Archive for December 9th, 2009
SIGNS OF DEPRESSION: LIFE SEEMS NOT WORTH LIVING
Posted on December 9, 2009, under Anti Depressants-Sleeping Aid.
As you can imagine, with all the symptoms I have just listed, including a grim and bleak view of your present situation and future prospects, a depressed person may easily reach the conclusion – or entertain the possibility – that life is not worth living. This symptom of depression, known to the clinician as suicidal ideation, is a very troublesome one. If you are experiencing any such ideas, please do yourself and everyone who cares about you a great favour and consult a doctor without delay. Depression is a condition where hope is in short supply and one way to get an infusion of hope is to reach out to those who may be able to guide you out of the dark place. Your GP is a logical first port of call in such an attempt to reach out. But if, for any reason, it is difficult for you to talk to your doctor about the problem, tell someone – a family member, friend, or even someone on a crisis hot line. Suicidal ideation is not a symptom that anyone ought to have to suffer alone.
As depression deepens, suicidal ideation may progress to passive suicidal longings, which may be accompanied by lack of self-care or carelessness. A depressed woman may feel a lump in her breast while taking a shower and may say to herself, ‘So what if it’s cancer? It would probably be all for the best anyway’ Another depressed person might cross the road carelessly and, in the back of his mind, be thinking, ‘Well, if I get run over, what loss will that be to anyone?’
Matters become even more serious when suicidal ideas begin to gel into actual plans, and even more so when actions are taken to put these plans into effect. It might seem unnecessary to say that if someone you know or love should mention suicidal ideas or plans to you, these should always be taken seriously. Unfortunately it is still all too common for people to minimize the seriousness of such communications. The idea that if someone tells you he is considering suicide, he is unlikely to act on it, is a very dangerous myth. Such divulgences should always be heard as a communication of despair, which may or may not involve immediate danger but which always warrants serious attention. At the very least it is an expression of severe mental anguish.
If you think that life is not worth living or have any thoughts or plans to end your life, you are very, very likely to be depressed. Please don’t delay in getting professional help for this problem.
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THE TREATMENT OF EPILEPSY: SHOULD ANTI-EPILEPTIC MEDICATION BE GIVEN?
A person who has had two or three seizures does not necessarily need treatment. For example, an adult who has two or three generalized tonic-clonic seizures (grand mal fits) in a two-week period and who might lose his job if he had a seizure at work requires early treatment, whereas a child who has cerebral palsy and learning difficulties and who had had two partial seizures six months apart does not necessarily require treatment with anti-epileptic drugs. Remember also that there are people whose seizures can be clearly attributed in part to a non-recurring cause. For example, seizures may begin for the first time whilst the person is on an antidepressant drug, such as amitriptyline, which is known to induce seizures in some people. Clearly the drug is not the only factor. Thousands of people take amitriptyline without having seizures. In those who do, the drug presumably acts on those with a low seizure threshold. Nevertheless it would seem reasonable to see how such a person gets on without antidepressants, before prescribing anti-epileptic medication. Other precipitating factors, if specific, such as occur in epilepsy induced by television may be avoided, and make anti-epileptic medication unnecessary.
It is therefore important that each patient is considered as an individual. The choice of whether or not anti-epileptic medication should be used is made in equal partnership between patient (or parent) and doctor. For example, a woman may wish to avoid anti-epileptic medication if planning a pregnancy even though her chances of further seizures are high.
One common decision that has to be made is whether or not to start anti-epileptic medication after a single seizure in an adult, often for which no clearly defined precipitating factor can be identified. It used to be advised that ‘one seizure did not make a diagnosis of epilepsy’. Although true by definition, the risk of a second seizure is in adults as high as 78% over the next three years, the risk being its highest in the first few weeks. Recent trials have shown clearly that an anti-epileptic drug given after the first seizure does significantly reduce the chances of a second. Patients should be offered the choice of anti-epileptic medication at this stage, with a clear explanation of the risks of further seizures and the relative drawbacks of medication, even though a number will decide to take their chances.
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TESTS IN EPILEPSY: BRAIN IMAGING INVESTIGATIONS AND THE CT SCAN
The EEG is a ‘functional’ investigation, recording the brain’s function through normal and abnormal electrical activity. Imaging procedures or brain scans provide information about the brain’s structure, and revealing normal and abnormal anatomy. Most, if not all patients who have epilepsy need to have at least one EEG, fewer than perhaps 1 in 5 or 1 in 6 patients need to have an imaging investigation. Research is underway to determine who should be scanned.
Two types of imaging techniques are currently available in the developed world; these are the computerized tomographic (CT) brain scan and magnetic resonance imaging (MRI).
The CT scan-This is an abbreviation the computerized axial tomography (CAT) scan. The technique was developed in the 1970s and is a type of X-ray investigation. Tomography is a word dating from earlier X-ray techniques. The patient lies still on a table whilst a rotating X-ray machine takes two-dimensional pictures of the head from many different angles or positions. The information is then processed by a computer to produce pictures (or images) at different levels of the brain. The test is safe, and other than keeping the head still, there are no particular precautions to be taken. Children may have to be given a sedative drug or short anaesthetic so that they can keep still for the scan. The test takes approximately 15-20 minutes. If an area of interest is seen on the initial images, some contrast (special dye) is injected into a vein in the hand or arm and then the scan repeated. The dye may enhance contrast in areas of interest and give more detailed information. CT scanning has proved to be very useful in detecting structural abnormalities within the brain, such as strokes, infections, tumours, and congenital malformations which may cause epilepsy. However, only 20-25 per cent of patients with epilepsy referred to special centres will have an abnormal CT scan. Abnormalities on the CT scan in patients who have epilepsy are more likely to be found in the following situations:
• patients whose seizures affect only one side of the body;
• patients whose EEG shows a persistent slow wave abnormality on one side of the brain;
• when epilepsy starts in newborn babies and continues;
• when epilepsy starts in later life; and
• if the patient has abnormal findings on neurological examination, for example, mild weakness down one side of the body, or changes in the reflexes.
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THE FACTS ABOUT PROTEIN DIET
At the risk of disappointing many steak lovers, I must state that there is no scientific truth in the high-protein-for-health theory. If you are really concerned with your health and long life, you must unlearn everything you have learned previously concerning proteins.
It is true that our bodies are built mostly of proteins. Twenty per cent, and more in some vital organs, of a cell’s composition is made up of protein. Since our body is renewing and repairing its cells constantly, we need lots of protein in our diet to supply needed nutrients for these repairs and for the building of new cells.
But how much is “lots”? Seventy, 100, or 150 grams a day, as advocated by many American “experts”? Due to the frame of this work we cannot, unfortunately, go into great detail in presenting this most interesting subject. Suffice here to say that the majority of responsible nutritionists in various parts of the world agree that our present beliefs on the protein question are outdated and that the actual need for protein in the human diet is far below that which has long been considered necessary. The famous nutritionists Dr. Ragnar Berg, Dr. R. Chittenden, Dr. M. Hindhede, Dr. M. Hegsted, Dr. William C. Rose, and others are reported to have shown in extensive experiments that our actual need for protein is somewhere around 30 grams a day, or even less. Many leading contemporary scientists and nutritionists in Europe, such as Dr. Ralph Bircher, Dr. Otto Buchinger, Jr., Dr. H. Karstrom, Prof. H. A. Schweigart, Dr. Karl-Otto Aly, and many others are in full agreement with the findings of Drs. Berg, Chittenden, Rose, et al., and are recommending a low-protein diet as the diet most conducive to good health.
Empirical experience and observation proves the correctness of the above fact. The healthiest people in the world—the famous Hunza people in India, the Semitic tribes of Yemen, Bulgarians and Russians, certain tribes of Central America and Africa—which are known for their good health, long fife, and resistance to disease, all five on a low animal protein, high natural carbohydrate diet. Even in the United States, some religious groups, like the Seventh-Day Adventists and Mormons, who advocate a low animal protein diet, have 50 to 70 per cent lower death rates than those of average Americans; this is shown by statistics. They also are reported to have a much lower incidence of cancer, tuberculosis, coronary diseases, blood and kidney diseases, and diseases of the digestive and respiratory organs.
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A PRACTICAL GUIDE TO USING ST JOHN’S WORT: GETTING THE DOSE RIGHT
Posted on December 9, 2009, under Anti Depressants-Sleeping Aid.
Since the target dosage in most of the anti-depressant studies of mild-to-moderate depression has been 900 mg of Hypericum per day, this is a reasonable dose to aim for. The Kira brand of St John’s Wort which, for reasons that I discuss later, is the one I recommend most highly, comes in only 135-mg dosage, at least in the UK, which would mean taking about six 135-mg pills every day. Whenever I start an anti-depressant, I always begin with a low dose and increase the dosage somewhat gradually until the final or target dose is reached. The reason for this is that some people are very sensitive to medications and it is often not possible to predict who will be very sensitive and who will not. An average dose of an anti-depressant may be far too much for such a person to tolerate, especially when just beginning the medication. If a highly sensitive person starts right out with an ‘average’ dose of an anti-depressant without building up to the final target dosage, unpleasant side-effects may result and the person may be disinclined ever to try the medication again. So I would rather err on the side of moving a little too slowly. In practice, this means that I start a person on 300 mg (approximately two 135-mg pills) of Hypericum once a day for two or three days, then twice a day for two or three days, then three times a day. In older people, say over 60,1 would proceed even more gradually.
If unpleasant side-effects should develop, I slow down this progression, always working within the patient’s comfort zone. In other words, if you are uncomfortable with two 135-mg tablets of
Hypericum per day, don’t move up on the dosage until the side-effects dissipate, as they generally will. Be sure to listen to what your body is telling you. Discomfort of any sort is a signal for you to slow down. In some sensitive people, including the elderly, a final dose of less than 900 mg, such as 600 mg (4 x 135 mg), may work best.
I should note that my practice of starting slowly differs from the widespread practice in Germany of starting with 900 mg per day – approximately two Kira tablets three times a day. According to my German colleagues, they do not experience problems with this approach.
Be sure to take the Hypericum with meals, as this minimizes the chances of developing indigestion or abdominal discomfort which may occur in certain people on the herbal remedy.
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SUGGESTIONS FOR THOSE WHO ARE STRESSED OR FEELING MILDLY BLUE, DOWN IN THE DUMPS OR UNDER THE WEATHER
Posted on December 9, 2009, under Anti Depressants-Sleeping Aid.
An old advertisement for an over-the-counter cold medication observed that you can’t take every cold to a doctor, and proceeded to plug the medicine in question. The advert was right. It is not sensible to go to the doctor with every cold – or, for that matter, whenever you feel blue, down in the dumps or lacking in energy and pep. On the other hand, a case of pneumonia should always be taken to a doctor – and promptly – and that applies to serious depression as well. And just as we have guidelines to help us distinguish between a cold and pneumonia, so we can distinguish between serious depression and feeling mildly out of sorts. In the mildly blue, stressed-out, under-the-weather category, I would put those whose symptoms are not seriously interfering with their work, personal relationships or other aspects of their functioning. Also, the problem should not have been going on for too long, not more, say, than for a couple of months.
If you think you qualify for this very mild category, I suggest that you read about the symptoms of depression anyway because depressed people are often not very good at recognizing how depressed they are – and they are not alone in this regard. Statistics indicate that even doctors fail to recognize and treat depression properly in a very high proportion of cases. If professionals underestimate depression to this extent, lay people can surely be forgiven for doing the same. Because many of the symptoms of depression do not actually involve sadness or depressed mood, but rather physical symptoms, they are easily attributed to other conditions. In addition, depressed people often believe that their problems are due exclusively to influences from the outside world rather than some internal problem. This set of beliefs may be associated with a fear of acknowledging that ‘there may be something wrong with me’ and a pessimism about being able to correct the problem. In fact, the opposite is often true as it may be easier to correct problems that stem from within yourself than those that arise in the outside world, over which you may have very little control.
If, after reflection, you still feel that you are not clinically depressed, but simply overstressed or mildly down in the dumps, you may well benefit from a trial of St John’s Wort as described below. It is always important, of course, to address any underlying causes of your unhappiness in addition to taking the herbal remedy.
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SCIATICA AND OVERWEIGHT: MORE TIPS TO TRY
Posted on December 9, 2009, under Pain Relief-Muscle Relaxers.
There are also numerous ‘tricks’, psychological or otherwise, that you can use to good effect to help you feel less hungry or make a smaller portion of food just as satisfying as a larger one. Researchers have found that the following ideas work well for most people, enabling them to adhere more easily to a restricted diet:
Drink a full glass of water half an hour or so before every main meal. The water makes you feel fuller when you begin to eat, so reducing your appetite.
Serve your food on plates smaller than those you normally use. The smaller plate will make a slimmer’s portion appear bigger than it really is, so deceiving your brain into believing that you’re having a larger meal than you are. Extending the same principle, try eating with a cocktail fork. This will force you into eating more slowly – the more slowly you eat, the more filling the food will seem to be.
Another useful ‘psychological’ tip in the same vein is to select food that is low in calories but which takes up a lot of room on your plate. Studies have shown that we eat what looks like the amount of food we think we want, subconsciously judging portions by the space they occupy. This means that choosing low-calorie foods, such as salads, that fill a lot of space on your plate can provide you with the illusion that you’re eating more.
Some more eminently practical suggestions that you can use to train yourself to eat less:
Much as you may hate to throw away good food, do not save leftovers from meals. Stashing away leftovers in the fridge, say the experts, is unconscious plotting to provide yourself with snacks between meals.
Keep foods that are low in calories in easily accessible places in your cupboards or fridge while placing high-calorie foods where they’re difficult to get to.
In so far as this is practicable, eat alone instead of in the company of others. Studies have determined that people eating on their own consume fewer calories on the average than those having a meal as part of a group. Additionally, those eating alone also spent less time at the table, thereby reducing the length of time during which they could have been tempted into having an extra helping.
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SCIATICA: LIGHTENING THE BURDEN
Posted on December 9, 2009, under Pain Relief-Muscle Relaxers.
It stands to reason that being at all overweight is not going to help your sciatica or back problems one bit. As we’ve seen, the spine’s design is such that it all too often has difficulty in coping with even the normal, ordinary demands put upon it through everyday living. If the burden it has to bear becomes even greater because you’re overweight, then it’s obviously more likely that something is going to give sooner or later.
There’s an additional point to take into account: most overweight people carry their extra pounds in the abdomen area, the hips and the thighs. Extra weight in the abdomen is particularly bad news for back sufferers because its presence not only puts extra strain upon the spine while you’re erect – such as standing or walking – but even when you’re sitting. And, of course, bending over or lifting anything creates even greater demands upon the spine when there’s excess baggage hanging out in front of it.
Keeping your weight down to a reasonable level can make a major difference in both preventing and easing back problems and sciatica. What’s more, of course, keeping to a healthy weight will also pay rich dividends in other health benefits. Additionally, many of the exercises that are so important to maintaining a flexible and trouble-free spine will be a great deal easier to do if you’re not carrying too many extra pounds- and a lot more fun, too! It’s a fact that the overweight – the very people who would perhaps gain the greatest benefits from frequent and regular exercising – are often those who exercise the least, part of the reason for this obviously being that exercising is all that much harder and therefore less appealing for them. This lack of exercising often imposes a double penalty upon the back: firstly, it is likely to contribute to the putting on of ever more extra weight; secondly, because the back muscles are not exercised, they’re likely to be in poor condition, lacking strength and flexibility, providing less efficient support for the back and the spine as a whole.
Faced with an obese patient with recurrent sciatica or other back problems for which no other obvious treatment is indicated, doctors will often recommend a weight-loss programme. Good though that advice is, most doctors unfortunately do not have the time to provide specific guidelines about how best to shed the pounds. Following are some of the things your doctor might suggest if he had the time.
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TUMMY TROUBLES: IRRITABLE BOWEL SYNDROME
Posted on December 9, 2009, under Gastrointestinal.
Q. Whilst we are discussing bowel disorders, what is irritable bowel syndrome?
A. This is a common bowel problem in which no organic disease can be found. It is probably nervous or psychogenic in nature, although certain dietetic factors (such as inadequate fibre) may play a part.
Q. What are the symptoms?
A. They are fairly constant and consist of long bouts of diarrhoea, which is worse when under stress and anxiety, does not involve the passing of blood, constipation or abdominal pain. Pain is eased by a bowel action or the passage of wind. These symptoms may occur separately, or in succession, or together. The patient’s general health is usually good. Often a lot of mucus is passed but not blood.
Q. What about diagnosis and treatment?
A. Symptoms of this nature always require a full bowel check to exclude a serious disease. X-rays and endoscopic examinations may take place. Treatment includes a high fibre diet, rich in unprocessed bran and fibre foods. Foods which obviously upset should be excluded. Medical hypnotherapy by an experienced doctor often produces excellent results.
A. This means swallowing air but usually means the symptoms that occur when there is too much gas or air in the G.I. system and when there is no organic disease.
Q. Where does intestinal gas come from?
A. It may only come from a few sources. These are air that is swallowed or gas produced within the intestinal system itself. It is easy to unconsciously swallow air, specially at times of emotional stress, when chewing gum, smoking, with excessive salivation or with a dry throat. