Some children are labelled as having wheezy bronchitis or asthmatic bronchitis rather than asthma. This is because the wheeze is usually present only during a respiratory infection. Most experts believe that these are all mild asthma.
It doesn’t really matter what the condition is called, as long as the child gets proper treatment and the parents are not frightened by having their children labelled as asthmatic.
Usually the diagnosis of asthma can be made on clinical grounds, but some tests may be necessary to confirm it, assess its severity or check for associated factors.
Testing lung function by having the patient blow into a special machine is accurate and gives a lot of information. It may be necessary to provoke an attack, do the test and then reverse the breathing difficulty by giving drugs that dilate the bronchial tubes.
In allergic individuals, skin tests to find to what substances the person is allergic are also of use.
*211/71/1*
An interesting letter arrived from a woman in Colorado, posing a question that had not been asked of me in a long time. In her letter Sherry said that she wanted to settle the nagging suspicion that endometriosis may have been induced through fate’s intervention. She specifically referred to two accident! in her past, in which she had been struck forcefully in the abdomen.
“Maybe I’m grasping at straws,” she wrote, “but I can’t help wondering bow I got endometriosis. There’s nothing like it in my family and I seem to be the only woman I know of out here with the condition. Isn’t there some likelihood that a shock to the system can start some internal chain reaction that brings on this disease?”
Sherry had been an active teenager, although menstrual cramps slowed her down through her high school years. During the last half of her senior year, her cramps worsened. Yet she suffered silently. “I was raised to be tough about things that made us physically and emotionally uncomfortable.” she wrote. “It isn’t unusual out here. This is a ranching community and lire can be hard. No one cares about complainers.” It was during a difficult bout with menstrual cramps that she played in a school volleyball competition and was struck by the ball as she jumped to hit it.
“I doubled over so suddenly, and I was in so much pain,” she wrote, “that I had to be carried off the court. For days after that, I felt like I had to urinate all the time. The pain soon stopped, but my cramps started to get worse from about that time.” Over-the-counter painkillers offered some relief while she waited to “grow out of” the problem. But it was not to be. Five years later. Sherry went on to say in her letter, she was horseback riding with her new husband when she was thrown by the horse, landing belly-down on a rock. This time, she began bleeding. Frightened, she went to a gynecologist.
Sherry was hospitalized and went into surgery for removal of an ovarian “chocolate cyst.” a cyst with blood in it that has become dark brown and thick as tar. When a biopsy of the cyst was performed, it revealed endometriosis. Curious, Sherry asked her doctor if the first accident might have set off some “internal disorder” that fostered growth of the disease. It was the doctors opinion that accidental traumas have no effect on the onset of endometriosis.
We have found no reference in any scientific journal that implicates any sort of trauma—such as being hit by a ball, falling off a horse, or being injured in an automobile accident—in the onset of endometriosis. In Sherry’s case, the second accident only helped identify the disease. The fall ruptured an endometriotic cyst, which, upon rapturing, leaked blood over the pelvic organs, causing extreme pain.
*35\43\4*
Hives, known medically as urticaria, are a very common problem They are sometimes known as ‘heat lumps’, appearing as raised’ red lumps which tend to come and go over any part of the body and which are extremely itchy. They are the result of increased capillary permeability, or ‘leaky bloodvessels’. The condition has been closely studied by allergists, dermatologists, pharmacologists, and immunologists. As a result the mechanism of action is reasonably well understood. It is thought that various processes, both allergic and non-allergic, lead to the release of certain chemicals, the most important of which is histamine. These chemicals influence the small blood vessels and capillaries of the skin, leading to skin changes which are characteristic of hives.
There are various known causes of hives (and probably as many unknown).
Infections. Parasitic infection, in particular various fungi, intestinal worms and hydatids, has frequently been associated with hives. So, also, have viral hepatitis and glandular fever in the presymptomatic stages. Similarly, upper respiratory tract infections may be accompanied by hives. Occasionally bacterial infections such as streptococcal or unsuspected focal dental or sinus infection may cause hives.
