Blog about medicines and adverse drug reactions.
June 3rd, 2010 admin
There is nothing more remarkable, I believe, than the power of living organisms to grow, to renew themselves, and to heal. In the human body our innumerable devices for this do a good job, sometimes beyond all expectations founded upon experience. Certainly, our body is affected by wear and tear always and by disease frequently. There is, of course, a foundation of pessimism here which we may never forget, it being solemnly and dolorously dinned into us. We acknowledge the inevitableness of these agents, so adverse to the individual and their ultimate triumph over us; but, with rare exceptions, we seek the aid of medicine to help us as we go, and to postpone the finish.
Not only do you, our patients, expect this aid, but you usually ask for a preview – what we technically call a prognosis. From the point of view of earthly life, we know that the outcome is certain, but rates of progress and the elapse of time in relation to disease cannot be charted accurately. Optimism is not only helpful to the patient but it is a worth-while attitude for the physician. Charles Sedgwick Minot, professor at the Harvard Medical School some years ago, was quoted as making a remark somewhat as follows, “Never tell an old woman she is about to die as she may live to dance upon your grave.”
Never underestimate the power of nature. Some years ago a child was brought to our clinic with what was evidently empyema. That is, one side of the chest was filled with pus, a condition which not infrequently follows pneumonia. (Or did before the advent of the wonder drugs.) A needle was introduced between the ribs and about a teaspoonful of pus was withdrawn, thus confirming the diagnosis. The family was told that the child must go into the hospital for operation and when they refused they were then told that the child would die were this not done. Unconvinced, the parents took the child away. A few months later the district nurse pointed out to the doctor a tough little urchin, knocking all the other youngsters about the lot. “That,” she said, “is the child whose death you promised if he was not operated on.” Now this family won a 1000 to 1 bet. The physician must however remember this off-chance.
One of the liveliest of Harvard alumni at the age of four was paralyzed from his toes to his neck, needing artificial respiration to keep him alive. Although his legs never recovered, he has led an unusually vigorous, valuable life.
The students of the heart are now among the most optimistic. In the past, children with heart murmurs were trained to live as chronic invalids. Now even when there is other and more definite proof that they have lesions of the heart valves they are allowed to lead normal lives, and many are known to have lived to old age. Doctors are now urged to take an optimistic attitude towards these heart cases.
In the old days we were told that college oarsmen were short lived because of the strain on their hearts. Today it is known that they are long lived. The famous Harvard crew on which Senator Leverett Saltonstall and Dr. Charles Lund rowed at Henley came back to their twenty-fifth reunion several years ago and every one of them climbed into the shell and rowed.
The hut boys at the Appalachian Mountain Club in the White Mountains carry up to the tops of mountains all supplies on their backs and it has been a matter of pride with them to take enormous loads. Well-meaning and officious people made an effort to stop this custom, claiming that the future health of the boys would be injured. The club made a careful investigation of the lives of former hut boys and interviewed many able doctors. They got no evidence that heavy use of a normal young heart causes future disease. Most doctors now agree that they are astonished at how well a majority of patients do, who have survived a coronary occlusion. It seems wise never to give a final opinion from the standpoint of their giving up work.
*103/276/5*
GENERAL HEALTH
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June 3rd, 2010 admin
We all know that praise works better than punishment in helping a child learn or behave. Or do we? Scientific observations reveal that parents and teachers alike tend to scold, mock, deprive, and strike children more often than they offer a few kind words.
Walk into any classroom. Count the number of times the teacher praises his or her pupils; also count the condemnations, insults, and threats. Negative words, as scientific research shows, outnumber helpful words by three to one (or more) in most classrooms. Ironically, punishment works only to control the worst behavior – fighting, lying, cheating, and stealing.
The National Institute of Education estimates that school vandalism costs this country almost 500 million dollars a year. In one California school system, a praise-and-reward program paid off by cutting school vandalism by 78.5 percent, and one school saved 25,000 dollars over the previous year. Other schools have reduced absenteeism from 33 percent to a scant 2 percent with free pizza and other rewards for perfect attendance.
