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TALKING ABOUT HEART SURGERY

July 22nd, 2011 by admin

Each year in the United States, doctors invade the chests of more than 750,000 patients to repair their hearts and clear their coronary arteries. Heart surgery once meant almost certain death for patients. Today, some say it has risen to the level of mass production. The annual surgical score-card for the United States reads as follows:•   400,000 bypass procedures, in which unclogged veins from legs and arms, and unblocked arteries from chests, are used to bypass clogged ones•   300,000 angioplasty operations, in which doctors snake tubes from the leg artery to the narrowed blood vessel, where they insert a balloon to push aside cholesterol blockage•   58,000 repairs to damaged heart valves•   2,000 transplants of healthy hearts into patients whose own hearts cannot be repairedThe cost of these operations is roughly 50 billion dollars a year, or 6 percent of the nation’s annual 900 billion dollars medical bill. But is this money well spent? Can patients be helped with far less risk and at considerably reduced expense? Experts are now asking, How necessary is heart surgery?If you’re slated for heart surgery, heed the saga of my good friend, Mimi Cole of Wayne, New Jersey.Years ago, Mimi danced with the Martha Graham Company. On stage, she was a luminous young woman – a pleasure to watch as she swept across the floor. She is now 70 and still teaches dance occasionally. Mimi thought she was in good condition. But, in 1992, trouble arose.”My chest felt funny,” she recalls. “I could not easily walk up a hill. I had a pain in my shoulder. My cardiologist in New Jersey sent me to a surgeon who examined me, found my arteries were blocked, and recommended surgery. I was terrified.”Blood could not pass through the plugged blood vessels to feed oxygen to Mimi’s heart muscle. Her doctor’s plan was to allow the blood to bypass the obstruction by taking unblocked veins from her legs and grafting them onto the heart arteries. But there was no way to accomplish this: the appropriate veins, which had become varicose, had been surgically stripped from her legs years ago.The alternative, her doctor said, was to use arteries from her abdomen or chest. He recommended a specialist at the Cleveland Clinic in Ohio. Mimi did not want to go so far from home. Instead, she found her way to Dr. Eric Rose, chief of cardiothoracic surgery at Columbia-Presbyterian Medical Center in Manhattan. Dr. Rose told Mimi he could work with her arteries, but first he wanted her to be examined by Dr. Michael Cohen, a heart specialist at Columbia. She agreed.Two days before the scheduled surgery, Drs. Rose and Cohen called Mimi in and announced that they preferred to treat her condition first with medication rather than surgery. It proved a good decision. They prescribed beta-blockers, which controlled the rhythm and power of her heart, eliminating her pain and shortness of breath. Mimi resumed playing tennis. In her case, the surgery remained unnecessary.Mimi Cole’s experience forces us to wonder how many other heart patients could have survived with an affordably priced pill instead of a costly and painful operation.*13/266/5*

WHY YOU CAN’T STAY AWAKE: MANAGEMENT OF APNEA – CONTINUOUS POSITIVE AIRWAY PRESSURE, OR CPAP

July 15th, 2011 by admin

During CPAP you wear a nasal mask attached to a machine that pumps air and provides a constant degree of background pressure in the airway. This pressure keeps the passage between the mouth and the lower pharynx open. CPAP is widely available commercially, reasonably inexpensive (compared to surgery), and relatively simple to operate. But, as one sleep researcher put it, “you have to sleep with a machine that sounds like a vacuum cleaner for the rest of your life.” CPAP can be uncomfortable and irritating; in some cases eye complications, stemming from the presence of the mask, have been reported. The most important drawback, however, is psychosocial. For many of my patients, especially the younger ones and their spouses, the thought of sleeping with a nasal mask and an air compressor every night can be disheartening. In those cases where CPAP is appropriate, the patients must possess the proper mental attitude to use the technique correctly and faithfully.*146\226\8*

WHY DOES THE HEAD ACHE?

July 8th, 2011 by admin

Since almost everyone suffers from headache at some time, it is often not regarded as a disease, although clearly it is ‘disease’ (i.e. not being at ease). But since headache interferes considerably with the lives of significant numbers of people, it seems illogical to regard it as normal. However, the changes occurring in the body are subtle, so that it is exceedingly difficult to analyze changes taking place, even with sophisticated research tools. Often, no sooner has some abnormality been discovered, than it is shown to be only secondary to pain, or not to be present in all who supposedly have the same symptoms. By comparison, the understanding of an obvious abnormality such as an infected chest is simple, as not only can changes be seen on an X-ray, but the ’cause’ can be isolated by observing the germ in the laboratory.The fact that a number of people have a specific form of headache does not necessarily mean that the cause is the same in all of them. In the same way, a blocked nose and sore throat may be caused by infection with germs or by allergy; the symptoms can be identical but the treatment of each is very different. Treating a ‘runny’ nose due to hay fever with antibiotics is worse than useless.The situation in the classification of headaches is analogous, except that a good deal is known about the structures concerned with pain and the nerves which carry the sensation.
*16/152/5*

