MEDICAL TREATMENT OF SEIZURES: PHILOSOPHY OF TREATMENT

Posted on May 13, 2011 by admin

Although once it was believed that all seizures should be treated, just because they were there, now it is generally believed that no judgment can cover every individual. Decisions about treatment should be made by the patient (or parent) and the physician acting in partnership. The decision should be based on risk-benefit analysis.
The risks and consequences of each medication vary with the medicine, with the dose, with the individual’s reaction to the medicine, with the age of the child, and with the length of time the child takes the medicine. The risk of further seizures varies markedly with the type of seizure, the frequency of seizures, and even the time of day in which they occur. A child who has only occasional tonic-clonic seizures at night will face very different risks from a child whose seizures occur during the day. A child with occasional complex partial seizures has different risks from the child with tonic-clonic seizures or the child with frequent absence seizures.
Most people’s seizures can be controlled with a single medicine used in a proper dose to achieve a proper blood level for that individual. There is no correct dose of a given medication. The “proper” dose of medication is the dose that completely controls the seizures without causing significant side effects. There is not a “correct” medication as such. Some medicines work better for some types of seizures than for others. The correct medicine is the one that works.
The treatment of epilepsy is empirical. This means that the treatment of each person’s seizures is a trial or search to find the appropriate dose
of the best medicine for that individual. This “experimentation” is often frustrating to parents since they are used to physicians’ knowing, for example, the right antibiotic and dose to use for a child’s ear infection.
For drugs like antibiotics, we know how they act, the proper dose, and the side effects. We know how much is necessary to kill the bacteria causing the infection. We can test the drug’s effectiveness in the laboratory. We know, for example, how “heart drugs” work and their side effects, we can use the electrocardiogram (EKG) to see if they are working or if they are producing toxicity. But, since we do not fully understand how anticonvulsant drugs work, and since we do not understand the factors that permit a seizure to occur at a specific time, each child must be his own laboratory as a doctor attempts to find the proper dose of the best anticonvulsant. Side effects will vary with each child’s metabolism and his individual reaction to the drug.
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TYPE II DIABETES: WHY IS HIGH BLOOD GLUCOSE BAD FOR YOU?

Posted on May 7, 2011 by admin

Too much glucose in your bloodstream can be toxic to a number of your body’s systems and organs. Prolonged high blood glucose levels can damage your blood vessels, your eyes, your nerves and your kidneys. Although you may feel good after you have eaten a wonderful meal (the result of elevated blood glucose levels), you may also feel drowsy and washed out. A good feeling from high sugars is only a short-term effect. Do this time after time for year after year, and you’ll start feeling negative instead of positive effects.
High blood glucose levels can make you feel depressed and helpless. The more depressed and helpless you feel, the more likely you will “feed” your depression with extra food – thus making things worse, rather than better.
High blood glucose levels eventually will damage the nerves, resulting in a condition called diabetic neuropathy. This condition often affects the feet and legs, resulting in severe pain and discomfort.
High blood glucose levels also affect both the small and large blood vessels. This results in such complications as diabetic retinopathy (loss of visual acuity and, in some persons, complete blindness) and diabetic nephropathy (kidney failure).
High blood glucose levels also result in the development of impotence in diabetic men who have had the disease, without good control, for ten or more years.
High blood glucose levels interfere with the body’s ability to transport cholesterol and lead to the clogging of blood vessels, which then could cause heart disease and stroke. These high blood glucose levels also interfere with blood clotting and thinning.
Last but certainly not least, high blood glucose levels speed up the normal aging process by accelerating such age-related problems as cataract formation and stiffening of the joints and skin.
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HYPERTENSION AND OBESITY

Posted on April 26, 2011 by admin

What is the extent of the link between hypertension and obesity?
There is a very close link between obesity, particularly abdominal obesity, and hypertension; it has been reported that up to two-thirds of cases of hypertension are linked with obesity. Obese people have over five times the normal risk of developing hypertension and people who are 20% overweight are eight times more likely to develop the condition. In fact, obesity has been described as the major modifiable correlate of blood pressure.
The Framingham study demonstrated that every 4.5-kg increase in weight led to a gain of around 4.3 mmHg systolic blood pressure, and that a 15% gain in weight was associated with an 18% increase in systolic blood pressure.