The Los Angeles County Office of Education developed a “constructive discipline” program for students. Its chief architects were G. Roy Mayer, a professor of education at California State University at Los Angeles, and Thomas W. Butterworth, now a retired consultant. The program cut vandalism and absenteeism in Los Angeles schools. Parents easily can adapt it at home. The technique has three parts:
1. Reward good behavior with praise, recognition, prizes, and privileges.
2. Ignore minor infractions or work out deals to reward children for reducing minor misbehavior.
3. Punish only major misbehavior – vandalism, truancy, disruption, fighting, resisting authority, drug use. (The punishments in schools range from a conference called with student and parents to suspension, expulsion, and even a call to the police.) Constant punishment actually induces students to escape through being tardy, skipping class, or dropping out of school. Children punished for every little thing also become more violent and destructive. It was found that vandalism was highest in schools where teachers abused their students the most. After a special teachers’ training program on how to be more positive, the incidence of vandalism in those schools plummeted.
Corporal punishment – spanking, paddling, whipping – actually may teach children to be physically aggressive toward those less able to defend themselves. (Physically abused children often grow up to be abusive parents.)
The absenteeism program at San Gabriel High School in California uses constructive discipline this way: Marisela Adams, the attendance counselor, sets up clear rules for unexcused tardiness or absences. The first incident results in a talk with a teacher; the second causes a postcard to be sent to the youngster’s home. At the ninth incident, the student comes in for a 4-hour Saturday work/study program. The 12th truancy or tardiness results in suspension.
On the positive side, students with perfect attendance are eligible for free pizzas, hamburgers, football game tickets, and buttons saying, “I am perfect.”
Dr. Beth Sulzer-Azaroff, a professor of psychology at the University of Massachusetts at Amherst, says, “With positive techniques, children learn better and retain their lessons longer. What’s more, the positive approach to learning is fun.”
She cautions to be careful with praise, however, and gives these hints: Praise the deed, not the child. You might say, for example, “That’s a well-drawn picture, Lilly.” Not, “You’re a good artist, Lilly.” And your facial expression must say, “I mean it.”
*103/266/5*
GENERAL HEALTH
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May 21st, 2009 admin
Sometimes children have bald patches on the scalp due to hair loss. Many babies are bald from birth, or lose their hair shortly afterwards, which is a normal pattern before permanent hair growth occurs. Often babies have a bald patch at the back or side of the scalp due to friction caused by lying on the mattress of their cot or in baby seats. This is also normal and as soon as the baby is able to spend more time sitting up, hair starts to grow back in these bald patches.
Cause
The commonest cause of abnormal hair loss is ringworm. In rare cases, older children may pull out their hair (trichotillomania) and this usually signifies some emotional disturbance. If there is no identifiable cause for hair loss, your child may be suffering from alopecia areata, which is hair loss that runs in families. In this case hair may be lost from any part of the body.
Clinical features
If your child has ringworm or impetigo, he may complain of an itchy scalp. Otherwise the only sign of alopecia is a bald patch.
Treatment
Treating the underlying cause, such as ringworm, will usually solve the problem of hair loss.
Prevention
It is important to remember not to overdo it with brisk hairbrushing and very tight pigtails or ponytails, as this can sometimes cause minor hair loss.
When to see your doctor
• if your child has significant hair loss for no apparent reason;
• if your child has an itchy scalp;
• if in addition to hair loss your child is generally unwell.
*310\90\8*
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May 19th, 2009 admin
A child with a chronic medical condition may need to see a number of different professionals, not just doctors but also allied health professionals. This care may take place largely in hospital clinics, and his contact with doctors and other health professionals may not only be frequent, but also confusing or even overwhelming. It is very important for you as parents to feel in control of this process, and for you to understand the illness, its treatment, any tests and so on.
