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South African Medical Directory (Quick Reference) D
Causes: It is usually caused by a combination of a slow blood flow through a vein.An increase in the natural tendency of the blood to clot,such as after surgery.A damage to the wall of the vein.Long periods of immobility such as those excperienced during air or road travel or while bedridden,ar as coomon cause of slow blood flow.Other causes include compression of a vein by the fetus during pregnancy or by a tumour.Leg injury may also cause a clot to form in the deep vein of the leg Symptoms & Treatment: A blood clot in a deep vein may produce pain or tenderness in the calf of the leg.Swelling of the lower leg or thigh.Enlarged veins beneath the skin.Treatment:To confirm the diagnosis you may have Doppler ultrasound scannng to measure blood flow through the veins and sometimes a venogram - in which dye is injected into a vein and then X-rays are taken to reveal blood clots.A sample of your blood may be taken and analyzed to see how easily it clots.Thrombolytic drugs are used to dissolve the blood clot in the vein and reduce the risk of a pulmonary embolism.Injections of anticoagulants are admininsted to prevent further clots.Although treatment can take place in the hospital, you may be able to self-administer anitcoagulant drugs at home.Rarely the clot is removed surgically.After you have had the initial treatment,your doctor will prescribe drugs to reduce the risk that the condition will recur Precaution:If there is a high risk,low doses of shortacting anticoagulant drugs will probably be given before and after any surgery,to prevent the blood from clotting.Your doctore may also advise you to wear special elastic stockings for a few days after the operation to help maintain blood flow to the veins of the leg.Women who use a combined oral contraceptive should stop it 2-3months before surgery and will need to swithch to an alterntive form of contaception.If you are confined to bed, you should regularly stretch your legs and flex your ankles.Your doctor may also recommend that you wear elastic stocking.During a flight - walk around at least once an hour and during a long drive, stop regularly to stretch your legs.You could also discuss with your doctor the possibility of taking a small dose of aspirin before during and after a long journey Complications: A fragment of the clot may break off and find its way to the lungs.Such a pulmonary embolism occurs in about 1 in 5 cases of deep vein trombosis.The seriousness depends on the size of the fragments.The symptoms associated with pulmonary embolism usually include shortness of breath and chest pain.Rarely - if the clot is large enough to compromise the blood supply to the lungs,severely, the condition is life-threatening.In some cases, thrombosis causes permanent damage to the vein and varicose veins may appear later
Risk Factors: Depression in the past or a family history of depression.Poor health - such as a stroke or history of depression. Widowhood and widowerhood.Loss of a child,partner, family member or close friend or animal companion.Victims of crime & violence.Personality problems,Isolation.Lack of confidence.Money & work matters.Marriage problems & Divorce.With elderly people,alterations in health and circumstances such as giving up the family home Causes: The cause of depression is complex but is probably related to a reduction in the level of certain chemicals in the brain called Neurotransmitters,which keep us in a good mood by stimulating brain cells.The best knwon of these mood elevators is Seratonin Symptoms: Tiredness,Sleep problems,Worry,Weepiness,Sadness,despair,misery,goom and blackness.Loss of affection towards oneself and others.A sense of failure,unworthiness,even self-loathing.Loss of interest in life,Loss of sex drive,Loss of self-esteem & confidence,altered appetite - usually loss, lethargy or sleeping for long periods as a means of escape,early-morning waking - typically between 2a.m - 4a.m. A convition that the world is against you.Paranoia,recurrent thoughts of death and even suicide Treatment: Try to see your doctor at once if you feel depressed.Do not wait and hope your mood will pass.Don't try to cope alone.Lean on people.Join a self-help group and get help with your everyday problems.Avoid being alone and make a point of being with people you like.Don't be affraid to approach organizations that are known to support depression sufferers.In the case of weepiness after the birth of your baby,see your doctor if you are still depressed after 2 weeks.The longer the postnatal depression stays untreated,the harder it