What is the relationship between hypertension and obesity?
The exact cause of the association is unclear and there are known to be multiple factors. One such factor is the raised insulin level (which occurs with the metabolic syndrome), which has a stimulant effect on the kidneys, leading to salt retention and hypertension.
Another factor could be sleep apnoea, which causes hypertension as a result of prolonged hypoxia and by changes in thoracic pressure. The collapse of the pharyngeal airway that occurs in sleep apnoea results in increased respiratory effort and increasingly negative intrathoracic pressure, until hypoxia causes arousal from sleep and normal service is resumed.
Many other phenomena associated with obesity also predispose to hypertension or potentiate the effects of hypertension, leading to coronary heart disease. These include left ventricular hypertrophy, increased coagulability, interference with the sympathetic nervous system and dyslipidaemia.
Blood pressure must be measured with a cuff that is large enough to embrace 80% of the upper arm; otherwise an abnormally high reading will result. Such a cuff should be readily available so that neither patient nor doctor is embarrassed by a search.

How does weight loss improve hypertension?
It has been shown that weight loss not only induces a reduction in blood pressure but that it also prevents hypertension in at-risk normotensive people. Weight loss of 10% has been demonstrated to cause reduction of blood pressure of between 10 and 20 mmHg systolic and diastolic. Jung demonstrated a reduction of 1 mmHg systolic and 2 mmHg diastolic for each 1% reduction in weight.

How is hypertension in obesity treated?
Blood pressure will often need treatment with antihypertensive medication at the same time as weight loss is occurring, although treatment can be temporary if sufficient weight loss is induced. Beta-blockers should be avoided because of the risk of weight gain and it is suggested that thiazide and other diuretics should be avoided because of the renal-induced salt imbalance.
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NATURAL REMEDIES FOR COMMON SYMPTOMS OF CANCER: SORE MOUTH

Posted on April 12, 2011 by admin

Sore Mouth may result from drug reaction, vitamin deficiency, small ulcers, fungal infections and bacterial infections.
Natural Remedies: The treatment for sores in the mouth produced by drugs, is to keep the mouth hygienically clean. The patient should also gargle several times daily, with lemon juice mixed in water. This gargle can be prepared by mixing 20 ml. of lemon juice in 100 ml. of hot water.
A simple but effective home remedy for ulcers and infection in the mouth is frequent use of a mouth-wash containing a teaspoon each of salt and baking soda in a glass of warm water. This should be used every two to three hours to keep the mouth as clean as possible. The use of alum (phitkan) is also valuable in these conditions. The patient should gargle with alum diluted in hot water. Concentrated solution of alum may also be applied with the help of a swab on the ulcerated spots.
Other symptoms of cancer are blood in the sputum, motions and urine; changes in the menstrual periods, especially heavy and excessive bleeding between periods; changes in appearance, size and colour of moles which are present for a long time; abnormal delay in healing of any sore, particularly on the face; difficulty in passing urine; a persistent dry cough; indigestion occurring for the first time in later life; raised birth mark and tender swelling of the bone and the tissue.
The American Cancer Society has prescribed seven signs or danger signals in general, which may indicate the presence of cancer. These are a sore that does not heal, change in bowel or bladder habits, unusual bleeding or discharge, thickening or lump in breast or elsewhere, indigestion or difficulty in swallowing, obvious change in wart or mole and persistent and nagging cough or hoarseness.
Cancers have a latency period varying from five to forty years between the initial exposure to a carcinogen and the time the symptoms appear. In a large number of cases, either trivial symptoms are noted or there are none at all. One has therefore, to be vigilant to recognize the first sign of the disease.
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SKIN AND REGULATION OF BODY TEMPERATURE

Posted on March 28, 2011 by admin

The skin plays an important part in the regulation of the temperature of the body, and the sweat glands in particular are involved in this ever present function. A constant balance of temperature has to be maintained; regulation is constantly taking place in relation to the varying temperatures outside the body. There is in the brain a heat-regulating centre which is responsive to stimulation of the skin. The skin helps to regulate the body heat by the amount of blood passing through it.
When the temperature of the body rises then the sweat glands go into action. They secrete perspiration, and the evaporation of it tends to cool the body. We should remember that in normal health the temperature runs between 97 degrees and 99 degrees F., and any substantial departure from this is an indication that pathological processes are at work. We speak of such a condition as fever, and skin has to play a vital part whilst the body is under this strain. One of the most important points in the skilful nursing of those who are suffering from fever is to watch the condition of the skin and to see that it functions under the best possible conditions.
The temperature of the air surrounding the patient is of great importance at such a time; sudden changes of cold and heat are a big strain, and the condition of the skin may be used as a guide to what is required. The good nurse knows how to regulate the atmosphere so that the patient is kept comfortable and restful.

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HIV: GET REGULAR MEDICAL CARE-LABORATORY TESTS

Posted on March 21, 2011 by admin

All people with HIV infection should have regular medical care. Options for medical care will depend to some extent on the resources available. For the person with HIV infection who feels well, regular medical care usually includes between two and four visits to a physician per year. During the visits, your previous medical problems should be reviewed, and any symptoms or conditions that may or may not be related to HIV infection should be discussed. During the visits, you should also have a physical examination and any necessary laboratory tests. Your physician should then candidly discuss your health status with you, and should recommend subsequent medical care.
Laboratory tests-The laboratory tests to expect are those ordinarily done during a medical evaluation, plus those done to keep track of the status of HIV infection. The main blood test used to evaluate the status of the immune system and the status of HIV infection is the CD4 cell count. Other tests, used for the same purpose but less frequently, include the erythrocyte sedimentation rate, beta-2 microglobulin, the levels of antibody to reverse transcriptase, neopterin levels, levels of antibody to CMV, and counts of-lymphocytes other than CD4 cells. Other tests done to evaluate a person’s general health include tests of kidney and liver function, a blood test for syphilis, and a complete blood count. Occasionally a chest x-ray or a test for the hepatitis virus will also be done.
Two tests are worth explaining in more detail. One is the test called a complete blood count, or CBC. The CBC is a standard laboratory test done during the medical evaluation of almost any condition. Few tests reveal more information for the price (usually $8 to $15 per test). CBCs count the numbers of red blood cells, white blood cells, and platelets. Any one or all three of these counts can be lowered by HIV infection, by opportunistic infections, or by various drugs. Red blood cells carry oxygen to all parts of the body; low red blood cell counts can cause fatigue. White blood cells, which include lymphocytes and neutrophils, are the cells of the immune system; low lymphocyte counts are to be expected with HIV infection, and low neutrophil counts can predispose people to bacterial infections. Platelets are responsible for the clotting of blood, so low platelet counts can cause a tendency to bleed excessively from minor cuts or injuries.
The second test worthy of special note is the CD4 cell count, a test regularly done with people with HIV infection to evaluate the status of the immune system. CD4 cells are those cells of the immune system that HIV infects. The CD4 cell count is therefore a reasonably good indicator of the strength of the immune system, of the stage of HIV infection, of the need for certain medicines, and of the potential importance of some of the symptoms described below.
Despite the importance of the CD4 cell count, a word of caution is necessary. The CD4 count varies significantly. The count can vary with the time of day and with medical conditions other than HIV—colds, drugs, and even emotional state. It can also vary depending on the laboratory technician who does the test and on the method used to do the test. The same laboratory technician doing the same test twice on the same blood sample can show counts that differ by as much as 20 percent. That means that a count of 500, if repeated, might be 400 or 600. When possible, it is desirable to have sequential tests done in the same laboratory, to avoid the variations between laboratories.
The CD4 cell count considered normal has a large range. For some labs, the range can be 550 to 1,450, or even larger. For most labs, the range is 700 to 1,300. When major decisions about treatment depend on the CD4 count, as they sometimes do, the usual recommendation is to repeat the count.
The tests discussed above are done during the first medical evaluation of someone with HIV infection and are, at that time, called screening tests. Results of the tests will be discussed either by telephone or during a subsequent office visit.
Many of the same tests, especially the CBC and the CD4 count, are also done periodically throughout the course of the infection. Which tests are selected depends on the symptoms, on the presence of any other medical problems, and on the idiosyncrasies of the physician. The
frequency of tests and which tests are selected also depend on which drugs are being taken, since these tests often reveal adverse reactions that are important to know about. For example, people taking AZT should have a CBC at least every three months because the main adverse reactions are anemia and neutropenia. The total price for both the screening tests and tests done during subsequent visits for people who feel well and have no other medical problems usually comes to less than $100.

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QUICK REFERENCES: SYMPTOMS AND ACTION – CONSTIPATION & CANDIDA

Posted on March 16, 2011 by admin

Constipation
1 Increase fluids; take as little milk as possible, cut down on tea and coffee.
2 Eat lots of fruit and vegetables.
3 Take linseed or bulking agent with lots of water.
4 Massage abdomen with or without oil
5 Do abdominal and breathing exercises.
6 If necessary get up earlier in order to sit on the lavatory in a relaxed manner, at the same time each day. Continue with this even if nothing happens on the first few occasions. Try stimulating the bowel action by pressing the anus with a pad of toilet paper. It is particularly important to keep to this routine if you are taking a bulking agent; because the stool is softer you may not be getting the same painful signals.
7 Consider why you are so reluctant to relax your muscles. Is it fear, anger or frustration? Find someone to talk to; also use self-talk.
Candida
J Kill the Candida.
2 Take supplements.
3 Keep bowel clean.
4 Avoid damp, mouldy environments.
5 Keep away from chemicals.
6 Get plenty of fresh air and if possible sunlight.
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MINERALS: POTASSIUM & SODIUM