PROLONGED IRRITATION AS A CAUSE OF CANCER

June 28th, 2011 by admin
It has been known for centuries that prolonged mechanical, physical and chemical irritation of the skin or mucous membranes can cause cancer. The edge of a broken tooth rubbing against the tongue, gall stones rubbing constantly against the gall-bladder, and smoking of short clay pipes used by labourers in Europe, have led to cancers of tongue, gallbladder and the lips respectively.
In the Godavari region of Andhra Pradesh, many men and women smoke locally rolled cigars (chutta) with the burning end inside the mouth. Some of these people are known to develop cancer of the mouth. Cancer below the umblicus, seen among Maharastrain men and women has been attributed to wearing of tight dhotis and sarees causing chronic irritation.
Excessive and continued drinking of very hot beverages may cause cancer of the throat and stomach. Prolonged irritation of the skin by chemicals or drugs may lead to skin cancer and continuous irritation of warts, pimples or slow healing sores may result in malignant tumours.
*15/355/5*

LEARNING ABOUT DISEASES: CANCER

June 11th, 2011 by admin
Cancer is a wild, unrestrained growth of cells. Some disturbance occurs which disrupts the balance of cells of different kinds in the body. The cells seem to return to their primitive state or to the infantile or fetal type. The body of a baby before birth grows much faster than does a cancer, but the growth of the cells in the developing child is controlled or regulated by an internal mechanism.
Many substances have the ability to stimulate the growth of cells. Pure chemicals, glandular substances, or physical forces like heat or pressure may stimulate cell growth. The changes that initiate the sudden, rapid growth of cancer cells and the traveling of these cells into other parts of the body involve many different factors related to the chemistry of the body, its nutrition, damage to tissues by inflammation and infection, and modifications of growth brought about by glandular action.
A variety of chemical products, particularly those related to tar, are known to be able to stimulate the growth of cancer. In tropical areas white people who do not protect themselves against the sun develop cancer in amounts out of all proportion to that which occurs among the native people with darker skins. To a large extent farmers also, as well as sailors, suffer from cancers of the skin.
Irritation is still a basic factor in the production of cancer. Continuous rubbing, irritation by irregular or jagged teeth, and heat from a pipe carried always in one corner of the mouth are known to be types of irritation that can excite the growth of cancer.

ARTHRITIS: CORTISONE PROVIDED BY NATURE

June 6th, 2011 by admin
Under favourable circumstances of correct diet, our adrenal glands can create very small quantities 199 of cortisone every day. Without this minute supply, everyone would be an arthritic. We all must have this hormone, but victims of arthritis require a certain type of cortisone which has heavier consistency. Why?
Arthritics need a special “heavier” cortisone containing a “sticky quality.” (This kind of cortisone can be obtained only by adding vitamin D oil to our daily diet.) What does the “stickiness” accomplish for our joints? It holds the lubricating oils in place and prevents them from seeping away from the joints.
A similar action is believed to take place in our connective tissues which surround our joints, as well as in the joint linings that we have been discussing.
Connective tissues contain collagen, a glue-like substance. Cortisone may increase the consistency of collagen—add an even greater “sticky quality.” In other words, cortisone will help hold oils in their proper place throughout this whole general area. The very area where an arthritic needs oil most.
Many medical experts now agree on the use of cortisone. Dr. R. H. Freyberg, a specialist at New York Hospital in Manhattan, believes that cortisone may have a working relationship with those tissues of our body known as “connective tissues.”
The present popularity of cortisone to combat arthritis is due to Dr. Freyberg and other outstanding rheumatologists throughout the United States. They have been champions of this drug, and have conducted extensive research to prove its effectiveness. The widespread use of cortisone today is a tribute to their initiative, when we stop to think that it was introduced to the medical world only a very few years ago.
*51\146\2*

EMERGENCIES: UNCONSCIOUSNESS

May 20th, 2011 by admin
To be out cold
When a person is unconscious, they are completely unaware of themselves and their surroundings. They have no control over body functions or movement. Usually they are not able to recall or remember any of the time spent in an unconscious state.
There are many causes of unconsciousness, including stroke, epilepsy, diabetic coma, head injury, alcohol intoxication, poisoning, heart attack, bleeding, electrocution and shock.
What you can do if someone has lost consciousness
Check for breathing. If necessary, open the airway and begin rescue breathing.
Check pulse. If no pulse, begin CPR.
Call for emergency medical assistance.
Keep the person warm unless you suspect heat stroke.
Lay the person down face up, with their head below their heart level. Move them as little as possible and only to provide life support or safety. Do not move person if you suspect a head or neck injury.
If there is vomit in the mouth, turn person on their side to allow fluids to drain out.
Look for medical identification or possible cause of unconsciousness.
Do not give anything to eat or drink.
*7\303\2*

DIAGNOSIS OF ACUTE BACTERIAL MENINGITISADJUNCTIVE THERAPY FOR ACUTE BACTERIAL MENINGITIS

May 12th, 2011 by admin
Steroid Use
Given that many of the damaging sequelae of acute bacterial meninges are due to the host’s inflammatory response, several studies have looked at the role of steroids as an adjunctive measure. Many of the studies have been done in children, and steroids have been shown to decrease the incidence of hearing loss in cases of H. influenzae meningitis in this population. Corroborating retrospective studies, a recent randomized double-blinded study from the Netherlands found significant mortality and morbidity benefit with the use of dexamethasone during the first 4 days of therapy for acute bacterial meningitis, convincingly for pneumococcal meningitis. The authors used doses of 10 mg IV every 6 hours for 4 days, commencing before or concomitant with the first dose of antibiotics. While they did not demonstrate better outcomes with steroids for non-pneumococcal meningitides, the number of non-pneumococcal cases was too small to reach a conclusion. Early steroid use should strongly be considered when the clinical picture with or without CSF data points to bacterial meningitis.
Supportive Care
Each patient’s neurologic status should be monitored closely and vigilantly for clinical deterioration, and, if this occurs, the practitioner should consider prompt reimaging, the use of modalities to lower intracranial pressure, and neurosurgical consultation for placement of a ventricular shunt or other neurosurgical intervention. While debate has surrounded intravenous fluid administration and cerebral edema, it is now generally accepted that fluids are often needed to maintain an adequate mean arterial pressure to provide sufficient cerebral perfusion pressure.
*7/348/5*

DIAGNOSIS OF ACUTE BACTERIAL MENINGITIS

May 1st, 2011 by admin
The lumbar puncture is critical to the diagnosis of acute bacterial meningitis. Several case series have looked at the presence of various CSF abnormalities of the lumbar puncture in cases of acute bacterial meningitis. Opening pressure is typically greater than 18 cm H20 and can be very high when cerebral edema is present. Generally, 80% of the time, the fluid is turbid. Gram stain is positive in 50% to 60% of cases. CSF cultures are positive in 65% to 75% of cases, although less often if antibiotics precede the lumbar puncture. The CSF cell count often exceeds 1000 cells/mm3. Neutrophilic predominance, with more than 80% neutrophils, is present in 80% of cases, although there are cases of lymphocyte predominance, seen most commonly with Listeria infection. The total protein usually exceeds 45 mg/dL in more than 95% of cases and is greater than 200 mg/dL in more than 50% of cases. The CSF glucose level is less than 50 mg/dL in approximately 70% of cases. However, these initial indices can be relatively normal in immunocompromised and neutropenic patients, and excluding the diagnosis of acute bacterial menigitis may necessitate a follow-up lumbar puncture. Partial antibiotic treatment, which is defined as the administration of intravenous antibiotics within 6 hours, oral antibiotics within 12 hours, or a prior recent course of antibiotics, does not usually not have a significant effect on CSF indices. Bacterial antigen tests in the CSF have been shown to have sensitivities of less than 75% and cannot be used to rule out disease. CSF analysis, combined with blood culture data, determines the diagnosis of acute bacterial meningitis.
Gram stain and culture of the CSF results should be performed immediately after the lumbar puncture and can direct antibiotic therapy. Since blood cultures are positive in more than 50% of cases of acute bacterial meningitis, two sets of blood cultures should be drawn prior to the administration of any antibiotic therapy.
*4/348/5*

THE THIRD STAGE OF STRESS BREAKDOWN

April 15th, 2011 by admin
Stage three sees marked changes in behaviour and attitudes quite out of character for the over-stressed person.
A person experiencing stage one and stage two symptoms of stress breakdown will, if the stress is not relieved, develop symptoms of stage three stress breakdown. These symptoms are observed primarily in changed behaviour towards others and are not easily recognized as stress-related. In contrast, the symptoms of stages one and two are usually easily identified as being stress-related.
A most important point about third stage symptoms is that they are often wrongly seen as variants of normal behaviour and may therefore be described variously as problems with communication, change in priorities, marriage problems, or life crises. It is essential that we understand the symptoms of stage three, so that we don’t respond inappropriately to them and make the stress situation even worse.
There are three extra symptoms in stage three
1. A relative intolerance of sensory stimulation.
2.   A loss of the ability to ignore things which were previously tolerated.
3.   Changed response patterns which superficially resemble a change of personality.
*25/129/5*