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South African Medical Directory (Quick Reference) A
With Acid reflux,acidic juices are regurgitated into the oesophagus from the stomach.This regurgitation causes a pain or discomfort in the upper abdomen and chest,known as heartburn,one cause is a Hiatus Hernia. Gastroesophageal reflux (GOR) commonly known as heartburn or acid reflux is probably the most common cause of indigestion.The discomfort is due to acidic juices from the stomach flowing back up into the oesophagus (the gullet,the tube leading from the throat to the stomach).The lining of the oesophagus does not have adequate defence against the harmful effects of stomach acid,which causes inflammation,sometimes even ulceration and a burning pain kwown as heartburn Causes: The stomach contents are prevented from entering the oesophagus by a double-action valve mechanism - the lower end of the oesophagus has a muscular ring,known as the ower oesophageal sphincter, which forms one part of the valve mechanism,and the other part consists of the Hiatus,a narrow opeing in the diaphragm muscle.The combination of these two muscular gateways provides an effective one-way valve.GOR may develop as a result of several factors acting together to make the valve leak 1. poor muscle tone in the sphincter 2. increased abdominal pressure due to pregnancy & obesity 3. a weakness in the Hiatus that allows part of the stomach to slide into the chest - Hiatus herna 4. many people develop mild attacks of GOR after eatiang rapidly or eating certain foods,especially pickles,fried or fatty meals,, or drinks,especially carbonated soft drinks,alcohol or coffee.Smoking worsens symptoms too Symptoms: The main symptoms of GOR are usually most noticeable immediately after eating a large meal or when bending over.They include 1. a burning pain or discomfort in the centre of the chest behind the breastbone,known as heartburn 2. an acidic taste in the mouth due to regurgitation of acidic fluid into the throat or mouth 3. erosion of theteeth due to acid 4. persistent cough and sometimes asthma at night and sore throat 4. hoarseness of the voice 5. belching 5. streaks of blood in the vomit or faeces 6. Longterm Problems: GOR that persist over many years can cause scaring in the oesophagus,which may eventually be severe enough to cause stricture (narrowing).A stricture can make swallowing very difficult and may lead to weight loss.Chronic GOR, may lead to the oesophageal lining replacing the stomach lining,increasing the risk of developing oesophageal cancer Treatment: The good news is that many products and treatment are now available to alleviate chronic heartburn and prevent stomach acid from damaging cells of the oesophagus- which have no protection against a frequent bath of acid.Acid reflux may also be aggrevated by drugs you can take for other conditions,so consult your doctor about the effects of both over-the-counter and prescription medications you take and ask whether substitutions may be helpful.More severe cases that do not respond to diet and lifestyle changes alone require medications,starting with over-the-counter antacids and Zantac (ranitidine) help,but may not be strong enough to control acid reflux fully.If not, your doctor can prescribe more potent acid suppressors called proton-pump inhibitors - such as Loser.Other potentially useful drugs protect the lining of the oesophagus and speed stomach acid emptying.If acid reflux cannot be controlled through diet, habits and drugs - surgery may be required.One of the newest procedures done through a laparoscope,involves wrapping a defective oesophageal sphincter to strengthen it against reflux.Experts agree that it is not enough merely to claim all the symptoms of heartburn.Rather acid reflux must be prevented and any cellular damage that has occurred must be healed.It is not enough to treat chonic heartburn sporadically stopping treatment when symptoms subside.It has to be long-term.To protect the oesophagus adequately,treatment must be aggressive,continuous and indefinite and so involves some major changes in your life.If you have heartburn two or more times in a week,see your doctor and perhaps request a consultation with a gastroenterologist.If the problem has been long-standing,an examination and biopsy of the oesophagus through an endoscope is the only good way to assess what damage has been done.If any.If there are abnormal cell changes,endoscopic examinations should be done every year or two to check for possible progression towards cancer.Should a pre-cancer condition develop,the oesophagus can be removed and replaced with a piece of intestine or stomach.There are also experimental treatments that use laser or other forms heat to obliterate the abnormal cells and allow healthy cells to replace them Self-help for chronic heartburn: Check food well and eat slowly.Watch what you eat.Stay away from spicy or fatty food as well as citrus juice,coffee,tea,alcohol or chocolate.Eat 5 or 6 meals rather than two large meals a day.Immediately after a meal,avoid exercising,bending over or lying down.Lose weight if you need to.You will feel better if there is some food in your stomach,so eat little and often.Raise your head of your bed by about four inches or sleep on at least 4 pillows.Antiacid tablets will help to neutralize the acids and protect the oesophagus.Give up smoking.Consult your doctor if the problem occurs 2 or 3 more times a week. If you have recently developed pain the the centre of your chest that seems to be unrelated to mealtimes,you should seek immediate help - because the heart condition Angina may sometimes be mistaken for the pain of severe heartburn
Teenage Acne: The greasy skin with blalckheads,pus-filled spots,purplish-red lumps and possibly scarring that characterizes acne is most common in Adolescents,more common in boys and may run in families.Acne mainly affects the face,chest and back and is caused by blockage and inflammation of the grease glands in the skin.There is a persistent adult form of acne.Our skin contains sebaceous (grease)glands that secrete an oily substance (sebum) to keep the skin supple and moist.If the exists from these glands become blocked,sebum bursts into the deeper layers of skin.Here it is highly irritant and causes inflammation,which can become infected.The result is pus-filled spots and the classical tender,purplish lijps of acne.When the lumps heal,scars and pitting may be left behind Stages of Acne: Acne is graded in stages of severit Stage 1 - an oily skin with blackheads Stage 2 - Stage 1 & pus-filled spots Stage 3 - Stage 2 with deep,tendeer,hard purplish lumps Stage 4 Stage 3 with pitted and scared skin Causes: MALE HORMONES: Are the cause of acne,and this goes for adolescent girls as well as boys.Under the influence of these male hormones (androgens),the best known of which is Testosterone,cells at the exit from the sebaceous gland overgrow and block the outlet.At puberty,androgens pour into the blood and reach their highest levels in both sexes.In girls,they are even higher than Estrogens.So at ADOLESCENCE,with all those androgens rushing about,sebaceous glands get blocked very easily.To make matters worse,androgens cause over production of sebum so sebaceous glands are stretched to bursting and some do.Many women have acne in a mild form just prior to MENSTRUATION,when Estrogen levels are low.People who take STEROIDS may get acne spots.SKIN BACTERIA are important too in the formation of the red and yellow spots.After puberty,the skin of the face and upper trunk,with or without acne,contains many bacteria.The most important bacteria in acne are called Propionibacterium acne.They get into the duct of the grease glands where they make chemicals that eventually escape into the deeper parts of the skin and cause more inflammation.This does not mean that acne is infective - it is not. It is not a question of hygiene either.Washing or the lack of it - does not cause acne.Sometimes acne persist into the late teens and 20s and rarely into the 30s - ADULT ACNE - and is more difficult to treat Factors that affect acne: No matter what you have been told or have read, acne is not caused by eating rich or fatty food,not washing thoroughly or by drinking too much alcohol.There seems to be a tendency for acne to run in families.In girls,a flare of acne is common just before the monthly period.Pregnancy does not usually influence acne.Sunshine may help acne,but sunbeds give little benefit.Diet probably has no role in acne.Poor personal hygiene does not worsen it.Squeezing spots usually aggravates the problem.Stress may make acne worse.Overcleansing - too much rubbing or using products that contain abrasives worsen acne - because they liberate bacteria from the grease glands onto the skin and promote more spots.If acne starts after adolescence, e.g women over the age of 25, the factors above also apply Treatment: See the doctor.Acne can be totally cured these days.But effective treatments are only available on prescription - not over the counter.The basis of treatment is 4-fold.To reduce the number of bacteria on the skin.To stop the multiplication of cells in the sebaceous glands,which results in blockage.To unblock pores.To lower sebum production General Principles of Treatment: With prescription treatment spots can usually be kept under excellent control and scarring prevented.90% of patients show a 50% improvement in 3 months and 80% improvements within 6 months,but continuous treatment is necessary for many years. There are 3 types of oral therapy.ANTIBIOTICS,HORMONES & RETINOIDS. All are available only on prescription and with the exception of retinoids,should be combined