Physical causes. Several rarer physical causes of hives exist. For instance the pressure of belts or shoes may cause localized hives (in this case called pressure urticaria), as may cold air, water or other cold substances. Heat may also cause localized hives if the heat source is local, or generalized urticaria if the condition is provoked by exercise. A still rarer form of hives, solar urticaria, is an allergy to different wave-lengths of ultraviolet light.
Internal disease. Very occasionally conditions such as lupus erythemaetosus, leukaemia, or cancer of some organ may cause hives. These can usually be excluded as possible causes by appropriate physical and blood examinations.
Psychological pressure. Emotional stress may either cause or aggravate hives. Whether emotional factors alone can produce these changes is uncertain. Before blaming ‘nerves’, the various other possible causes must be adequately excluded. Furthermore, treatment should be instituted to relieve the distressing appearance and itch, which only aggravate the stress. Adequate explanation and reassurance that the condition is self-limiting, must also be given to the patient.
*62\44\4*
The satiety value of carbohydrate is clearly greater than fat, however this varies according to the type of carbohydrate. Including a low glycaemic index and a high resistant starch or fibre content can all act to boost the satiety value of specific carbohydrate-rich foods.
The relationship between appetite and the commonly reported ‘carbohydrate addiction’ is less clear. This dietary phenomenon supposedly occurs because of a central imbalance in the metabolism of the neurotransmitter seratonin. The consumption of carbohydrate-rich foods is believed to boost seratonin levels, promote satiety and induce a mood calming effect.
Based on this hypothesis, all carbohydrates should be able to satisfy uncontrollable cravings (a baked potato should do the job just as well as a doughnut). However, this is not the case according to Professor Adam Drewnowski from the University of Michigan. He suggests that it is the ‘powerful hedonic synergy’ of fat and sugar that forms the basis of food cravings. In an interesting study, he discovered marked differences in food preferences between men and women. When males were asked to list 10 of their favourite foods, they expressed preferences for meat, fish and eggs. Obese women rated ice cream, chocolate, cookies, dough-nuts and pies high on their list. He concluded that whilst men prefer protein-rich foods, women’s desires tend toward mixtures of sugar and fat. This finding indicates that the term ‘carbohydrate addict’ may be a misnomer and the term ‘sugar-fat addict’ may be more appropriate.
*116\186\4*
You may feel overwhelmed by the various options of treatment that are presented to you. These options may include having no treatment at all — adopting a wait and see approach. This may be the case especially if your endometriosis is mild with few symptoms and you are planning to get pregnant.
Perhaps you were trying to get pregnant before your endometriosis was discovered and the prospect of a six to nine month course of drugs which will prevent you from getting pregnant during that time will be exasperating.
You may have to consider going on a course of fertility drugs if you want to get pregnant — something you may never have considered before.
Having to make a decision about which hormonal or surgical treatment is best for you will almost certainly be overwhelming.
Isolation
‘I feel so alone. I have never heard of this disease and most of my family and friends don’t even know how to pronounce it let alone understand what it means. How can I explain it to them in simple terms when I don’t understand it myself?’.
This is a common cry for help. Many women find it difficult to discuss their gynaecological problems with family or friends because they are embarrassed or simply do not want to burden people with their problems.
Some may find that they feel isolated because partners or family and friends have heard about the symptoms for so long that they no longer want to discuss it now that a diagnosis has been made.
Others believe that once the woman has had surgery such as a laparoscopy or laparotomy she is cured and should have no more problems. Little do they realise that this may be just the beginning.
*105\83\2*
O-date, no treatment has been developed that is effective for all women with endometriosis because little is known about the causes of the condition. However, many different approaches have been tried.
In general, the treatments aim to relieve the symptoms and, where desired, improve the chances of conception by eradicating as many endometrial implants, cysts and adhesions as possible.
