise depending on the severity of the blow or injury.

However there are some people who are more prone to a bruise:
1.Age
The injury required to produce a bruise varies with age of the patient.
In the elderly person the skin together with its blood vessels has become thinner due to age, small knocks or scrapes of the skin may cause extensive bruising or ecchymosis as compared to a young person.
Bruising may even occur without prior injury in the elderly.

2. Medications:
In some cases bruising may also be affected by medications which interfere with blood clotting.
These drugs include many prescription arthritis medications called non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen as well as over-the-counter medications such as aspirin.
Warfarin is often prescribed to prevent clotting in patients who have had blood clots in their legs or heart. Warfarin can cause particularly severe bruising.
Corticosteroids medications, such as prednisone, promote bruising by increasing the fragility of the tiny blood vessels in the skin.

3.Inherited blood clotting problems
In addition, patients with inherited clotting problems (such as in hemophilia) or acquired clotting problems (such as in patients with liver diseases like cirrhosis), can develop extensive bruising or even life-threatening bleeding.

4. Blood cancer especially Leukemia patients tend to bleed more easily than normal people because of the low platelets.

How do you treat a bruise?
-------------------------------

There are a few things which can help:
1.apply a cold compress such as a cold water pack or an ice bag on the bruise.

2. Apply some cream like Silvadene (containing silver nitrate)which has the effect of coagulating the blood vessel and hence prevent more blood from leaking into the tissue.

3. Treat the cause .
In the case of leukemia blood transfusion may need to be given.

In most cases bruises disappear on their own within 1 week.

A Simple Guide to Chronic Obstructive Lung Disease

A Simple Guide to Chronic Obstructive Lung Disease
-----------------------------------------------------------

What is Chronic Obstructive Lung Disease?
------------------------------------------------

Chronic Obstructive Lung Disease (COLD) is a disease of the lungs characterised by the obstruction to the air flow in the airways of the lungs.

The narrowing of the airways together with distension of the air sacs beyond the terminal bronchioles with destruction of the alveolar walls over the course of many years damages the air sacs reducing the surface area left for the exchange of oxygen and carbon dioxide.

As a result the patient become increasingly short of breath.

What is the cause of Chronic Obstructive Lung Disease?
-------------------------------------------------------------

Chronic Obstructive Lung Disease is associated with
1.Chronic bronchitis .
Chronic bronchitis is an ongoing inflammation of the lining of the breathing tubes (the bronchi), which is caused by bacterial infection or cigarette smoke irritation.

As the inflammation progresses, the bronchi fill up with mucus resulting in a chronic cough, as the body attempts to rid itself of the excess mucus that is irritating the lungs. The excess mucus in the bronchi also makes the diameter of the bronchi narrower and reduces the amount of air that can pass through. There is obstruction to air flow and hence breathlessness.

Smoking is the main culprit here.

2.Chronic asthma-
the narrowing of the airtubes caused by spasm of the muscles of the lining the airtubes triggered off by the allergens can cause permanent damage to the airtubes causing obstruction to airflow and hence difficulty in breathing.

3.Emphysema -
here the narrowing of the airway extends to the smaller airways or bronchioles with damage and overdistension of the air sacs resulting in obstruction and less air getting through to the lungs.

4.Chronic infection of the lungs like pneumoconiosis and tuberculosis may cause damage to the lungs with difficulty in breathing and poor air flow.

In all cases of the above conditions air flow is impeded and there is hyper inflation of the lungs.

What are the Symptoms of Chronic Obstructive Lung Disease?
--------------------------------------------------------

Symptoms include:
1.Cough is usually the first symptom to develop.
It is usually a wet cough with phlegm(sputum).
Initially the cough is intermittent but becomes persistent as the condition progresses.

2. Excessive sputum or mucus is produced by the damaged airways.
This results in excessive production of phlegm

3.Chronic shortness of breath or shortness of breath occurs with mild exertion.
As the illness continues, breathlessness occurs even when sitting and can be very distressing to the patient.

4.There may even be breathing difficulty when lying down.

5.Wheezing may occur due to the sound of the air trying to squeeze through narrow airways.

6.Bluish coloration of the skin due to lack of oxygen

7.Dizziness can occur if the brain does not receive enough oxygen

8.Fatigue also occur when the body does not receive enough oxygen

Besides these main symptoms, other symptoms are:
1. Nasal flaring and bulging eyes

2.Vision abnormalities

3.Anxiety, stress, and tension

4.Ankle, feet, and leg swelling

5.Unintentional weight loss

6.Headache (especially in the morning)

7.Excessive daytime sleepiness

8.Insomnia

How is the diagnosis of Chronic Obstructive Lung Disease made?
----------------------------------------------------------

1. medical history of cough, excessive sputum, breathlessness and their duration.
Any history of smoking,asthma, exposure to environmental toxins.

2. Physical examination for barrel-shaped chest and flattened diaphragm.

3. Pulmonary (lung) Function Testing-
this is a very important tool used to confirm COLD.
The patient is asked to into a machine called the spirometer which measures the amount of air the patient is able to blow out from his lungs.
The readings from the spirometer will confirm the diagnosis of COLD and assess the severity.
It is also used to monitor the patient's progress.