with topical therapy.People who respond to oral antibiotics may need repeat courses,each lasting at least 6 months.Gel and creams containing PEROXIDE are often recommended to help unblock pores.Long-term therapy with ORAL ANTIBIOTICS often helps.The antibiotics are prescribed regularly for up to 6 months at as time.They have an effect not only on the bacteria in the skin,but may also have a direct effect on inflammatory cells in acne spots, as well as on sebum production.A daily dose of the antibiotic TETRACYLINE has been shown to help acne sufferers a great deal.There are usually no side effects and the dose is reduced according to the progress of the treatment.Creams based on VIT A reduce sebum production but may have side effects such as reddening of the skin, and should only be used under medical supervisuion.The treatment of severe acne has greatly imporved with the use of oral RETINOID DRUGS such as Isotretinoin (related to vit A) which are prescribed only when antibiotics and other measures haven't helped.Oral isotretinoin is very affective - but it can only be prescribed by a Dermatologists,whose instructions must be strickly followed.A 4 month course is usually needed,after which most acne will be virtually clear.Side Effects of Isotretinoin:These drugs must be used cautiously because they may cause liver damage and will cause malformations in an unborn baby.Contraception must be used for two months before,during and three months after treatment.Depression has also been reported as a possible side effect.All patients develop considerable drying of the lips and skin.Some have mild aches and pains of their joints and headaches.However these side effects can be easily and well controlled - by using a moisturizing cream or a simple painkiller such as paracetamol.Acne cysts can often be treated by INTRALESIONAL THERAPY (direct injection into the acne spots) which also helps to reduce scarring.In some cases of severe and extensive scarring, DERMABRASION (that is the removal of the top layer of skin under a genrral anaesthetic) may help get rid of pits and scars.A special form of the ORAL CONTRACEPTIVE PILL may be prescribed for women because it is often successful in settling acne down.Ordinary contraceptive pills have little or no effect on acne.However your doctor can prescribe one particular pill (Dianette) that is often helpful.The reason being that the Estrogen in the pill reduces the production of sebum.It also opposes the effect of male hormones in blocking sebaceous glands and frees them up.It is usually taken for 12-36 months.The side effects of Dianette are the same as those of an ordinary contraceptive pill - so ask your doctor to explain these to you if you want further information.A doctor is unlikely to prescribe the pill beforr the age of 17 - unless it is for contraception,because the hormones may interfere with growth If your are unhappy with the results of treatment - you can ask your GP if you can see a DERMATOLOGIST - who will tell you about the very latest advances in acne treatment and special procedures that are available.Acne is a condition that can be virtually cured in expert hands and if it is really bothering you,insist that you see a Dermatologist Treatment of scars: Carefully select patients with bad scarring may be considered for Dermabrasion.This procedure is usually performed by plastic surgions, under a local or general anaesthetic.The success rate is between 25 & 70%.Only patients who are strongly motivated to have the procedure should be recommended for it.If in doubt - this procedure should be avoided Don't Give Up! Acne is usually one of the easiest of the persistent skin conditions to treat,but it must be trated sooner rather than later.Early treatments minimizes the risk of scarring.Do not give up your treatment.Doctors can now offer therapies that can guarantee a satisfactory result in virtually everyone.Herbalists will almost certainly recommend special diets and special creams and possibly certain natural or herbal medicines to take by mouth.Sage,Plantain,Verbascum and Ground Ivy are said to have uselful astringent properties.Shepherd's Purse,has cleansing properties.Aromatherapists advocate the use of Bergamot,Camphor,Cedarwood,Juniper and Lavender Self-Help: How to cope with acne DE-FAT YOUR SKIN BY CLEANING IT YOUR REGULARLY: Cleanse your skin meticulousy.The aim is to de-fat the skin.Use an antiseptic soap or soap solution.Bring it up to a lather in the palm of your hand,gently massage it into your skin for at least 2 min,then rinse off. Wash this way at least 3x a day.It is not wise to use proprietary acne cleansers as they scrape the skin, break down the pustules and spread germs all over the skin - thereby encouraging acne lesions elsewhere STEAMING HELPS FOR BLACKHEADS: Blackheads can be treated by STEAMING your face.Hold your face about 30cm above a bowl of hot water from the tap (caution) and cover your head with a towel NEVER SQUEEZE - IT CAN SPREAD THE INFECTION: You should never squeeze anything but a blackhead.Try to keep your fingers away from the acne pimples - touching and rubbing simply spreads germs into surrounding skin.Much worse,squeezing forces sebum out of the glands and into the skin,causing those hard,tender,purple lumps NO EXTRA GREASE PLEASE: Do not put anything greasy on the skin.It will make your acne worse.If you are a female,wear heavy-textured oil-free make-up to cover the spots.Many people mistakenly believe that make-up blocks the pores.Thst is completely wrong.Nothing put on the skin - except paint - ccan block pores.Make-up won't make acne worse and it does improve morale, which in turn makes acne better MODERATE EXPOSURE TO SUNLIGHT CAN BE HELPFUL: This can be helpful as it dries out the skin.Doctors advocate a mild peel from mild sunburn to unblock the pores HAVE A BALANCED DIET & DRINK LOTS OF WATER: Do not let acne affect your diet. There are a lot of myths regarding acne been caused by certain food-stuffs.Research has shown that foods such as chocolate actually do not have the slightest effects on acne.So eat a good balanced diet to improve your general health
Acrocyanosis: A harmless deficiency in the circulation of the hands, fingers, feet and toes of young women Acrophobia: The fear of heights
Acquired Immunodeficiency : Immunodeficiency is the complete or partial failure of the immune system - the body's natural defence system against disease.If the immune system fails at some point during life,the condituon is known as 'acquired' immunodeficiency Causes: In the most infamous form of this condition - 1.Acquired Immunodeficiency Syndrome (AIDS),the Human Immunodefiiency Virus (HIV) destroys a particular type of white blood cell,the T cell - this cause progressive weakness and vulnerability of the immune system 2.Infections such as measles or flu damage the body's ability to fight infection.They do this partly by reducing the number of white blood cells involved in fighting the infection.Usually this type of immunodeficiency is mild, and the immune system returns to normal once the infection is overcome A mild form of immunodeficiency may develop in some 3.chronic disorders including Diabetes Mellitus & Rheumatoid Arthritis.This may occur partly becasue thse diseases put stress on the immune system,reducing its ability to resist other diseases. 4.Certain types of cancer,particualr tumours of the Lymphatic system(Lymphomas) may cause a more sever form of immunodeficiency by damaging the cells of the immune system and by reducing the production of normal white blood cells 5.The long-term use of corticosteroids suppresses the immune system and has the inevitable effect of casuing immunodeficiency.Immunosuppressant drugs, which may te givven to prevent the rejection of an organ following transplant surgery,also produce immunodeficiency and affect the body's ability to fight infections. 6.Chemothrerapy can damage teh bone marrow,where the majority of blood cells are made,and may also lead to the development of acquired immunodeficiency. Immunodeficiency may also develop 7.after removal of the spleen,and organ in which some of the white blood cells are produced Treatment: Your doctor may suggest continual low doses of Antibiotics,Antiviral drugs and / or Antifungal drugs and various Immunizations - such as the Pneumococcus vaccine, to protect against Pneumococcal Pneumonia.The effects of immunodeficiency can usually be controlled by treatment,although immunodeficiency due to HIV invection - tends to worsen over time *also see AIDS* Acute Pancreatitis: In acute Panceatitis,the pancreas suddenly becomes inflamed due to damage from its own enyzymes,causing very severe upper abdominal pain and other symptoms. The condition is serious and can be life-threatening if left untreated.Acute pancreatitis almost exclusively affects adults and excessive alcohol consumption is a risk factor Causes: May be caused by gallstones, viruses (mumps,hepatitis),injury,gallbladder surgery,certain drugs (diuretics,sulphonamides),long-term alcohol abuse or hyperlipidaemia Symptoms: Acute pancreatitis cauises a range of symptoms that occur suddenly and my be severe - including sudden and very severe upper abdominal pain,often spreading to the back and made worse by movement and relieved by sitting up.Nausea and vomiting.Bruised appearance of the skin around the abdomen.Fever.In severe cases,inflammation,affects the whole abdomen,making it rigid and increasing pain.Acute pancreatitis may also lead to shock,a potentially fatal condition in which the blood pressure falls dangeroulsy low Treatment: Blood tests, a computerized tomography (CT) scan or endoscopy of the pancreas (ERCP) may be used to confirm a diagnosis of acute pancreatitis.Your stomach will be kept empty to prevent the pancreas from being stimulated to produce more enzymes.A tube will be passed through the nose into the stomach to remove its contents by suction.Fluids will be given intravenously.If tests have detected a gallstone,ERCP test (see under Endoscopic Retrograde cholangio-pancreatography) may locate the stone more precisely and remove it.Rarely,if damaged pancreatic tissue becomes infected,surgical drainage may be needed.If the pancratitis was caused by gallstones,it may be advisable to have your gallbladder removed once you have recovered Prognosis: About 9 in 10 people survive an attack of acute pancreatitits,but the gland may be damaged so that it is unable to produce adequate amounts of enzymes, and you develop- malabsorption syndrome.You may then need to take enzyme supplements for the rest of your life
Infection with HIV ,which in many cased leads to AIDS (Acquired Immunodeficiency Syndrome) has been the most written about, most researched and most feared infection of the past two decades.Despite the development of highly effective drugs to limit the disease - there is still no vaccine against the virus and the number of people with HIV infection contiunes to rise,especially in South Africa and other developing countries WHERE DID HIV ORIGINATE FROM ? HIV is believed to have originated in Africa,where is similar virus is carried by some species of primates.The virus is thought to have spread from monkeys to humans through saliva in bites,then around the world from person to person in body fluid.The first recognized cases of AIDS in the US occured in 1981,when there was an outbreak of unusual cases of Pneumonia and Skin Cancer in young homosexual men in Los Angeles.Two years later,the virus was isolated and identified as HIV WHAT DOES IT MEAN TO BE HIV POSITIVE ? - HIV infects and gradually destroys cells in the immune system,weakening the body's response to infections and cancers.People infected with HIV may have no symptoms for many years,or they may experience frequent or prolonged mild infections,but they all develop antibodies to the virus,which can be detected by a blood test.They are said to be HIV POSITIVE WHAT DOES IT MEAN TO HAVE AIDS ? - When the immune system becomes severly weakend,an infected person is said to have AIDS.A person with AIDS develop serious infections caused by organisms that are normally harmless to healthy people and is also susceptible to certain cancers HOW MANY PEOPLE HAS BEEN AFFECTED ? By the end of 1998 - there were about 22 000 people in the UK who had HIV infection, with 2,000 new cases a year.Worldwide - over 33 million people are thought to be infected.South Africa has one of highest occurance of HIV in the world. Many carry the virus and unaware that they have the condition & the number is rising. As a result of developments in the drug treatment,deaths due to AIDS have fallen dramatically in the developed world since 1995 PRECAUTION - HOW CAN HIV BE CONTRACTED ? It is important to know that the HIV is not contagious like the common cold but is easily transmitted through various methods 1. ALL BLOOD PRODUCTS & BODY FLUIDS - HIV is carried through Blood Products,Semen,Vaginal Secretions,Saliva & Breast Milk - although not to the same degree.All body fluids do not therefore have the same potential for infection. Saliva from an infected person contains HIV, but in such small quantity that it would be exceedingly difficult to be infected by saliva 2. SEXUALLY - HIV is most commonly transmitted sexualy - by vaginal,anal or oral sex.You are more susceptible to HIV infection and more likely to pass on the virus if you have another sexually transmitted disease 3. CONTAMINATED NEEDLES- You are also at increased risk of HIV infection - if you use intravenous drugs and share or reuse needles, contaminated with the virus.Medical workers are also at risk through handling contaminated needles or from contact with infected body fluids,but the risk is very low 4. BLOOD TRANSFUSIONS & ORGAN TRANSPLANT - Although the virus can also be transmitted through organ transplant or blood transfusion - however the risk is low in developed countries,since the screening of organs,blood or tissue for HIV is now compulsory & routine 5. HIV INFECTED PREGNANT WOMEN & MOTHERS - HIV infection can be passed from an infected pregnant woman to the fetus or to the baby at birth or during breast-feeling 6. THROUGH SEXUAL ASSAULT OR RAPE - To prevent the victim from contracting HIV they should be treated with anti-retroviral drugs as soon as posible after an assault EXACTLY HOW DOES THE VIRUS WORK? HIV enters the bloodstream and infects cells that have a special structure,known as the CD4 receptor,on their surfaces.The infected cells include a type of white blood cell,known as a CD4 lymphocyte, which is responsible for fighting infection.The virus reproduces rapidly within the cells and destroy them in the process.At first - the immune system is able to function normally despite the infection,and symptoms may not develop for years.However especially if the infection is untreated ,the number of CD4 lymphocyes eventually begins to fall,causing increased susceptibility to other infections an some types of cancer WHAT ARE THE SYMPTOMS ? The first symptoms of HIV infecdtion usually appear within 6 weeks of infection.Some people experience a flu-like illness that may include some or all of the following symptoms 1. swollen lymph glands 2. fatigue 3. rash 4. aching muscles 5.sore throat These symptoms usually clear up after a few weeks and namy people with HIV infection feel completely healthy.However in some people - any of the following minor disorders may develop 1. persistent,swollen lymph glands 2. mouth infections - such as thrush 3. gum disease 4. severe,persistent herpes simplex infection - such as cold sores 5. Extensive gential warts 6. itchy flaky skin - seborrhoeic dermatitis 7. neurological symptoms similar to dementia COMPLICATIONS - AIDS DEFINING ILLNESSES The time between infection with HIV and the onset of AIDS varies from person to person,but it can be anywhere between 1-14 years.Often people are totally unaware for years that they are infected with HIV - until they develop one or more serious infections or Cancers known as AIDS-defining illnesses These infections may be caused by protozoa,fungi,viruses or bacteria - and they are often life-threatening 1. PNEUMONIA - One of the most common illnesses in people with AIDS is a severe infection of the lungs by the parasitic Pneumocystis carinii 2. TOXOPLASMOSIS - Other common diseases are protozoal - such as toxoplasmosis - which can affect the brain 3. CANDIDA ALBICANS - A fungus that causes mild superficial infections in healthy people but may produce much more serious infections in people who have AIDS 4. FEVER, HEADACHES LUNG INFECTIONS - Cryptococcus Fungus may cause fever,headaches and lung infection 5. TB, LISTERIOSIS, HERPEX SIMPLEX, SEPTICAEMIA,MENINGITIS, VIRAL ENCEPHALITIS - People with AIDS suffer from severe bacterial and viral infections,include Turberculosis & Listeriosis,which may lead to Blood Poisoning (septicaemia).Viral infections include those caused by the Herpes virusses.Herpes simplex infections can affect the brain,causing Meningitis and Viral Encephalitis 6. PNEUMONIA, VIRAL ENCEPHALITIS, EYE INFLAMMATION, BLINDNESS - The Cytomegalovirus may cause a number of severe conditions,including Pneumonia,Viral Encephalitis and a type of eye inflammation that can result in blindness.However,people with AIDS are no more susceptible to common infections such as colds 7. KAPOSI'S SARCOMA, non-HODGKINS LYMPHOMA & CERVICAL CANCERS - The most common cancer that affects people with AIDS is Kaposi's Sarcoma - a type of skin cancer that can also affect the inside of the mouth and internal organs.Other cancers that commonly develop in people with AIDS include Lymphomas - such as non-Hodgkin's Lymphoma.Cancer of the cervix is an AIDS defining illness in women infected with HIV 8. DEATH TREATMENT - HIV POSITIVE - WHAT TO DO ? If your HIV test results is positive,you will probably be referred to a specialist / centre where you will recieve monitoring,treatment and advice from a team of health-care professional Drug Treatment -Reverse Transcriptase inhibitors & Protease inhibitors: May be started when you are diagnosed with HIV infection or when CD4 lumphocyte levels start to fall.Advances in the use of anti-retroviral drugs,that prevent HIV from replicating - have made it possible to prevent progression of HIV infections to AIDS and to suppress the viral infection to undetectable levels in some people There are two main groups of anti-retroviral drugs used in the treatment of HIV infection and AIDS 1. Reverse Transcriptase inhibitors 2. Protease inhibitors. The drugs work by blocking the processes neccessary for viral replication without significantly damaging the body cells that the viru has invaded.Reverse Transcriptase inhibitors,such as Zidovudine(AZT), alter the genetic material of the infected cell (which is needed by the virus to replicate) or the genetic material of the virus itself Protease inhibitors ,such as Ritonavir,prevent the production of viral proteins necessary for replication IF YOU DEVELOP AIDS - WHAT CAN BE DONE ? Once AIDS has developed,opportunistic infections are dealt with as they occur,usually by treatment with anitbiotic drugs and in some cases,they may also be long-term preventive treatment against most common infections Emotional support and practical advice can be obtained from the many support groups & charitable organizations that help people with HIV infection & AIDS PROGNOSIS FOR HIV INFECTION & AIDS There is NO CURE for HIV infection.But the drug treatments available in the develop world have made it possible to regard the condition as a chronic illness rather than as a rapidly fatal one.In the two years following the introduction of anti-vrial drug combination therapies in 1995,deaths from AIDS in the developed world fell dramatically.However for most of the people with HIV who live in the developing world,prognosis is bleak.Few have access to up-to-date treatment and left untreated,half of all people infected with the virus develop AIDS within 10 years & die PREVENTATIVE MEASURES - HOW NOT TO CONTRACT HIV ? 1. EDUCATION - HIV infection can be prevented through education and teaching everyone about the risk of infection from an early age 2. DO NOT PLAY WITH YOUR LIFE- The two main precaution that everyone can take to avoid sexual transmission are to abstain or practise safe sex -that is to use a condom during any sexual intercourse and to avoid sex with multiple partners.Never give in to the temptation to have sex with a partner you barely know,no matter how wonderful they seem to be.Be on guard if they get angry or resentful when talking about the risks involved 3. HAVE A HIV TEST BEFORE - Both partners migh think about having an HIV test before having unprotected sex in a new relationship 4. TAKE RESPONSIBILITY FOR YOUR UNBORN CHILD & BABY - If you are HIV positive & Pregnant,anitviral drugs may be given to reduce the risk of transmission to the fetus.You may be advised to to have a caesarean section.Avoid breastfeeding if your are HIV positive to reduce the risk of transmitting the virus to your child 5. MEDICAL PROFESSION ARE TAKING PRECAUTIONS - Medical professionals take many steps to prevent transmissions of HIV,including screening all blood products and tissues for transplant and using desposable or carefully sterilized equipment 6. SUFFERERS NEED TO BE RESPONSIBLE -People with HIV need to take special are to prevent others from coming into contact with their blood or body fluids and should always inform their partners & dental or medical staff that they are HIV positive 7. USE CLEAN NEEDLES - Specific groups also need to take special precautions e.g if you inject drugs intravenously,you must use a clwan needle everytime 8. AVOID ALL RISKY SITUATIONS & ALL SEXUAL RISKY PEOPLE MYTHS ABOUT HIV INFECTION YOU WON'T GET HIV FROM............... 1. Swimming in the same pool as an HIV-positive person 2. From kissing an infected person on the mouth,although there is a slight risk if the person has inflamed or bleeding gums 3. From drinking from a glass or eating from a plate that is been used by an HIV-pisitive person 4. By going to school or college with an HIV-positive person 4. By visiting someone with HIV at her home or in hospital 5. By hugging,touching,shaking hands or dancing with someone who is HIV positive 6. By sitting on a toilet seat or use a telephone that has been used by an infected person 7. By standing next to an infected person who is sneezing - the virus does not travel through air 8. You cannot get HIV from been bitten by an insect 9. Won't get HIV If you give blood at a blood transfusion unit
HayFever is due to inflammation of the membrane lining of the nose,throat & eyes.This inflammation is the result of an allergic reaction to specific airborne substances known as allergens.It can occur only during the Spring and Summer - in which it is known as Seasonal Allergic Rhinitis or hay fever and is due to inhaled pollen.If it occurs all year round - it is called Perennial rhinitis and is most commonly due to an allergy to house dust.Allergic Rhinitis is more common in people who have other allergic disorders,such as Asthma,eczema or Migraine - that is - they have Atopy Causes: Seasonal allergic Rhinitis is usually due to grass,trees,flower or weed pollens, it occurs mostly in the Spring and Summer when pollen counts are high.The most common allergens that provoke Perennial Allergic Rhinitis include house dust and dust mites, animal fur and dander,feathers and mould spores Symptoms: The symptoms of both forms of allergic rhinitis usually appear soon after contact with allergens,but tend to be more severe in hay fever.They include - Itchy senstation in the nose.Frequent sneezing.Blocked runny nose.Itchy red,watery eyes.Some people may develop a headache.If the lining of the nose is severely inflamed,nosebleeds may occur Treatment: Your doctor may recognize Allergic Rhinitis from your symptoms,particularly if you can identify the substance that triggers a reaction.A skin prick test may be performed in order to identify the allergen that causes the Allergic Rhinitis.In some cases the allergen cannot be found.If you can avoid the allergens that affect you - your symptoms will subside.Oral antihistamines are often combined with decongestants to relieve inflammation and itching. Many anti-allergy drugs are available over the counter or by prescription. eg. allergies can be blocked by nasal sprays that contain Cromolyn Sodium.Alternatively nasal Corticosteroids in the form of a spray are effective for hay fever - but may take a few days to work.Nasal sprays containing decongestants can relieve symptoms - but should not be used regularly.Eyedrops may help relieve eye symptoms.Rarely if symptoms are severe,your doctor may prescribe and oral corticosteroid.The most specific treatment for AllergicRrhinitis is immunotherapy, in which your are infected with gradual increasing doses of allergen with the aim of desensitizing the immune system.This treatment typically takes as long as 3-4 years,is not always successful Self Help: Perennial Allergic Rhinitis - Avoid keeping furry animal as pets if you are allergic to them.Replace pillows and quilts containing animal materials such as duck feathers with those containing synthetic stuffing.Cover mattresses with plastic.Remove dust collecting items such as upholstered furniture and curtains if possible Hay Fever - Avoid areas with long grass of where grass is being cut.In summer,keep doors and windows closed and spend as much time as possible in air-conditioned buildings.Try to stay inside during late morning and early evening when the pollen count is highest.Keep car windows shut while driving.Make sure your car is fitted with an effective pollen filter.While outside,wear sunglasses to help prevent eye irritation,sunglasses can help stop the pollne from entering eyes.Shower and change when you get home.Wash hair regularly.Eat health-building foods such as fruit & vegetables.Homeopathic preparations are seen by users as preventatives.Aromatic tissues impregnated with vapours help dry up mucus.Spectacles now exist that can filter the air around the eyes. Supplements such as Zinc,that are said to boost the immune system are taken for Hay Fever
Alopecia may be localized - in which hair is lost in patches - or generalized - in which there is thinning or total hair loss over the whole scalp.Hair loss can be temporary or permanent.Alopecia is not always associated with ill health - but may cause embarrassment.If your scalp has patchy scarring you may need a skin biopsy to idanose the underlying cause.Scarred areas may be treated with tppical corticosteroids or antifungal drugs,but if the damage is sevee and has affected the hair follicles it is unlikely that new hair will grow Causes: The most common cause of Alopecia in men is oversensitivity to the hormone testosterone,producing a characterisitic pattern of hair loss (male-pattern baldness).This is an inherited condition and the most common form of Alopecia.The process starts when normal hair at the temples and crown is replaced by fine downy hair.The hair-line then gradually recedes.Only a trained Dermatologist can determine if the hair follicle - the pit in the skin from which the hair grows - is so badly damaged that hair loss is permanent.Patchy hair loss is usually due to Alopecia Areata - an autoimmune disorder that causes bald patches to appear on the scalp,surrounded by short,broken hairs.The hair will usually regrow within 6 months,but in rare cases Alopecia areata can cause permanent loss of all body hair - Alopecia Universalis.Hairstyles that pull on the scalp are a common cause of patchy hair loss.If the pulling is continuous, hair loss is permanent.Patchy hair loss may be the result of a rare psychological disorder in which the hair is compulsively pulled - Trichotillomania.Burns or skin disorders - such as ringworm,that scar the scalp may cause permanent patchy hair loss.Generalized thinning of the hair is noticeable after the menopause,and hair loss is normal in elderly people.Hair loss may occur temporarily after pregnancy for up to a period of 18 months.Hair loss is also a common side effect of Chemotherapy and Hypothyroidism.Other causes of thinning hair include acute illness,stress and malnutrition Hair Loss in women: Estrogen receptors in hair follicles maintain the health of each hair,which is why problems can occur at the time of menopause if Estrogen levels are lwo.So it is possible that if you have a problem with hair loss - it may be due to a hormone imbalance and hormone replacement therapy (HRT) might help.Consult your doctor for advice about this.It is also possible you have an underactive thyroid as hair loss is one of the symptoms.A simple blood test can diagnose this.Iron-deficiency Anaemia can aslo cause haire loss.Women who suffer with heavy periods are often deficient in iron.Rapid weight loss and stress is also thought to affect the hair folicles by constricting the blood vessels that supply them and so limiting their supply of oxygen.General thinning of the hairi is common after pregnancy.The pregnancy hormones