It is always useful to have one of your child’s doctors act as a central reference point, not only to co-ordinate the child’s care, but also to make sure that you (as well as the child) understand fully what is going on. Your child’s general practitioner is ideally placed to do this, and sometimes a paediatrician will also be helpful in this role. The co-ordinating doctor will normally have copies of all the medical reports and other relevant information about the child, and will be able to support the child and the family in coping with the chronic illness and its possible consequences.
*14\90\8*
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May 18th, 2009 admin
At those times in your life when you are behaving in a defeated, passive manner and feeling inadequate, helpless, and hopeless, you may experience some of the same problems in sexuality as the husbands and wives below.
DIMINISHED PRE-EJACULATORY FLUID: I used to feel real full, like my penis was ready to explode. My underpants would be wet even before I came. Now I just don’t notice that feeling. I just don’t see much of the fluid.
HUSBAND
While the aging process accounts for some diminishing of pre-ejaculatory fluid, emotional and interactional factors can also inhibit its emission. Sixty-three men reported experiencing this problem.
DIMINISHED LUBRICATION: I used to be too wet sometimes; now I just feel dry. It hurts when he enters. I feel turned on, but I’m dry.
WIFE
Aging, hormonal changes, some disease processes, other factors affect lubrication of the vagina, but emotional factors are also influential. While amount of lubrication does not indicate amount of arousal, a noted change in amount of lubrication can signal emotional states incompatible with this response. Five hundred sixty-five women reported problems with lubrication at least occasionally.
Prior work in the field of sexuality has equated male erection problems with female failure to lubricate. Female clitoral erective problems were essentially ignored. As you read above, male and female erective difficulty is related to hot-running times, to hyperarousal. Inhibition of secretion of lubricatory fluids in men and women is related to the cold-running times, those times when there is a lack of life energy, eagerness to be close, to merge. We don’t need to lubricate if there is little likelihood of the joyful friction of joining and staying together.
*173\97\8*
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May 18th, 2009 admin
Our sample couple scored high toward imbalance. The wife was clearly doing almost everything, and was even responsible for sexual frequency. “I am the Hunchback of Notre House. I walk around like this, hunched over, scanning for junk, mostly other people’s junk. I guess my family thinks that their dirty clothes have special magnets in them so they fly straight to the washer, rotate to the dryer, fold themselves into neat piles, and levitate to the correct drawer. Maybe they think I have magnets on me. Other people’s dirty clothes sure seem to cling to me.”
The husband reported, “I think I carry the major burden. If I don’t provide for our security, who will? I know it sounds kind of sexist, but I really am the breadwinner, you know. What would you think is more pressure, winning the bread or cooking it?”
It does not matter who is right or how dated and sexist this disagreement may seem. Neither partner felt a balance in their marriage. Sexually, the situation was the same.
“I told you before,” reported the wife. “I set the sexual frequency. I have to set it for both of us. If I am not in the mood-spontaneous, as he calls it—then I have ruined everything. He might even sulk. I guess he hopes for mercy sex, sex because he is sulking.”
“I have to work, really work at sex with her,” reported the husband. “She’s kind of like a big cement wheel. Once I get her started, I still have to work. My hand gets tired from rubbing her nipples, then her clitoris. I always make her come before I come. Not once have I come before she comes in bed.”
When this type of marital and sexual imbalance is present, both partners feel that they are the one who carries the weight. The situation resembles a scale, with both sides weighted down so heavily that the entire scale collapses. Who “starts it,” how often, and when are three of the most talked-about concerns in sexual therapy.
Remember that there are no “high” or “better” scores on this test. Too much balance, continued efforts to equalize, share, divide, assign, and assume marital or sexual responsibility robs the marriage of its spontaneous potential for a natural flow between partners, the sexual Tao. Too much attention, marital hypersensitivity, can smother the individual spouse and take away from both partners’ uniqueness for the other. Too much feedback can result in over- or premature adjustments within the marriage, making it and the individual spouses hyperreactive. Too much connection can result in stagnation related to lack of new and stimulating input for the marital system. Too much order prevents change and growth.