4. Chest X-ray is useful as an aid in the diagnosis of COLD(hyperinflated lungs and depressed diaphragm is typical).
It is also useful to rule out other conditions besides COLD.
It also detects any complications of COLD.

What is the Treatment of Chronic Obstructive Lung Disease?
-------------------------------------------------------

There is no cure for COLD.

Medications and lifestyle changes may help in the relief of symptoms and preventing the progression of the disease.

Lifestyle Changes:
1.Stop Smoking is the most important step for a COLD sufferer.
While the damage to to the lungs cannot be reversed, stopping smoking will help prevent the progression of the condition.

2. Avoid air pollution and second hand smoke in the workplace and wear a mask if the air pollution index is high

3.Pulmonary Rehabilation- this involved a structured programme which includes education, exercise training,psychosocial support and instruction proper breathing techniques.
Benefits include improvement in the ability to exercise, reduced breathlessness and fatigue resulting in improvement in the quality of life.

4.Nutrition- eat a well balanced diet.
If chewing and swallowing interfere withbreathing, take small frequent meals.

5. Rest, meditation,adequate sleep are factors which will help improve your quality of life.

Medications:
1.Bronchodilators are medicines that relax the muscles aound the airways in your lungs, It opens the airways allowing air flow in and out of the lungs to improve. Bronchodilators may be taken orally or in inhalers.

2. Corticosteroids helps reduce airway inflammation and decrease the mucus production. Again these medicines can be taken orally or in inhalers.
Side effects are less with inhalers.

3. Antibiotics are taken to treat any underlying infection.

4. Vaccinations:
a.Yearly influenza vaccination is given if there is a higher risk of pneunomia if you suffer from influenza.
b.Pneumoccal vaccination for protection against pneumococcal infection.

Oxygen Therapy:Those wth severe symptoms may benefit from a regime of oxygen therapy for at least 15 hours a day.

Surgery:
Sometime removal of section of lung which has collapsed may improve symptoms. Sometimes a few may be considered for lung transplantation.

What are the Complications of Chronic Obstructive Lung Disease?
-----------------------------------------------------------

Most patients ends up with pneumonia and death because of the chronic progression of the disease.

Many if treated are able to live a long time before succumbing to pneumonia.

Other advice:

Air travel may be possible if the doctor deem that you are fit to travel.

Sometimes arrangement for oxygen and medications during the air flight may be necessary.

A Simple Guide to Endometriosis

A Simple Guide to Endometriosis

---------------------------------------

What is Endometriosis ?

----------------------------

Endometriosis is a disorder of the endometrial tissues (which line a woman's uterus) in which these tissues are implanted in places outside the uterus, usually in other parts of the pelvic cavity and abdomen.

However, in women with Endometriosis, blood from the implanted endometrial tissue is trapped inside, becomes inflamed, and develops into scar tissue.

Because of this inflammation, severe pain, infertility and bowel problems occur.

What are the Causes of Endometriosis?

----------------------------------------------

The cause of endometriosis is still not known.

There are a few theories:

1.during menstruation, some of the menstrual tissue is pushed back through the fallopian tubes into the abdomen where it implants and grows.

2.it may be due to a genetic process

3.certain families are predisposed to endometriosis:

Higher socioeconomic groups

women who marry late and have no or few children

4.Stress may constrict the opening of the uterus .

Some endometrial tissues are pushed backward into the abdominal cavity instead of through the opening of the uterus

What are the Symptoms of Endometriosis?

--------------------------------------------------

Endometriosis occurs usually years after the periods begin.

Symptoms may worsen as the endometrial area increases in size.

However after menopause, the implanted tissue shrinks away and the symptoms subside.

Common symptoms include:

Severe menstrual cramps

Pelvic pain apart from menstrual periods

Diarrhoea or painful bowel movements during menses

Menstrual irreuglarities

Menorrhagia

Painful intercourse

Backache

Pain with exercise

Painful pelvic exams

Painful and frequent urination

Bloating

Constipation

Fatigue

How do you made the Diagnosis of Endometriosis ?

------------------------------------------------------------

A diagnosis can only be made via laparoscopy.

A laparoscope is a tube with a light in it which is inserted through a small incision in the navel area. The misplaced endometrial tissue can then be found and the location, extent and size of the endometriosis detected.

What is the Treatment for Endometriosis?

----------------------------------------------------------

There is no cure for endometriosis.

If the symptoms are mild, only medication for pain is required.

Treatment depends on the size, extent of the lesions, age of the patient and the desire for pregnancy.

If these women want to be pregnant, the best course of action is to have a trial period of unprotected intercourse for 6 months to 1 year.

Once pregnancy occur, the endometriosis will cleared by itself because there is no menses for nine months. Whether the endometriosis will recur after delivery depends on the patient. Most patients do not have a recurrence.

If the patient is not seeking pregnancy and where specific treatment of the endometriosis is required, hormone suppression treatment may be tried. This prevents ovulation and less endometrial tissue is formed. Because of this the endometriosis may reduced resulting in less symptoms. A course of treatment may last 6 months.

Where hormone suppression therapy do not work, some patients may require surgical treatment to remove the endometriosis tissue in the abdomen.

In severe cases, where the uterus and ovaries are affected, removal by surgery of the uterus and/or ovaries is required especially in those nearing menopause or who do not wish to be pregnant.