The main options available for the management of endometriosis are:
Observation
Symptomatic management
Hormonal treatment
Surgical treatment
Combined treatment
Alternative therapies
Observation
Observation or a ‘wait-and-see’ approach involves no active treatment. Rather, as the name suggests, it simply involves a period of observation and monitoring. Such an approach should still involve regular visits to your gynaecologist to monitor any possible progression of your endometriosis and its symptoms.
Some gynaecologists believe that a period of observation is the most appropriate form of management for young women who have minimal endometriosis with no significant symptoms. Others believe that it is inappropriate because they believe endometriosis should be treated as it usually progresses.
A period of observation may be the most appropriate form of management if a woman decides that she does not want to have active treatment, particularly if she has minimal or no symptoms.
Symptomatic management
Symptomatic management for endometriosis involves treating only the symptoms — usually the pain — without attempting to treat the underlying disease.
It usually involves the use of various analgesic or anti-inflammatory drugs if the pain is intermittent, or a range of pain management techniques if the pain is chronic and ongoing.
Symptomatic management may be appropriate if a woman decides not to have treatment or if she has symptoms that have not responded to previous treatments.
Symptomatic management may also be used as an adjunct to conventional or alternative treatments in order to relieve ongoing symptoms.
If you decide to have only symptomatic management you need to be aware that it will not treat your endometriosis in any way and that in fact your endometriosis may progress.
Hormonal treatments
The hormonal treatment of endometriosis uses drugs to treat the condition. In general, hormonal treatments aim to eradicate the endometriosis by suppressing the menstrual cycle and preventing the growth and development of the endometrial implants and cysts.
Surgical treatments
In general, surgery for endometriosis aims to remove as many endometrial implants, cysts, endometriomas and adhesions as possible and to repair any damage caused by the disease. In the case of a hysterectomy, surgery aims to cure the disease by removing the uterus and sometimes the ovaries as well.
Combined treatment
Combined treatment is the use of a course of hormonal treatment before, or after, surgery to enhance the effects of the surgical treatment.
Alternative therapies
A variety of treatments are used by alternative therapists. Each therapist uses a combination of treatments, although the actual treatments used for each individual will usually depend on an assessment of her problems.
*46\83\2*
It’s a fact that many highly-stressed individuals simply refuse to accept that they may be more stressed than is good for them; this denial, of course, allows them to ignore the situation and just carry on as before. But there is no question that all of us, no matter how much we may like to think that we’re always totally in full control of our emotions, are to a greater or lesser degree susceptible to stress, either because we over-react to events or because we have a low stress tolerance level in the first instance.
Although a little bit of undue stress now and then may not do a great deal of harm, ongoing undue stress at a high level certainly will eventually exact a price to be paid in overall poorer health, whether this manifests itself as back pain or any one of a dozen other conditions whose incidence is at least partly linked to stress or worsened by it.
Doctors, of course, have many ways of determining whether someone is overstressed, but there is also a very simple and remarkably accurate way of finding this out for yourself and that is to just ask yourself whether you’re under undue stress. If ‘yes’ is the answer that immediately springs to your mind in response to this self-questioning, then it is most likely that this will indeed be so. Equally, should your own self-assessment suggest that you’re not particularly stressed, then that, too, is most likely to be the correct conclusion.
Naturally, how much stress you’re under usually varies considerably from day to day, week to week, month to month, and year to year. Just because you’re not feeling stressed at a given moment doesn’t necessarily mean that your body isn’t nevertheless paying a price for previous times when you might have been under a great deal of pressure.
Because stress is seldom constant in its intensity, many people fail to come up with either a clear-cut ‘yes’ or ‘no’ answer when they ask themselves whether they’re stressed, instead saying things like, “Well, I do get stressed now and then, but I can cope with it and it doesn’t bother me” or “No, I’m pretty sure that I’m not under great stress – well, perhaps now and then things do get on top of me.”
