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South African Medical Directory

(Quick Reference)

E

Eating Disorders: Eating disorder like Anorexia Nervosa & Bulimia are abnormal ways of controlling weight,but neither is what is popularly described as the 'slimmers disease'.Both are expressions of deep inner turmoil of psychological problems that are too difficult for the person to cope with in any other way

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

Ectasia: Dilatation of the Milk Ducts.The underlying change in the normal anatomy of the milk ducts as a woman grows older is called Ectasia or dilatation.Ectasia occurs in the last part of the breast's development cycle, and if the dilatation is excessive the nipple may retract, making it slit-like in appearance.The condition is normal and may effect both breasts.By the age of 70, 40% of women have substantial Ectasia.Sometimes Ectasia is accompanied by nipple discharge or lumpiness.Although the cause of this discharge or lumpiness is very rarely cancer, you should always consult your doctor if you discover either of these things.You may be offered surgery to correct Ectasia if nipple dischare or the nipple's inverted appearance bothers you
Ectopic Heart Beats: Extra contractions of the heart that are out of the normal Rhythmic pattern - but are nonetheless normal.We all have them occasionally.Most people have at least one Ectopic beat every day
Ectopic Pregnancy: A pregnancy in which the fertilised ovum grows outside the Uterus -usually in one of the Fallopian Tubes
Ectropion & Entropion: Conditions of the lower eyelids in some older patients Entropian-turning in of eyelid Ectropian- turning out of the eyelid

Eczema: Dermatisis.The word comes from the Greek word meaning to 'Boil over'.An irritating allergic Skin condition.Producing an extremely itchy,dry,scaly red rash of the face,neck and hands and the creases of the limbs

There are several types of Eczema -The most common type of Exzema is Atopic Eczema - sometimes refered to as 'allergic eczema'. If someone is Atopic they carry a gene that makes their skin react to stress (a virus infection,an irritant in contact with the skin,psychological disturbances) with patches of Eczema.Once you have Eczema or Dermatitits - you will always have the tendency to develop it,so episodes may return throughout your life. Atopic Eczema sufferers may also develop asthma or hay fever or may have relations who have those conditions.The gene for Atopy,tends to run in families but may express itself differently in family members, e.g migrine in one,hay fever in another,allergies in another,asthma etc.All these conditions are close relatives of Eczema. Though the tendency to develop Eczema is undoubtedly genetic,certain food (commonly dairy products,eggs and wheat) and skin irritants (such as pet fur,wool or washing powder) can act as triggers especially in children

Symptoms of Eczema: Dry,red scaly rash,which is extremely itchy occurring on the face,neck and hands and in the creases of the limbs.The rash usaully stats off as minute pearly blisters beneath the skin's surface.When very severe,the rash may weep.Sleepiness may result if the itchiness is very bad

Aggravating Factors of Eczema: Symptoms vary from mild to severe and can be made worse by climate changes,especially if exposed to cold winds or excessive heat.Water,especially hard water,Soaps,washingpowders,detergents,cleansers,bubble bath,cosmetics & perfume.Pollen,pet hair animal dander,dust,Stress and anxiety.Synthetic or wool fibres.Certain chemicals acids,alkalis,oxidizing or reducing agents,oils,solvents,Colds,flue,infections of any kind

Precaution: People with eczema should avoid contact with soap,detergents and other irritants.This means wearing rubber gloves for household wet work,or cotton gloves for cleaning.They should avoid jobs or occupations that expose their skin to irritants,such as in hairdressing,catering,mechanical engineering and perhaps nursing,especially if the Eczema affects the hands.Reduce the population of house dust mites in the home by regular dusting and vacuuming of carpets.Dust mite bed covers have benefitted some sufferers and frequent airing and changing bed linen should reduce the house dust mite population in bedding.Bed clothes should be washed at 50o c or more to kill house dust mite.Old mattresses are more likely to harbour large populations of house dust mite and furry toys are another source of exposure.Shaking soft toys vigorously or placing them in plastic bag in the freezer for a few hours helps.Some atopic people are sensitive to cat or dog fur and it makes sense to avoid during these animals as pets when a family member suffers from atopic eczema.The use of make-up can irritate facial skin in a person with eczema and these preparations should be used with care.It is best to keep the airconditioner turned as low as is comfortable as it has a tendency to dry out the skin.Cotton clothes are less irritating on eczema skin than polyester or wool.Bathing or showering are safe,provided that a soap substitute such as aqueous cream is used ,or a bath oil is added.Bubble bath should be avoided as it is a detergent.The moisturizer that the person uses should be applied after the skin has been patted dry.Holiday in a warm environment are beneficial as the skin's moisture is improved and of course,the person is more relaxed.Although sunlight is usually helpful,atopic aczema may make the skin more sun-sensitive and covering up with cotton clothes and using a sunblocking cream are advised in hot climates to avoid burning.People with eczema can go swimming.Putting an emollient ointment or a barier cream on the skin before and after swimming reduces irritation.Your doctor will advise you to add bath oil to bath water and to stop using soap.Soap can be an irritant to the already sensitive skin,the oil will help to keep the skin supple and less dry

Eczema in Babies & Children: Baby eczema - also called infantile eczema is common and usually develops when a baby is about 2-3 months old or 4-5 months when solid food are introduced.Most children grow out of eczema by the age of three or, if not,by 7 years old.Important facts: Baby eczema is less common in breast-fed babies than those fed on the bottle.It is not caused by an allergy and allergy tests don't help.Children with eczema don't benefit from a special diet.Treatment: If your baby is scratching,look at his neck,face,scalp,hands and the creases of his elbows,knees and groin - the classic sites for baby dermatitis.Keep his fingernails short to minimize the possibility of breaking the skin.If the skin becomes broken,put mittens on him to prevent infection.If you have just started weaning your breast-fed child,return to breast-feeds until you have seen your doctor.If you have been using formula milk,return to that.Apply oily calamine lotion to ease irritation and soothe the skin.Soap should be avoided as it de-fats the skin and makes it drier,more scaly and irritable.Avoid woolen or hairy garments - use COTTON or linen instead.Use and emollient cream whenever your child washes.That will keep his skin soft,prevent if from drying out and damp down the itchiness.Underplay the condition in front of your child.Your anxiety can make the condition worse.Keep your child's fingernails short so scratching does not cause the skin to break and give rise to infection.Make sure all your child's clothes and anything that comes next to his skin,are rinsed thoroughly to remove all traces of washing powders and conditioners.If the eczema if found to be made worse by pet fur,you may need to consider giving your family pet away.Use an aqueous cream from your chemist as a soap substitute.Use a bath emolient dissolved in bath water to put a protective layer over your child's skin.Think about installing a domestic water softener.Dress your child with cotton next to his skin at all times.Don't eliminate any foods from your child's diet without your doctor's supervision.Remove as many irritants from your child's environement as possible e.g feather & down pillows can be a source of irritation.Vaccinations: It is generally safe to vaccinate children with eczema in the usual way.However,if a child has a proven egg allergy,their MMR (measles,mumps & rubella) vaccinations should be given in a hospital setting in case there are problems,although this is very rare in practise

Prognosis for Eczema: Many children outgrow eczema and asthma around the age of 7years old.They will however retain a life-long tendency to develop transient eczema if the body is put under stress and may pass on this tendency to their children.In adult life,dermatitis is not the same as that in a child.The eczema looks different,it is in different places and it may come and go.It may take the form of Seborrhoeic,Contact or Photo-dermatitis (caused by light)

Ejaculation: The discharge of Semen form the Penis

Electrocardiogram - ECG: A record of the minute electrical impulses generated by the Heart.Used to determine the Heart's condition.It involves placing metal plates on the head which record the impulses graphically

Electroencephalogram - EEG: A recording of the electrical activity of the Brain. It involves placing metal plates on the head which record the impulses graphically.Used to determine whether or not any Brain disorder exists

Embolism: The sudden Blockage of a Blood Vessel, caused by a Blood Clot or other Foreign solid (known as an embolus)

Emphysema: Inflation of the tiny air sacs in the Lung.They become distended, their walls become thin and rupture. Any recurrent or severe infection of the lungs may lead to loss of general elasticity causing the lung to become overdistended and uneffective.Most common cause is Chronic Bronchitis usually in smokers