Posted on February 21, 2011 by admin

Potassium
Functions:   Works with sodium to control fluid balance of the body
Sources:   Green leafy vegetables, oranges, apples, potatoes, bananas, lean meat
Causes of   Deficiency:   Water tablets, diarrhoea or vomiting, long term steroids, abusing laxatives, large quantities of tea or coffee
Deficiency Signs   Muscle weakness, dizziness, confusion, constipation, impairment of nerve function.
Sodium
Functions:   Water balance; muscle contraction and nerve impulses; keeps heart rhythm steady
Sources:   Widely available in the diet
Causes of Deficiency:     Prolonged diarrhoea or vomiting, heat stroke, burns, heavy physical work causing profuse sweating
Deficiency Signs   Lethargy, dizziness, cramps, palpitations.
Note: too much salt causes increased risk of heart disease and high blood pressure; fluid retention.
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SEIZURES AND EPILEPSY IN CHILDHOOD: UNDERSTANDING YOUR CHILD’S TESTS – SPIKES

Posted on February 14, 2011 by admin

Since a clinical seizure requires that a sufficient number of brain cells fire together to cause the alteration in movement or behavior, one would expect this “firing” to cause a change in the electrical activity recorded on the EEG. That is exactly what does happen. The normal EEG  represents an almost random firing of brain cells; when the cells fire simultaneously they produce an electrical abnormality in the EEG called a “spike”.
A spike is a mini-electrical seizure. Only if that electrical disturbance spreads to involve more cells (a sufficient number to change behavior) would a true clinical seizure occur. Thus, repeated spikes coming from a particular area represent the local response to a provocation there, an epileptic focus or scar. In a child (or adult) who has had a focal seizure, spikes may indicate the area of the brain where the seizure started.
Multifocal spikes, by comparison, suggest that there are many abnormal areas of the brain.
Spikes are not of significance unless they are found consistently in one area.
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DIETS FOR PEOPLE WITH DIABETES: NUTRITIVE AND NON- NUTRITIVE SWEETENERS

Posted on February 6, 2011 by admin

Nutritive Sweeteners
Nutritive sweeteners include fructose, honey, corn syrup, molasses, fruit juice or fruit juice concentrates, dextrose, maltose, mannitol, sorbitol, xylitol, and hydrogenated starch hydrolysates, as well as sucrose. Research has shown no significant advantage or disadvantage of any of these nutritive sweeteners over sucrose.
Fructose, which occurs naturally in fruits, vegetables and honey, provides 4 kcal/g, as do other carbohydrates, but causes a smaller rise in plasma glucose than do sucrose and other starches. For this reason, it has been a popular sweetener in meal plans for people with diabetes. However, there is no reason to recommend that people should avoid consumption of fruits and vegetables, in which fructose occurs naturally, or moderate consumption of fructose-sweetened foods.
Sorbitol, mannitol and xylitol are common sugar alcohols (polyols) that cause a lower glycemic response than do sucrose and other carbohydrates. They are used as bulking agents and sweeteners in foods. Their energy value is 2-3 kcal/g. The main disadvantage of their use is the osmotic diarrhea effect, if consumed in large amounts. Polyols do not appear to have significant advantages over other nutritive sweeteners. When 30 g sorbitol (the amount in 10 pieces of small hard candy) or more is ingested in a single dose, the result may be abdominal gas, discomfort and osmotic diarrhea, depending on the individual’s gastrointestinal sensitivity. An individual’s tolerance level may be as low as 10 g/day.

Non-nutritive Sweeteners
Aspartame, acesulfame-k and saccharin are currently approved for use. Each of these products underwent rigorous testing by the manufacturer and scrutiny from the FDA before it was approved for consumption. All can be used safely by people with diabetes.
The average intake of all the non-nutritive sweeteners is much less than the acceptable daily intake (ADI), which is determined by the FDA. The ADI represents the amount of a food additive that, even if consumed on a daily basis throughout an individual’s lifetime, is still considered safe by a 100-fold safety margin. It is not a toxic threshold and even if an individual occasionally ingested a substance in amounts greater than the ADI, it would not pose a health risk.
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