When you try this self-test and find that your own answer sounds a bit like those above, then most experts would suggest that you are indeed at least partly affected by stress. And, if you’re having back problems, then the chances are that somewhere along the way stress has made a considerable difference to how much these have affected you. If so, it follows logically that reducing or controlling your stress level in the future is likely either to reduce your back problems or at least make them more bearable.
*52\124\2*
Some of the most helpful things you can do to live an anti-depressant lifestyle involve taking control of your life wherever possible. One well-known animal model of depression, developed by Martin Seligman, is learned helplessness. In this model, rats in cages are given electrical shocks at random until, presumably realizing that there is nothing they can do to prevent these shocks, they simply give up and lie down, resigned or, perhaps, depressed. Life may feel like that to some people. At work, you may be faced with one difficult situation after another. Your boss may be constantly disgruntled or repeatedly abusive. Similarly in marriage or a relationship it sometimes feels as though you just can’t win. No matter what you do or say you land up in trouble with your partner. These are topics of satire, but in reality are not very funny. For example, in the highly successful comedy series Fawlty Towers, the unfortunate innkeeper, Basil Fawlty, is always falling foul of his wife Sybil. On one occasion Sybil harangues him about his gambling. When, later in the episode, she checks on whether he has been betting on the horses again (which he has) he responds, ‘No dear, that avenue of pleasure has been closed off to me.’ In depression, where avenues of pleasure are already closed off to the depressed person, it is particularly important that extra sources of unhappiness be tackled or avoided.
*67\75\2*
What about the words used to describe epileptic seizures? The word ‘seizure’ is that most commonly used by neurologists for all types, but, depending upon the manifestation of the seizure, they may call them convulsions. Often they will use the words employed by their patients—for example, fit, turn, attack or dizzy spell. People who have two types of seizure often call them ‘big ones’ and ‘little ones’. As long as the patient and the doctor find themselves talking about the same events, this is perfectly acceptable.
The word seizure is really too sudden and violent a word to describe the minor distortions of consciousness that may be the only manifestation of some types of epilepsy such as absences, but we do not have a better word to cover all types.
Sometimes in correspondence and conversation doctors employ the words ‘epileptiform’ or ‘epileptoid’. In our experience, doctors who use such terms are skating round the subject and avoiding frankly stating that their patient has had an epileptic seizure. The only justification for such a term might be the description of attacks called anoxic seizures in which a few jerks of the limbs arise during a profound faint, in which the blood supply to the brain is briefly insufficient. Apart from this example, and strokes, which used to be called apoplectic seizures, by common usage in English-speaking countries a seizure now means an epileptic event.
*6\188\2*
Troublesome dryness of the skin can occur as the result of daily bathing or showering, especially in older people. The skin, particularly that over the lower legs, feels itchy and appears white, rough, scaly, even cracked, so that it may bleed and become red and infected.
The best way to deal with this common problem, the U.S. Pharmacist (13#12:24) advises, is to first soak the skin in warm (not hot) water for about 10 minutes. After this, the skin must be thoroughly dried with a towel and then, and only then, it should be immediately covered with a film of ointment or cream. The soaking gives time for the water to penetrate into the deepest layers of dry skin and the thin layer of ointment or cream then acts as a barrier to prevent the water from evaporating away. However, since water and oil don’t mix, the surface must be completely dried before ointment or cream can be properly applied. Without the soaking, a cream or ointment cannot do much good.
Since ointments are more oily than creams, they form a more lasting water-retaining barrier. However, because ointments are stickier and less easily washed off, creams are more popular, especially during the day. With creams, though, one must be prepared to soak the skin more often.
Containing still less oil, or even none at all, lotions, although soothing, are almost useless for treating skin that is already excessively dry. They may provide some help, of course, in preventing normal skin from becoming dried out. Gels, which usually contain some alcohol, may actually dry the skin.
Cutis (37:384) recommends that we add Alpha Keri oil to our bath water. Those who preferred showering to sitting in the tub got the same benefit from Alpha Keri oil by rubbing it on the skin immediately after drying. Other bath oils probably have the same effect.
*196\143\2*