*33\97\8*
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May 15th, 2009 admin
When we get a fright, such as from a car rushing at us or someone jumps out and says “boo”, our brain sets off a chain of reactions.
A nervous impulse goes to the adrenal glands, which lie above each kidney. Adrenalin is poured out into the blood and this acts on various organs so as to key us up to deal with the danger.
The autonomic nervous system governs all those actions of the body which are not under voluntary control. The autonomic nervous system is divided into the sympathetic and parasympathetic parts. These have both antagonistic and complementary functions.
Stimulation of the sympathetic autonomic nervous system acts to prepare the body to react to danger by either fight or flight. It may “overshoot” in this reaction and then the parasympathetic acts as a damper. Sometimes this also overshoots the mark.
Stop and think what happens when you get a fright.
Your heart starts to beat faster, it may even miss a beat. Your lungs breathe deeper, the pupils of your eyes dilate, your muscles tense up, you get a tight feeling in the throat and you may break out in a cold sweat. Digestion stops, there is a sinking feeling in the stomach and you may want to pass water or use your bowels.
*542/71/1*
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May 15th, 2009 admin
Deafness due to damage of the nerve from the effects of loud noise was once called “boilermaker’s deafness.”
Now we know it may also occur in those working in many industries and also from the modern phenomenon of the pop concert. Most sensible musicians who play in these bands wear ear protection but their enthusiastic fans don’t.
A sudden loud noise may cause temporary or permanent deafness but noise-induced deafness is more likely to be due to exposure over a prolonged time. At present, the law in Australia limits the amount of noise exposure of workers to 90 decibels for an eight-hour day. Above this, protection should be worn.
Most authorities accept that this may be too generous and the law is due to change, limiting the exposure to 85 decibels but there are some who will suffer loss at even lower levels.
A rough measure of whether the noise in which you work is too loud or not is to note whether you have to shout to be heard when you are about 30cm from the other person’s ear. Of course, the length of exposure is important and a moderate noise may be tolerated for some hours before the risk of damage becomes high.
*285/71/1*
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May 12th, 2009 admin
The Sudden Infant Death Syndrome, or SIDS, is not a new phenomenon. Its existence has been known for hundreds of years. And its incidence is not increasing. But because children are no longer dying of infection and congenital illness, SIDS is now the major cause of death in infants.
The scientific definition of this condition is “the sudden death of any infant or child which is unexpected by history and in which a thorough post-mortem examination fails to demonstrate an adequate cause of death”.
It commonly affects infants between the age of two and five months, but may occur up to the age of two. The story is usually that the child is well or maybe suffering from a slight cold when put down to sleep. The child is then found dead by the parents or whoever is minding him.
Cot death will strike about 500 children each year in Australia, with just over 100 in Victoria. There are about 60 per cent boys to 40 per cent girls.
*34/71/1*
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April 28th, 2009 admin
Carotene is the natural yellowish-red pigment in carrots and tomatoes that is also present in many other vegetables, such as broccoli and squash, which do not look yellow at all. Excessive intake of these vegetables results in deposition of the pigment throughout the body and yellowish discoloration of the skin. This is particularly noticeable on the palms and soles and on the cheeks beside the nose. Unlike jaundice (which occurs in liver disease), the whites of the eyes are not affected.
Most cases of carotenemia, the Journal of the American Medical Association (247:926) reports, occur in women who do not eat red meat and consume large quantities of raw vegetables instead. Some such women gradually stop having periods long before the menopause and may become sterile, an effect thought to be due to carotene’ s chemical influence on a part of the brain that controls the ovaries.
Otherwise healthy young women with this problem can expect to start having periods again within about four months, the Journal reports, if they alter their diets to decrease the blood level of carotene.
*199\143\2*
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