drive most of the scalp hair into a growing phase.Under normal circumstance, hairs are at different stages of resting and growing phases and therefore hair loss is gradual and imperceptibl.The dramatic hair loss associated with pregnancy is because great numbers of hairs come out of the resting phase at the same time and are lost simultaneously.This may go on for anything up to 18months or two years.Although very disturbing, it is no cause for alarm because it is self-limiting and reversible - although hair may take a long time to grow back,and straight hair may become curly and vice versa.Chronic scratching of the scalp - particularly at the back near the nape of the neck,is quite a common symptom of anxiety and can give rise to hair loss.However, this is rarely complete and always recovers when scratching stops.Hair pulling - Trichotillomania - can occasionally cause bald patches but it can always be diagnosed because hair loss is never complete and there are often broken hairs of different lengths present in the bald patches.Like chronic scratching,Trichotillomania nearly always has a psychological cause Treatment: 1. The hair usually regrows once the underlying cause has been treate 2. Your doctor will probably be able to diagnose Alopecia areata by the appearance of your scalp.This condition does not usually require treatment,but corticosteroids injected into the hairless patches may be effective in promoting regrowth 3. In most cases of hair loss, the hair usually regrows once the underlying cause has been treated 4. If you scalp has patchy scarring - you may need a skin biopsy to diagnose the underlying cause.Scarred areas may be treated with topical corticosteroids or antifungal drugs,but if the damage is severe and has affected the hair follicles, it is unlikely that new hair will grow Possibilities for Permanent Hair Loss: 1. Hairpieces: This is the safest and least painful way (health & money) to camouflage hair loss.Some can be permanently attached to the head, either by being tied to existing hairs or by being sewn onto the scalp.The latter can cause infection and are not recommended for that reason.The only other possible side effect is that occasionally people are sensitive to the adhesive that is sometimes used 2. Hair Implant: This is a quasi-surgical procedure where strips of hair are attached to the scalp - in the form of sugical threads implanted in the balding area.The implants are usually synthetic so a hairdryer mus not be used 3. Hair Transplants: This is a surgical procedure that generally results in permanent replacement of hair although even when well established, it is not as luxurious as the hair you have lost.Plugs of hair are cut from the remaining healthy hair on the sides and back of the head and implanted in bald spots.This hair normally falls out after transplant - but is replace by new hair.Quite a few follicles must be transplanted in the same session and the process needs to be repeated in the total baldd area is to be covered 4. Hairweaving: This is a non-surgical procedure that adds replacement hair to existing hair in order to cover bald patches.The new hair is braided strand by strand onto the edges of the hair in situ.Hair weaving requires maintenance and careful cleansing 5. Scalp Colorants: A spray available from pharmacies - covers the head in an organic dust to disguise any bald patches.Coloured creams can darken the scalp to camouflage pale,hairless skin 6. Medication: During research on adfrug to control high blood pressure, it was discovered that Minoxidil, promoted hair growth.It has to be applied to the scalp twice daily for a minimum of 4 months for any effect to be noticeable.Treatments has to be continued or hair loss will reoccur.The one thing that all thses treatmetns have in common, is the expense involved over a long period of time.It is sensible to seek advice before committing yourself to any particular form of treatment 7. Self-Help: If possible, try not to worry about your hair loss because anxiety makes the problem worse.Very often it is worth considering wearing a wig so that the psychological effect of the hair loss dos not take too great a toll Alzheimer's Disease: In Alzheimer's Disease there is a progressive deterioration in mental ability due to degenertion of brain tissue.It is normal to become mildly forgetful with increasing age,but severe impairment of short term memory may be as sign of Alzheimer's Disease in which brain cells gradually degenerate and deposits of an abnormal protein build up in the brain.As a result the brain tissue shrinks,with progressive loss of mental abilities known as dementia.Alzheimer's disease is the most common form of dementia and the fourth commonest casue of death in the West.It affects about 7 in 100 people by the age of 65 and 3 in 10 people by the age of 85 Causes: The underlying cause is unknown although genetic factors are almost certainly involved.Studies have shown that 15 in 100 people with Alzheimer's disease have a parent affected by the disorder.In women,the lack of oestrogen after the menopause probably plays a role and hormone replacement therapy (HRT) is advocated to prevent the onset of Alzheimer's Symptoms: 1. The first sign is usaully forgetfulness.The normal deterioration of memory that occurs in old age becomes much more severe and begins to affect intellectual ability.Memory loss is eventually accompanied by other symptoms including 2. impairment of memory,particularly when trying to recall recent events 3. gradual loss of intellect,affecting reasoning and understanding 4. reduced vocabulary 5. emotional outbursts 6. wandering and restlessness 7. neglect of personal hygiene 8. poor concentration 10 . difficulty understanding both written and spoken language 11. wandering and getting lost,even in familiar surroundings In the early stages of the disease people are aware that they have become more forgetful.This may lead to depression and anxiety.Over time, the existing symptoms may get worse and additional symptoms may develop including 12. slow movements and unsteadiness when walking 13. rapid mood swings from happinsess to tearfulness 14. personality changes,aggression and feelings of persecution 15. Sometimes people find it difficult to sleep and become restless at night 16. After several years most people with the disease cannot look after themselves and need full-time care Diagnosis: New tests can help in the early diagnosis of Alzheimer's Disease.However severe depression may mimic dementia - so called pseudodementia.Tests may be arranged to exclude other possible causes of dementia e.g blood tests may be carried out to check for vitB deficiencies.Imaging tests such as CT scannng or MRI may be done to show up shrinkage of the brain and exlcude other brain disorders,such as subdural haemorrhage or a brain tumour.An assesment of mental ability,including memory and writing tests, may be done to determine the severtiy of the dementia Treatment: There is NO cure, but drugs such as donepezil may slow the loss of mental function to mild to moderate cases.Some of the symptoms that are associated with Alzheimers disease such as depression and sleeping problems, can be relieved by antidepressant drugs.A person who is agitated may be given a sedative drug to calm them.In women HRT,should be tried or if possible taken from the onset of the menopause as a preventative.Eventually,full-time care will probably be necessary either at home or in a nursing home /facillity.Caring for a person who has Alzheimer's disease is often stressful and many carers need practical and emotional support,especially if the affected person becomes hostile and aggressive.Support groups can help people cope with caring for an elderly relative with the disease.Most people with Alzheimer's disease survive for 5-10 years from the time of diagnosis
Primary Amenorrhoea is usually due to late onset of puberty, although it can also be caused by a disorder of the reproductive or hormonal system The most common reason for Secondary Amenorrhoea is pregnancy.If the hormonal balance is interrupted for any other reason, however, periods may stop.e.g. many women who breast-feed find that their periods do not start again until they wean their babies. More seriously, Amenorhoea can be a side effect of being grossly underweight, such as with Anorexia Nervosa.Ths will be suspected if your weight is as much as 12kg,below average for your height and frame.Stress,chronic ailments such as Thyroid disease, and long-term medication with drugs such as antidepresants can also cause Amenorrhoea, as can excessive physical training if it reduces body mass index (weight in kg divided rby height in metes)to less than 20.Amenorrhoea is of course - a permanent condition after the Menopause, or if you undergo a Hysterectomy.Procedure: If you have never had a period, your doctor will probably give you a phyical examination and take a blood sample to measure the level of the Pituitary Hormones.They include those responsible for menstruation.With Secondary Amenorrhoea, once pregnancy is excluded by a specialist, and if you are taking any long-term medications,these should be checked and stopped if necessary.Your doctor may arrange for you to have an X-ray or MRI scan to make sure that your pituitary gland is of normal appearance.If you are not ovulating and wish to conceive, he may suggest that you take a course of fertility drugs or pituitary hormones Other Possible Causes: tThe lack of periods is not dangerous and in most cases there is no cause for alarm.Be patient and they will start up naturally.The tendency to start menstruation late may be inherited, so if your mother started her periods late, don't worry if you aren't developing at the same rate as your friends.However if you are 16 and have not yet menstruated, contact your doctor to check that there is no abnormality.If you are sexually active, pregnancy could be the cause,so do a pregnancy test first before contacting the doctor.Or you may need to change your lifestyle to correct any dietary or physical problem - if either is though to be the cause.See your doctor if your periods have been absent for 6months and you are not pregnant or Menopausal