is to cure Psychothera - whether individual or in a group - is most useful for those whose personality and life experiences are the main cause of their illness Cognitive Therapy - The aim of one of the most successful treatments is to change the way you think about problems and therefore be able to deal with them Drug Treatment - Is usded for people with predominantly physical symptoms.There are two main groups of antidepressants,tricyclics,introduced in the 1950's wiht well-known side effects and selective serotonin re-uptake inhibitors (SSRIs) - which appeared mainly in the 1990's.The newer antidepressants,such as SSRI's are costly,but have fewer side effects than the older drugs and patients seems to like them.Yet large studies show tricyclics work equally well to cure depression if you can tolerate them.Antidepressant drugs are effective in more than two-thirds of patients,provided the drugs are taken in a different dosage over a long enough period of time.They take between 2 and 3 weeks to work.Patients compliance is high,important because halting medication too early is a big factor in depression returning Antidepressants and psychotherapy in combination - Patients who stop drug therapy before 6 months will relapse.But maintenance therapy with either drugs of psychotherapy will halve their relapse rate.What is more,cognitive therapy,continues to work after it is stopped.Its effectiveness being the same as maintenance drug therapy,something to remember if you do not like taking drugs for long periods Mild Depression - Self help methods are.Work - if work distracts you,increase your workload.Keeping active - any kind of activity helps reduce sadness and will bring the pleasure of achievement.Completing a task gives your a sense of self-worth,which in itself is an antidode to depression.Sex - good,wholesome sex makes all aspects of life seem brighter,so if your libido is not depressed,keep sexually active.Diet - avoid junk food and sugar an increase your intake of wholegrain cereals,vegetables,fruit,lean meats,low-fat dairy products and fish.The amino acid tryptophan has been found to relieve depression and natural sources include turkey,chicken,fish,peas,nuts and peanut butter.Wher possible eat them with carbohydrates,such as potatoes,pasta or rice,which facilitate the brain's uptake of tryptophan.Cut out or down on caffeine and alcohol.Exercise - alleviates all kinds of mental stress.It also increases blood flow to the brain.Jogging for 30 min 3x a week,can be as effective as psychotherapy in treating depression.So a regular routine of exercise of walking,swimming or whatever appeals,is good for your mood.Aromatherapy - essential oil of clary sage is both a powerful relaxant and mentally uplifting.It can ease mental fatigue and promote sound sleep.Put 2-3 drops into a bowl of steaming water and inhale or inhale 4-6 drops from a tissue.Relaxation - techniques to reduse stress, such as massage,yoga,aromatherapy and meditation,are helpful in alleviating the anxiety that is common with depression Dermabrasion: The removal of the top layer of skin under a general anaesthetic performed by a Specialist
*also see Eczema,Contact Dermititis & Seborrhoeic Dermatitis & Atopic Gene*
Symptoms: Polymyositis results in - weakness of affected muscles,leading to e.g. difficulty raising the arms or getting up from a sitting or squatting position.Painful,swollen joints.Fatigue.Difficulty swallowing if the muscles of the throat are affected.Shortness of breath if the heart or chest muscles are involved.In cases of Dermatomyositis,the symptoms outlined above may be preceded accompanied or followed by the following additional symptoms - a red rash, often on the face,chest or backs of hands over the knuckles.Swollen reddish-purple eyelids Treatment: This condition must always be treated by a specialist.Usually high-dose steroids are given along with analgesics for symptomatic relief
Diarrhoea is the production of stools that are more watery,more frequent or greater in volume than is normal for you.Although not a disease itself,Diarrhoea may be a symptom of an undelying disorder.In some cases,diarrhoea is accompanied by abdominal pain,bloating,loss of appetite and vomiting.Severe diarrhoea can lead to dehydration that may be life-threatening.Short episodes of diarrhoea, especially if they are associated with vomiting,are often due to gastroenteritis or food poisoning.Diarrhoea that lasts more than 3-4 weeks usually indicates that there is an intestinal disorder and requires medical attention Causes: Diarrhoea that starts abruptly in a person who is otherwise healthy, is often caused by a change in diet or contaminated food or water and may last a few hours - 10 days.This sort of diarrhoea often occurs during travel in a foreign country.Diarrhoea may also be caused by a viral infection that is spread by close personal contact.Such infectious Gastroenteritis is the most common cause of Diarrhoea in babies and young children.People taking drugs such as antibiotics may develop sudden diarrhoea if the drugs distrub the normal balance of bacteria in the colon.Persistent diarrhoea may be a result of chronic inflammation of the intestine due to disorders such as Chron's disease or Ulcerative Colitis Diarrhoea is a symptom of some conditions,such as coeliac disease,in which the small intestine cannot absorb nutrients.Lactose intolerance, a disorder in which lactose - natural sugar in milk - cannot be broken down and absorbed,can also cause diarrhoea.Infection with parasites,such as giardiasis and amoebiasis, lead to chronic diarrhoea.Irritable Bowl Syndrome (IBS) may produce abnormal contractions of the intestine,which result in alternating episodes of diarrhoea and constipation SYmptoms & Treatment: In most cases,diarrhoea clears up within a day or two.Other symptoms that can accompany diarrhoea,such as headache,weakness and lethargy,are most often caused by dehydration.The symptoms of dehydration disappear as soon as the fluids and salts that have been lost, are replaced.If your diarrhoea lasts longer than 3-4 days,you should consult your doctor who may request a sample of faeces to look for evidence of either infection or unabsorbed nutrients.If your diarrhoea persists for more than 3-4 weeks or if there is blood in the faeces,your doctor will probably arrange for you to have certain investigative procedures,such as contrast X-rays of the intestines or sigmoidoscopy or colonoscopy (endoscopy of the rectum or colon).Specific treatments given for diarrhoea depends on the underlying cause.If you need to curtail your diarrhoea quickly,your doctor may prescribe and antidiarrhoeal drugs,such as loperamide.However,antidiarrhoeal drugs should usually be avoided if your diarrhoea is due to an infection,because they may prolong the infection.Antibiotics are only needed to treat persistent diarrhoea that has a known bacterial cause
Disseminated Sclerosis: Also known as Multiple Sclerosis.Chronic disease of the nervous system Diverticula: These are the small pea or grape-sized pouches that forms in the wall of the Colon *also see Diverticulitis & Diverticulosis*
This condition is rare before age 50 but about 1n in 3 people between the age of 50 & 60 has diverticulosis, and it becomes progressively more common after age 60.However,most affected people have no symptoms.Diverticulitis is strongly associated with a low-fibre Western diet,which may cause constipation Symptoms: More than three-quarters of all people with diverticulosis do not know that they have the condition because there are no symptoms.If symptoms are present,they may include the following things such as episodes of abdominal pain,especially in the lower left abdomen,that are relieved by a bowel movement or a release of intestinal gas.Intermittent episodes of constipation and diarrhoea.Occasional bright red bleeding from the rectum,which may be painless.In some cases - Diverticulosis is difficult to distinguish from Irritable Bowel Syndrome (IBS) because both have similar symptoms.If diverticulitis develops, the symptoms may become worse with - severe lower abdominal pain and tenderness in the abdomen.Fever,nausea & vomiting.If you notice any change in your bowel habits or you have rectal bleeding,you should consult your doctor immediately - because these symptoms may indicate a more serious underlying disease,such as colorectal cancer.If an inflamed Diverticulum bursts,faeces and bacteria can spill into the abdominal cavity.As a result and abscess may from next to the colon or Peritonitis - an inflammation of the membrane that lines the abdominal cavity,may develop.Fortunately both are very rare Diagnosis & Treatment: If your doctor suspects that you have Diverticulosis, a Barium enema to highlight the shape of the intestines will be arranged.If your symptoms include rectal bleeding,a Colonscopy may be carried out to examine the colon and exclude colorectal cancer.Often,a high-fibre diet with plenty of fluids is the only treatment needed fro Diverticulosis.You may also be given antispasmodic drugs to relax the intestine and relieve abdominal pain.If you develop severe Diverticulitis - you will be given antibiotics to treat bacterial infection Diverticulosis: This is the presence of small pouches known as Diverticula in the wall of the colon