Encephalitis: Inflammation of the Brain usually caused by a Virual Infection.Most common causes in children viral infections such as chickenpox or mumps. Always serious and can be FATAL in babies

Encopresis: This is a condition where a child frequently soils his underpants after he has been toilet trained.Most common course of encopresis is Chronic Constipation, when hard dry stools accumulate in the bowl and loose, watery motions trickle out past it.You may even mistake this for diarrhoea In a child of four or five, uncontrollable bowel motions should be regarded as a symptom of a problem rather than of slow development.The problem often starts as the result of some emotional distrubance in the child's life

Endocarditis: A rare and serious infection of the Endocardium-Lining of the Heart Cavity, the Heart and the bloodstream

Endocrinologist: A Doctor who specializes in the study of Hormones and the Diseases casued by their disorders

Endometrial Cancer: Uterine Cancer.Cancer of the uterus is a tumour that grows in the lining of the uterus - the Endometrium' - and is sometimes known as Endometrial Cancer.It has a relatively low malignancy *see Uterine Cancer for more detail*

Endometriosis: Endometriosis is a very common condition,defined as the presence of cells from the lining of the uterus - at other sites in the pelvis.The principal route of spread for these 'seedlings' is via the fallopian tubes.Deposits find their way to the ovaries,bowel,bladder and the pelvis,forming very small cuts and localized scarring.The seedlings respond to the cyclical changes of ovarian hormones, so bleeding occurs into the cysts when you are menstruating,but the blood cannot escape.The cysts becp,e swollen and tender and in athe ovary may enlarge so 5-6cm in diameter,causing menstrual pain,painful sexual intercourse and generalized pelvic tenderness.Adhesions may form around the cysts, interfering with ovulation and possibly conception

Symptoms: Heavy of abnormal bleeding.Severe cramping pain,starting before the period is due and continuing during menstruation,after which it gradually eases.Urinary or bowel pain, including diarrhoea.Fertility problems.If you are in your late 20s and have been unable to conceive,or if you suffer very painful periods or pain deep in your pelvis during intercourse, you should see your doctor as soon as possible.If you have never suffered from dysmenorrhoea (painful periods) before,it is very likely to develop in your late 20's without there being a major reason

Treatment: The drugs used to treat endometriosis suppress ovulation and menstruation,thus permitting the disease to regress.The drugs include the continuous use of high-dose oestrogens and/or progestogens or drugs called HnRH analogues to suppress ovarian-stimulating hormones.All these treatments are contraceptive.Medical treatments of endometriosis is usually only offered to women who are not trying to conceive, it has not been shown to improve fertility rates.For women wishing to conceive,surgical treatment usually laparoscopic,includes diathermy or laser vaporization of the endometriosis deposits and adhesiolysis (removal of adhesions) Radical surgery with removal of the uterus and ovaries (hysterectory) may be necessary in older patients with advanced disease who don't wish to have more children

NB In Vitro fertilization (IVT) should be offered immediately to women trying to conceive who have dense,widespread adhesions that are not amenable to - or recur after,surgery.You can also join a support self-help group where you can share your experience with other women and discuss the latest treatments and side-effects of treamtment

Endoscope: An instrument enabling a Doctor to look into a body cavity, usually the Oesophaus, Stomach or Duodenum.Photographs and tissue samples can also be taken and some small growths removed, with an endoscope

Endoscopic Retrograde Cholangio-pancreatography (ERCP): This test is used to look for problems in the bile ducts and pancreatic duct.A contrast dye is injected into the ducts via an endoscope passed through the mouth and the path of the dye is then tracked on X-ray images.Doctors can also look directly down the endoscope.The procedure is done in hospital under a general anaesthetic and takes about an hour

Endoscopic Surgery: This is a technique that enables various surgical prodedures to be performed without making large incisions in the skin.An endoscope is a tube-like viewing instrument with a light source.Some endoscopes have a built-in miniature camera that relays pictures to a monitor.Endoscopes are inserted either through a natural body opening such as the anus or through a small incision,depending in the site to be accessed.Most endoscopic surgery through incisions is performed under general anaesthesia - endoscopic surgery through natural openings may require only a local anaesthetic

Endoscipic surgery performed through skin incisions is often called - minimally invasive or keyhole surgery.Tiny instruments,such as forceps are passed through small incisions in the skin or through side channels in the endoscope to reach the operating site.These instruments are operated by the surgeon,who is guided by the view through the endoscope or on the monitor Since endoscopic surgery may not involve any incisions or only require small ones, the length of stay in hospital and recovery time are shorter than for open sugery.However,there is a slightly greater risk of damage to an organ or blood vessel with endoscopic surgery than with open surgery because the surgeon has to work in as smaller area.As with all surgery there is a risk of an adverse reaction to a general anaesthetic,which depends on the person's pre-operative health,the specific anaesthetic used and the type of operation being done.During the operation,the surgeon may need to access a larger area and perform open surgery.You will be asked for your consent to open surgery before an endoscopic operation

Endoscopy: The procedure in which an Endoscope is used

Enema: A procedure where Liquid is injected into the rectum, usually to produce a bowel movement or for diagnostic purposes.An enema should be given only on doctor's orders

Enlarge Prostate: Most men will suffer from an enlarged prostate to some degree.It's part of normal male ageing and Western men suffer from it more than Asain men.Indeed doctors and scientists don't fully understand its functions and there is still a lot to be learned about the prostate and about the disease affecting it.The prostate gland lies underneath the bladder.Its main job is to produce a thin,clear fluid that nourishes sperm while they are being stored in hte siminal vesicles awaiting release through ejaculation.The prostate needs hormones from the testicles - mainly Testosterone & Prostaglandin - so that it can work properly and if they are low - the prostate shrinks.Close to the prostate are two important bladder muscles, called Sphincters, one above and one below the prostate.They control the outlet from the bladder, stopping it from leaking urine.They also help to expel semen at ejaculation.A man's prostate usually becomes larger after the age of 50.The fact the the prostate grows - isn't important in itself and indeed the trouble it causes doesn't depend on its actual size.However, the prostate surrounds the tube from the bladder called the Urethra and as it enlarges it squeezes the urethra and narrows the opening out of the bladder.This is called obstruction and it impedes the flow of urine.25% of men aged 50 and over will experience urinary symptoms due to prostate enlargement

Symptoms of Obstruction: As obstruction occurs gradually,many men don't realize it's happening.They may notice that their urine steam doesn't travel as far as it did when they were young and they may be aware that it's less forceful.Then there may be a delay in getting started - hesitancy - and the urine stream tails off at the end,sometimes causing troublesome dribbling.There may be a feeling that the bladder isn't quite empty - known as incomplete emptying

Reasons for Enlargement of Prostate: The main cause is simply age.The benign non-cancerous enlargement is called Benign Prostatic Hyperplasia (BPH).The exact reason for enlargement is uncertain,but male hormones are require so it doesn't occur in men castrated at an early age.Most men over the age of 80 have the condition,and about half will have some symptoms from it.BPH starts in the inner part of the gland and as it enlarges,it squashes the rest of the gland.However big the prostate, it remains covered by the capsule rather like a chestnut in its shell.A doctor examines a prostate by doing a rectal examination - the prostate lies right up against the back passage.A prostate with BPH, has a smooth surface with an uneven shape and feels rubbery,rather than hard

Prostatitis: Inflammation of the prostate.Inflammation of the prostate from infection or other causes is not uncommon and can occur at most ages,affecting approx 1 man in 10.Somethimes is causes symptoms like cystitis - such as burning pain while passing urine.In older men it might cause a sudden increase in prostate symptoms.The prostate is very tender when the doctor does an internal rectal examination

Symptoms of an Enlarged Prostate: If you have difficulty starting to pass urine.If it takes longer to pass urine than it did before.If you stop and start.If you need to pass urine twice or more during the night.If you are sometimes caught short.If your experience includes two or more of the symptoms above - see your doctor

Treatment of an Enlarged Prostate: If you have a Prostate problem, your doctor will ask you about your symptoms then do a rectal examination to access the size of your prostate.Tests will be arranged for confirmation and to help plan your treatment.You'll be asked to give a sample of your urine and a blood sample is usually taken to check how your kidneys are working and to measure a substance called Prostate-Specific Antigen (PSA).Until very recently,virtually the only treatment for benign enlargement of the prostate was an operation.Operations on the Prostate are usually very successfull if a man has severe symptoms, but it could sometimes be disappointing if symptoms are only mild

Options

!. Surgery: Transurethral vs Open-Surgery.The earliest operation on the Prostate were done as open-surgery, removing the enlarged part of the gland through a surgical incision in the front of the abdomen.Just before the Second World War, urologists in the US started doing an operation called Transurethral Resection (TUR).It was one of the earliest types of endoscopic of 'keyhole' surgery and now nearly all prostate operations are done this way.An instrument called a resectoscope is passed into the prostate via the urethra.The urologist can see the prostate directly and sends a special type of localized electric current through a metal loop to cut the prostate out in pieces,leaving a cavity in the middle of the gland through which urine will pass easliy.A general anaesthetic amy be used,but as the operation only takes about half and hour, it's often doen with the patient awake but numb from the waist down under an epidural anaesthetic, given through a needle in the back.It's quite possible for a man to follow his operation being done on a monitor in front of him if he wants to

2. Drug Treatment: Drug treatment of Benign Prostatic Hyperplasia (BPH) is usually for mild symptoms where the obstruction isn't too bad.Drugs may be tried in more severe cases if there are medical reasons to avoid surgery or for temporary relief when waiting lists are long

3. Hormonal Treatment: The drugs that shrink the prostate interfere with the action of the male hormone testosterone, which is part of the cause of BPH.Only one called finasteride is used at present,given as a single tablet once a day.It may take three months or more before the prostate shrinks enough to improve the symptoms, so don't stop taking it after a week or two because it doesn't seem to be working.A small number of men do experience failure of erections and oher sexual difficulties.If sex is very important,you might feel that this treatment isn't right for you - although sexual problems are more common with a TUR and then they aren't reversible.As soon as the drug is stopped,the prostate grows again very rapidly,so if it is working - keep on taking it

4. Alpha-Blocker Drugs: The other type of drug used for treating BPH is called an Alpha-Blocker.Alpha-Blockers relax the muscle,reduce the obstruction and improve symptoms almost immediately,although they can cause side effects such as faintness, weakness and tiredness

5. Laser Treatment: Is more like a TUR and is an alternative way of removing the enlarged part of the prostate or of simply widening the urethra - it can be done as a day case or short stay and is associated with less bleeding

6.Microwave or Thermotherapy: Is where heat instruments is used to destroy prostate tissue,may help some patients with less severe symptoms

Postoperative: Pain is uncommon - but the catheter can be uncomfortable and may make the bladder feel full.Sometimes painful spasma occur.If they are severe, you will get drugs to control them.You will asked to drink a lot of water each day to help flush out your bladder.It is usual to have some frequency for a day or two, and often it is difficult to control the urine at first.A physiotherapist for nurse will teach you some exercise to help control the urine flow.Sometimes it is difficult to start passing urine but perservering for a few hours - does the trick.If not, the catheter may be re-inserted.Don't despair - usually everything is fine when it is taken out again.Inside, the prostate is raw and needs time to heal.Continue to drink plenty of fluid - but not alcohol.Avoid driving,lifting heavy things and sex for two - three weeks.You will see some bits of tissue and blood in the urine from time to time - this is like a scab coming off the skin and when a scab comes off, there are sometimes a little bleeding.Frequency - an abnormally short time between passing urine - may take longer to improve and may not return completely to normal.Needing to pass urine in the night may persist after the operation but it is a symptom of getting old as much as of prostate trouble.Leakage at the end of passing urine,may persist,but can usually be controlled by taking a little care.Interference with sex;At the end of sex - a man may have a normal climax - but no semen is ejaculated.This is called retrograde ejaculation - having a dry run - describes exactly what happens and it's because semen is leaking back into the bladder rather than coming out normally.A few men do experience difficulty in getting an erection after the operation,so ask your sugeon before having the operation for his opinion

Prostate-Specific Antigen Testing: Any man with an enlarged prostate will have a fairly new test that measures the level of prostate-specific antigen (PSA) in the blood.The test has been given a lot of publicity as a method of early diagnosis of prostate cancer.Just because your doctor does a PSA test,does not mean he suspects cancer.He is just being thorough.Think of the PSA in the blood as if it's 'leaking' out of the prostate.More PSA will come from a large prostate than from a small one - so the older your get - the PSA can increase quite normally as the prostate enlarges.PSA is prostate specific - but not cancer specific.So if your PSA is higher than normal,it doesn't mean you have cancer.As older men have larger prostates and also more have non-cancerous diseases of the protate the average PSA is higher in men of 75 than in men of 55

Enteritis: Refers to any infection or food poisoning causing Diarrhoea.Gastroentritis - indicates vomitting as well as Diarrhoea

Entropian: Condition of the turning in of eyelid.Ectropian- turning out of the eyelid in some older patients

Epidermal Cyst: Type of Cyst that forms in the Sebaceousv(oil) glands of the Skin.Can appear anywhere on the body and easily becomes infected

Epididymal Cyst: Is a harmless swelling arising from the epididymis, the coiled collecting tube attached to the back of each Testes.Small pea-sized epidiymal cysts are common in men over the age of 40.These cyts are often multiple and may effect both sides.The are filled with a clear,colourless fluid and are usually left in place rather than removed

Epiglottitis: Inflammation of the Pharynx and swelling of the epiglottis.Relatively rare but serious illness usually in children aged one to six years of age

Epiphysis: This is the knobbly growing end of a Long Bone which fits into anohter bone to from a Joint

Epilepsy: Condition in which the sufferer has recurrent seizures.This occur when the normal electrical impulses in the brain are disturbed.There are 3 main Types

Episcleritis: Fairly uncommon cause of persistent redness of the eye

Equinophobia: Fear of horses

Erysipelas: Bacterial infection o the Skin which rapidly spreads to the deeper tissues

Erythroblastosis Fetalis: Rare blood disorder of the Newborn.Baby's red blod cells are destroyed.Incompatibility of Mother and baby's blood

Erythromelalgia: Attacks of red, warm and painful blotchs on the hands and feet.Usually in the middle -aged

Eustachian Tube: A tube that connects the Throat and the Ear.In children under six, this tube is relatively short and infections of the Throat and Nose can easily be spread to the Middle Ear

Excessive Hair Growth: Hursutism / Hypertrichosis There are to types of excessive hair growth - Hirsurtism & Hypertrichosis.HIRSUTISM:affects women only.In this condition,excessive hair develops particularly on the face,trunk and limbs.This type of excessive growth is more common in women over the age of 60, due to estrogen deficiency,especially those who are of Mediterranean,Asian,Hispanic or Hispanic or Arab descent.HYPERTRICHOSIS: can affect both males and femals.In this condition,the hair grows all over the body,even in the area that do not normally have hair

Causes: Mild Hirsutism in women is often considered normal, especially following the menopause when there is a realtive excess of male homones (Androgens) as Estrogen levels fall.Hirsutism may be the result of an increase in normally occurring Androgens in women with disorders such as Polycystic Ovarian Syndrome (PCOS).Hypertrichosis may occur with Anorexia Nervosa or may occur as a side effect of Immunosuppressant or antihypertensive drugs

Treatment: If you are a young woman with Hirsutism, your doctor may arrange for a blood test to measure your male hormone levels and exclude Polycystic Ovarian Syndrome (PCOS). If Androgens (male hormones) are high,you may be given a drug to block the hormone's effects and be treated for an underlying disorder such as Polycystic Ovarian Syndrome.If Hypertrichosis occurs as a side effect of a drug, a change of treatment usually reverses the condition

Hair Removal: You can deal with excessive hair yourself by bleaching it or by shaving,plucking,waxing or using depilatory creams.The only way to remove hair permanently is by ELECTROLYSIS or LAZER TREATMENT - but they are can be uncomfortable & is expensive

*also see under Hair Removal*

Excretion: The removal of the body's internal waste matter by natural processes, such as urination,sweating and exhalation

Extradural Haematoma: Serious complication of Head injury

Extrasystoles: An irregularity in the Heart Rhythms.A beat occurs immediately after a normal beat, followed by a longer interval before a regular rhythm resumes