Causes & Symptoms: The most common cause of anal itching is Candida (moniliasis,thrush) with redness and scaling of the adjacent skin.Localized itching may also be caused by poor personal hygiene,haemorrhoids or threadworm infestation.Generalized itching around the anal area may be a symptom of a skin disease such as psoriasis or eczema or be due to an allergic reaction to a substance such as laundry detergent or washing soap.Once the skin has been thickened by chronic scratching (neurodermatitis) it is very difficult to break the itch-scratch-itch cycle Treatment: There are several measures you can take to relieve anal itching.It is important to keep the anal area clean by washing and drying carefully (but not excessively) after a bowel movement.Avoid using soaps that irritate the skin,and try not to scratch because it will worsen the itching.A warm bath or shower before bed may soothe night-time itching.Loose underclothes made of natural fibres are less likely than synthetic materials to cause irritation.A over-the-counter cream containing a mild topical corticosteroid may give relief.Itching that lasts for longer than 3 days should be assessed by a doctor.Yuur doctor may examine your anus and arrange for tests to look for causes that need treatment.e.g severe haemorrhoids may need to be removed *also see Haemorhoids*
Causes: Anaphylaxis is most commonly triggered by insect stings or certain drugs such as penicillin.Foods such as nuts or strawberries may also trigger this serious form of allergic reaction Symptoms: If you have extreme sensitivity to a substance,you may experience some or all of the following symptoms as soon as you are exposed to it.Sudden feeling of extreme anxiety,swollen face,lips and tongue,wheezing and difficulty breathing,in some cases,an itchy,red rash and flushing of the skin.Lightheadedness or in some cases, loss of consciousness.If either you or anyone are with - develops these symptoms,you should call an ambulance or emergency service immediatly Emergency Treatment: Emergency treatment for Anaphylaxis is an immediate injection of adrenaline.Injections of antihistamines or corticosteroids,together with intravenous fluids,are also given.You should avoid any substance to which you are sensitive,especially if you have had a previous Anaphylactic reaction.Your doctor may provide you with syringes of injectable adrenaline called Epi-Pens.Keep one at home and one at work and carry one with you at all times.In the event of an episode of anaphylaxis,inject adrenaline immediately,then call for an ambulance.You will also be advised to carry an emergency card or bracelt to alert others to your allergy *also see Angioedema*
It is important to know that there are many other causes of central chest pain - but they don't all have significance of Angina.Some conditions are Heartburn,indigestion,peptic ulcer,gallstones,anxiety,muscle strain or inflammation Treatment: Your doctor can usually distinguish these from a heart condition by the nature of the pain - but you may have (ECG) Electrocardiography, a radionuclide (thallium) scan, an aniogram or coronary catheterization.An exercise ECG will show a heart that's under stress on exertion.Nitrate drugs increase the blood supply to your heart by widening the Coronary Arteries.You can get immediate relief by putting a (GTN) Glyceryl Trinitrate tablet under your tonque.Always keep them with you and never run out.You can also use them as a preventive before exertion - such as before intercourse.Beta-blockers,calcium-channel blocker or potassium-channel blockers reduce the amount of work you heart does by slowing down the heart rate and reducing the heart's need for oxygen.Side effects are uncommon -but include impotence, so report anything untoward to your doctor and you tablet could be changed.Surgical Treatment - Coronary angioplasty will improve the flow of blood to your heart.This isn't major surgery and you will be home in two days.Coronary bypass is when the narrowed section of your Coronary Arteries are bypassed by an artery or vein grafted from another part of your body,usually your leg.This is major surgery and you'll be in hospital for a week *also see Heart Attack*
In Angiodedma,the mucous membranes and tissues under the skin suddenly become swollen due to an allergic reaction.In some cases swelling of the mouth,throat and air passages is severe enough to prevent swallowing,even breathing.For this reason Angioedema requires emergency medical treatment Causes: The most common cause of Angioedema is an allergic reaction to a type of food - such as seafood,nuts or strawberries.Less commonly may result from an allergic reaction to drugs - most often antibiotics.This condition may also develop after an insect bite or sting.Rarely a person may inherit a tendency to develop Angioedena that is unrelated to an allergy.In such cases,episodes of unexplained Angioedena may begin in childhood and may be triggered by stressful events,such as an injury or a dental extraction.It is not unusual for people to have only a single episode of Angioedema,for which no cause can be determined Symptoms: Swelling usually develops within a few minutes and is often asymmetrial e.g. only one side of a lip may be affected.The main symptoms are - swelling of any part of the body,especially the face,lips,tonque,throat and genitals.Sudden difficulty breathing,speaking or swallowing due to swelling of the tongue,mouth and airways.In about half of all cases,an itchy rash (urticaria) affecting areas that are not swollen Warning: Any severe allergy may develop at some time into an attack of Angioedema.The swelling may affect the larynx (voice box) and can be lifethreatening if the airways becomes blocked.Angioedema may occur at the same time as Anaphylaxis - a potentially fatal allergic reaction that requires urgent medical attention.If you develop the symptoms of Angioedema or experience difficulty breathing - you should immediately call an ambulance / emergency mobile unit or report without delay to the Emergency Unit of your clinic or hospital Emergency Treatment: Severe Angioedema requires an urgent injection with adrenaline,followed by observation in hospital.In milder cases,a corticosteroid or an antihistamine may be prescribed to reduce the swelling,this may take hours or days to subside.Your doctor may carry out tests to determine the cause.If a food allergy is suspected,a skin prick test may identify the substance to which you are allergic.If you suffer from severe angioedema,your doctor may teach you how to self-inject adrenaline *also see Anaphylactic Shock*
Anorexia Nervosa: Diet is easy to be good at,you just have to starve yourself.But it is impossible for an Anorexic to believe it is the only thing she is good at,so thinness becomes an obsession.Anorexics judge themselves only according to how much they have eaten,the less they eat the more successful they judge themselves to be.All their self-worth becomes bound up in not eating and so starving becomes very difficult to give up.Anorexics have food and crave love.They remember the time when they felt secure in being loved and did not have to take any grownop responsibilities,so they may subconsciously try to remain a child.As a child they did not have to perform and they did not have to exxcel.By starving they fight against their developing body - they lose or don't develop breasts and do not menstruate Bulimia: Bulmics go for several days with very little food and then become crazed with an uncontrollable desire to eat so that they gorge on almost anything ins sight that is edible.This may mena eating exraordinary mixtures of raw and cooked food,sweet and savoury mixed in huge quanities.Some women have died after a binge,because their stomachs have ruptured under the strain.Some women eat normally,but then force themselves to vimit immediately afterwards ortake huge quantities of laxatives to induce purging.This pattern of starving,bingeing,vomiting and purging is very had to break.It is also much more common than people think,but treatments can help Causes of Eating Disorders: 1. The desire for control: Dieting can be very satisfying,especially for girls in their teens who feel that weight is the only part of their lives over which they have control.Not eating becomes and end in itself 2. Social pressure:In societies that don't value thinness,eating disorders are very rare.In surroundings such as ballet schools, or modeling schools,where people value thinness hightly,they are common 3. Cultural pressure: Generally in Western culture 'thin is beautiful'.The media are full of slim,attractive young men and women and there is a huge pressure to conform 4. Family: Some children and teenagers find saying no to food is the only way they can make their feelings felt and have influence in the family.Eating becomes an important social tool with which to exert pressure on parents 5. Not growing up: A girl with Anorexia may lose or not develop some of the physical traits of an adult woman,such as pubic hair breasts and monthly periods.As a result,she may look very young for her age.Not eating therefore can be seen as a way of putting off some of the demands of growing up,particularly the sexual ones 6. Depression: Many bulimics are depressed and binges may start off as a way of coping with unhappiness.A third of people with eating disorders are depressed and can be helped with the new generation of antidepressants 7. Upsets: For some people,Anorexia and Bulimia seem to be triggered off by an upsetting event,such as the break-up of a relationship.Sometimes it need not even be a bad event,just an important one,such as a marriage or leaving home Consequences of Anorexia & Bulimia: 1. Starvation - leads to broken sleep,constipation,difficulty to concentrating or thinking straight,depression,feeling the cold,brittle bones that break easily,muscles becoming weaker - it becomes an effort to do anything,mensturation failing to start or stopping,inability to have a baby and even death 2. Vomiting - Stomach acid dissolves the enamel on teeth and swollen salivary glands leads to a puffy face,irregular heartbeat,muscle weakness,eventually to kidney damage and even epileptic fits 3. Laxative use - Causes persistent tummy pain,swollen fingers and damage to bowel muscles that may lead to long-term constipation 4. Bladder Problems - Become common.New research shows that women with Anorexia, are far more likely to have bladder problems than other women. Nearly two-thirds of women with Anorexia,at least three time more thannon-sufferers, had symptoms suggestive of an unstable bladder,with a sudden and overwhelming desire to go to the loo 8 x or more in 24 hours and sometimes actual incontinence.These symptoms usually start about a year after Anorexia began Treatment of Eating Disorders: The sooner you ADMIT to having an eating disorder and ACCEPT HELP,the better the chance of a cure.Left untreated,Anorexia has one of the highest death rates of all psychiatric illnesses,though deaths can be prevented by proper treatment.No one form of treatments in 100% effective,what is effective for one person may not be effective for you.And despite best efforts,some people only partly recover.But there are lots of avenues to explore 1. Your GP - to help yourself,you have to be open and honest with your family doctor.You don't need to be ashamed of being Anorexic or Bulimic or reluctant to admit that you have a problem.You don't need to be frightened of the concequences of admitting that your have an eating disorder.You are entitled to complete confidentiality.It is your right to be referred for assessment by a specialist who has training in eating disorders and you should be seen as soon as possible so that delays and waiting lists can be avoided.You may get worse if you wait too long and then need 'in-patient' rather than 'day-patient' treatment 2. Self Help - self-help support groups can be a very useful addition to treatment but they are not an alternative.They are very helpful in getting patients and families to understand they are not alone with the illness 3. General Treatment - Treatments mus address the psychological aspects of Anorexia & Bulimia Nervosa as well as the abnormal eating pattern.All these treatments work,so don't be afraid to try them - Counselling,Psychotherapy,Cognitive Therapy, Group Therapy,Family Therapy,Day hospital programmes,In-patient treatment,Dietetic advice, Drugs can be of help in the short term,particularly to Bulimics who are depressed. Re-feeing is last resort,but may be necessary to save life. Alone,however,it is only successful in short-term weight-restoration,but usually is not effective in the long term 4. Counselling - For Anorexia,counselling is more effective during the early stages - when less than 25% of body weight has been lost.Research shows that cognitive behaviour therapy is especially effective for people with Bulimia 5. Specialist Treatment - You should be involved as much as possible in your treatment programme and care plan,so you should be able to see your case notes and be involved in setting target weights.Therapy should not be conditional on weight gain,and vegetarian menus and appropriate food for minority groups shoud be available 6. Hospital Treatment - Some severely underweight people with Anorexia Nervosa can be treated sucessfully as day-patients rather than in-patients.If you need in-patient treatment,you have the right to - a quite and safe environment,continuity or care from staff with an understanding of eating disorder,support during and after your meals,appropriate food,on-going counselling or psychotherapy,follow-up and support after in-patient care 7. Compulsory Admission - Out of people who had been admitted or detained against their wishes,50% said they thought it had been 'a good thing' in retrospect.So,in extreme circumstances,and when all other alternatives have failed,people may be detained under the Mental Health Act - in order to save life or reduce risk 8.Teamwork - Good treatment demand selfless teamwork with families,careres and friends all working together.The impact on the family of someone with an eating disorder can be enormous.Families also need support .They need advice on what they should and should not do to help a person's recovery
Causes: An increased susceptibility to anxiety disorder may be inherited or may be due to childhood experiences.e.g poor bonding between parent and child,abrupt separation of a child from a parent have been shown to play a part in some anxiety disorders.Generalized anxiety disorder may develop after a stressful life event,such as the death of a close relative.However,the anxiety frequently has no particular cause.Similrly,panic attacks often develop for no obvious reason Symptoms: People with generalized anxiety disorder and panic attack experience both psychological and physical symptoms.However in someone with generalized anxiety disorder, psychological symptoms persist,while physical symptoms are intermittent In panic attacks,both psychological and physical symptoms come on together suddenly and unpredictably.The psychological symptoms of anxiety include 1. a sense of nameless foreboding with no obvious reason or course 2. being on edge and unable to relax 3. impaired concentration 4. repetitive worrying thoughts 5. disturbed sleep and sometimes nightmares In addition you may have symptoms of depression,Physical symptoms of the disorder which occur intermittently - include headache,abdominal cramps,sometimes with diarrhoea and vomiting,frequent urination,sweating,flushing and tremor,a feeling of something being stuck in the throat Psychological and physical symptoms of panic attacks include - shortness of breath,sweating,trembling and nausea,palpitations (awareness of an abnormally rapid heartbeat),dizziness and fainting,fear of choking or of imminent death ,a sense of unreality and fears about loss and sanity.Many of these symptoms can be misinterpreted as sign of a serious physical illness and this may increase your level of anxiety.Over time,fear or having a panic attack in public may lead you to avoid sutuations such as eating out in restaurants or being in crowds Treatment: You may be able to find your own way of reducing anxiety levels,including relaxation exercises.If you are unable to deal with or identify a specific cause for your anxiety,you should consult your doctor.It is important to see a doctor as soon as possible after the first panic attack.If you are coping with a particularly stressful period in your life or a difficult event,your doctor may prescribe a Benzodiazepine - but these drugs are usually prescribed for only a short period of time e.g 3-4 weeks,because there is a danger of dependence.You may be prescribed a beta-blocker drug to treat symptoms of anxiety,If you have symptoms of depression,you may be given antidepressant drugs,some of which are also useful in treating panic attacks,particularly the newer SSRI's (selective serotonin re-uptake inhibitors).In most cases the earlier anxiety is treated the quicker its effects can be controlled.Without treatment,anxiety disorder may develop into a life-long condition.There are also several measures you can try to help control a panic attack,such as the simple expedient of breathing into a bag.For any anxiety disorder,your doctor may suggest counselling to help you manage stress.You may also be offered cognitive therapy or behaviour therapy to help you control anxiety.A self-help support group may also be useful *also see under panic attacks*
Appendicitis: Inflammation of the Appendix, causing the appencix to become swollen and infected.Serious condition needs immediate attention Arachnophobia: Fear of spiders
Causes: Most arrhythmias are caused by disease of the heart or its blood vessels.The most common underlying disorder is Coronary Artery Disease.Less common causes include various Heart Valve Disorders and inflammation of the heart muscle.Causes of arrhythmias that originate outside the heart include an overactive thyroid and a lack of potassium.Some drugs may also cause arrhythmias, as may caffeine and tobacco.Symoptoms: Do not always develop but if they do - their onset is usually suddenly and include - Palpitations (awareness of an irregular heartbeat) Light-headedness, sometimes leading to loss of consciousness, Shortness of breath,Pain in the chest or neck like Angina.Stroke and heart failure are possible complications Treatment: (ECG) Electrocardiography, ECG over 24 hours to track the arrhythmia,Ambulatory ECG, a wearable device that is worn for 24 hours and detects intermittent arrhythmias.Anti-arrhythmic drugs such as digoxin,beta-blocker,calcium-channeled blockers,amiodraone,flecainide and propafenone.Cardioversion (defibrillation) - restoration of a regualr heart rhythm by passing an electrical current through the heart under a general anaesthetic. Or a Cardiac pacemaker
In Children: Asthma is primarily an allergic disease that affects air passages (bronchi) that are extra sensitive to triggers.When the allergic reaction takes place, the bronchi constrict and become clogged with mucus,making breathing difficult.The muscle around the wall of the airways tightens so that inhaled air can not be forced out.An Asthma attack can be very frightening for a child,because the feeling of suffocation can cause panic,making breathing even more laboured .The initial cause of the allergic reaction - the allergen - is usually airborne (pollen or house dust).Once Asthma is established,emotional stress or a mild infection such as a cold can also bring on an attack.Asthma does not usually begin until a child is about 2 years old.The condition tends to run in families and may unfortunately be accompanied by other allergic diseases,such as eczema,hay fever and penicillin sensitivity.However the good news is that more children get better as they get older Wheezing in Babies: Many babies under one year wheeze if they suffer from bronchiolitis,when their small air passages becomes inflamed.These babies are not necessarily suffering from Asthma- as they grow - their air passages widen and the wheezing will stop.Infection and not an allergic reaction is the usual cause of this kind of wheezing Is it Serious? Asthma attacks can be frightening,but with medication and advice from your doctor you child should suffer no serious complications Possible Symptoms: Laboured breathing - breathing becomes difficult and the abdomen may be drawn inwards with the effort of breathing in.Sensation of suffocation.Persistent cough - particularly at night.Wheezing.Getting short of breath - a child does not run around as much as usual.Blueness aroung the lips (cyanosis) because of lack of oxygen Home Treatment: 1. Consult with your doctor immediately if your child is having any kind of difficulty with breating 2. If the attack occurs when your chld is in bed,sit him up,propped up with pillows.Otherwise,sit him on a chair with his arms braced against the back - to take the weight off his chest - this allows the chest muscles to force air out of the lungs more efficiently 3. Stay calm - a show of anxiety would only make your child more fearful 4. While waiting for the doctor,try to take your child's mind off the Asthma attack.Sing to him - or try something to help him forget about the wheezing 5. Put a humidifier in the room to ease his sensitive air passages 6. Give him/her lots reassuring cuddles Your Doctor: the mainstays of treatment are reliever drugs to relieve and attack of Asthma and preventer drugs to stop an attack from happening.Preventer drugs must be taken all the time to keep a child free of Asthma symptoms 8. Your doctor will treat the attack with a reliever drug,usually a bronchodilator,which opens up the bronchi by relaxing the muscles in the lining of the air passage.This drug is inhaled directly into the bronchi and gets right to the site of the obstruction.A severe attach may need treatment in hospital,where bigger doses of bronchodilator drugs may be given by inhalation or by intravenous drip.If there is evidence of a chest infection,your doctor will prescribe anitbiotics.Your doctor will want to prevent further attacks.He may,for instance try to determine the allergen,so that your child can avoid it - probably by performing skin tests for the most likely allergens,such as pollen and house dust.He will give you a supply of a bronchodilator drug,usually as an inhaler used with a 'spacer' that is easy for children to use,to be taken as soon as an attack begins.Your doctor will ask you to inform him if your child has a severe attack,or if an attack does not respond to 2 doses of the bronchodilator.Your doctor may prescribe a steriod drug if other simple measures don't stop further attacks.Don't be afraid,steroids for Astham are nearly always inhaled into the deepest parts of the lungs,and are quite safe.A small dose of steroid may be inhaled 3-4 times a day What can your do? : If your doctor has not pinpointed the allergen,try to track it down yourself.Notice when the attacks occur and at what time of day or night.Avoid obvious allergens such as feather pillows and keep the dust down in your house by damp-dusting and vacuuming floors rather than sweeping them.Many Asthmatic's are allergic to animals - their hair,fur,feathers & saliva.If you have a pet,ask a friend to look after it for 2 weeks and see if your child's attack reduce in frequency.Make sure your child has the prescribed drugs nearby at all times.Inform his school about the possibility of attacks occuring.It is vital your child takes his preventer medicine continuously and does not stop just because he is feeling fine.Never stop a preventer without consulting your doctor.Ask to be referred to a physiotherapist so your child can learn breathing exercises to help him to relax during an attack.Encourage your child to stand and sit up straight so that his lungs have more space.Do not let him get overweigth,as this will put an extra burden on his lungs.Moderate exercise can help his breathing,but too much can bring on an asthma attack.Swimming however,can be especially helpful for children with Asthma
Athlete's foot affects the soft area between and underneath the toes and seems to have a preference for sweaty feet.The infection is aggravated by by sweaty feet because the fungus - Tinea - which also causes ringworm elsewhere in the body,thrives in warm moist conditions.Athlete's foot may also affect the toenails.Not everyone exposed to the fungus gets the infection Symptoms: 1. White,blistered skin between and underneath the toes.The are is itchy and when scratched,splits and leaves raw,red skin underneath 2. Dry peeling skin 3. Thick yellow toenails Treatment: Athlete's foot is a common condition requireing simple treatment and good hygiene to cure it.However it is contagious and you should act quickly so that the condition in not spread.Consult your doctor as soon as possible if the underside of the foot is already affected or if the nails are distorted or yellowing.Consult your doctor if self-help measures fail to improve the condition within 2-3 weeks . If the fungus has affected the toenails,they turn whitish,thicken and sometimes detach from the nail bed.Usually debris from the infected nail collcects under its free edge.The diagnosis is confirmed by examining a sample of the nail debris under a microscope,where the fungus can be seen growing and culturing it ot determine which fungus is causing the infection.If you have consulted your doctor because self-help measures failed,your doctor will prescribe another antifungal fowder or cream and will advise you on the correct procedure for good foot hygiene.If your toenails are affected,your doctor will prescribe an antifungal medication that may need to be taken for 3 months.The infected nails will eventually grow out completely Self-Help: Keep your feet clean & dry,particularly the area between the toes.Check the area between and underneath the toes for blisters,redness and cracking.Check the condition of the toenails.Buy an antifungal powder or cream from your pharmacy and after washing and drying the feet thoroughly,apply the treatment following the manufacturer's instructions.Keep your towel and bathmat seperate from those of the rest of the family and wash them every day.Do not go barefoot until the condition has cleared up.Make sure you wear clean socks every day,preferably made from natural fibres such as cotton or wool.Rotate your shoes,especially trainers so they dry out between wearings
Different Types: In some autoimmune disorders,the tissues of a single organ are damaged,preventing normal function.Here are some examples of organs that may be affected. The Thyroid gland - in Hashimoto's disease,The Pancreas - in Diabetes Mellitus.The Adrenal glands - in Addison's disease. A second group of autoimmune disorders affects connective tissue,the glue that holds together the structures of the body e.g. Scleroderma and Lupus.In these disorders,the immune system may react against connective tissues anywhere and everywhere in the body,resulting in many and varied symptoms Treatment: If your doctor suspects an Autoimmune Disorder,you will have blood tests to assess your immune function and look for evidence of tissue inflammation.The treatment of autoimmune disorders depends on which organs are affected.In Hashimoto's Thyroiditis or Addison's disease damage to the affected organs leads to a deficiency in the hormones they normally produce.However,replacement can often restore health.In other cases the aim of treatment is to block antibody production in the first place with drugs such as immunosuppressants and corticosteroids or limit the effects of anitbodies.Non-steroidal anti-inflammorty drugs (NSAID's) can treat symptoms such as pain and stiffness Prognosis: The outlook for people who have autoimmune disorder depends on the amount of damage to the body's tissues and organs.Autoimmune disorders are nearly always chronic,but the symptoms can often be controlled with drugs.In some cases,serious complications such as kidney failure may develop.Quite often though,the disease eventually 'burns out' in middle age and symptoms subside
Avulsion Fracture: A piece of bone is pulled away from the main bone by a tendon that attaches a muscle to a bone.It usually results from a sudden violent contraction of the muscles *also see under fractures*
info sources: South African Family Medical Adviser Family Health Guide & The Baby & Child Health Care Handbook - Dr.Miriam Stoppard
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