Symptoms: Small, upward slanting eyes, nose with a wide bridge,short broad hands with a deep crease across the palm,gap between the first and second toes.Some degree of learning difficulty Treatment: The degree of learning difficulty varies widely in children with Down's Syndrome and a few may be within the normal intelligence range.Modern theories reject the idea that all children with Down's Syndrome should be educated in special institutions. The education of a child with Down's are usually educated in mainstream schools.As with all children the emphasis should be on what the child can do rather than what she/he cannot.Almost all children Down's Syndrome will learn to walk and talk and some will learn to read and write.They need extra help to fulfil their potential,but with this help many will go on to lead semi-independent lives
Dysentery: Shigella bacillus - Bacterial infection of the lining of the Large Bowel causing severe Diarrhoea and fever.Very serious in children and babies because of the risk of DEHYDRATION Dyslexia: Dyslexic children are of average or above intelligence.Some may appear clumsy.This is a Specific Learning Disorder concerning Reading and Writing.Dyslexic children have problems interpreting Visual symbols.Although the hearing and vison are normal and they have the dexterity to form letters, they may have difficulty in perceiving letters or words in their proper order, or they may confuse certain letters such as b & d and p & q.Which have a similar overall configuration.They may disregard punctuation and read monotonously and quite often they produce incorrect spellings that nevertheless reflect the sound of words or that transpose letters
Causes:For some women,superficial pain during sexual intercourse may be caused by psychological factors - such as anxiety,disorder guilt or fear of sexual penetration.These factors can also result in vaginismus A fairly common cause is vaginal dryness especially in women of premenopausal,menopausal or postmenopausal age.Superficial pain during intercourse may also be caused by infection of the urinary tract or the genetals.Pain that is felt deep within the pelvis during intercourse may be due to a disorder of the pelvic cavity or of the pelvic organs such as pelvic inflammatory disease Treatment: If you think you pain is due to vaginal dryness,causes by a lack of arousal,talk to your partner about spending more time on foreplay.You could also try to a lubricating jelly.In menopausal women - estrogen creams or pessaries inserted into the vagina help tremendously.If you consult your doctor - he/she may take swabs from your vagina and cervix to test for infection and my arrange for ultrasound scanning and computerized tomography (CT)scanning of the pelvis to look for abnormalities.If none are found you must consider that the cause may be psychological and go for counselling *also see vaginismus* Dyspepsia: Indigestion Dyspepsia is caused by pain or discomfort in the upper abdomen brought on by eating is - commonly known as indigestion.There are various causes e.g stress,overweight,smoking and certain dietary habits are risk factors Symptoms: Indigestion is a word covering many upper abdominal symptoms related to eating food,including heartburn,fullness,discomfort,pain,nausea,flatulence and belching.For most people it is a feeling of discomfort induced by eating too much, too quickly or by eating very rich spicy or fatty food. 'Nervous indigestion' can be a reaction to stress and can be a symptom of peptic ulcer,gallstones or heartburn Treatment: Eat small meals often or at least regularly 3x a day.Avoid foods and situations that bring on indigestion.Take an antiacid when symptoms start.See your doctor if you need to take antacids often or if your pain lasts longer than a few hours.Indigestion starting suddenly in middle age,must always be investigate to exclude stomach cancer Self Help - Prevention: Eat small portions of food at regular intervals without rushing or overfilling your stomach.Avoid eating in the 3 hours before going to bed to allow your body enough time to digest food.Reduce or eliminate your intake of alchohol,coffee or tea.Avoid rich,fatty food such as butter and fried foods.Keep a food diary to help identify foods that causes indigestion.Learn to overcome stress.which can often trigger episodes of indigestion.Try to lose excess weight and avoid tight-fitting clothing.If possible avoid medicines that irritate the digestive tract,such as aspirin and non-steridal anti-inflammatory drugs (NSAID's)
info sources: South African Family Medical Adviser Family Health Guide & The Baby & Child Health Care Handbook - Dr.Miriam Stoppard |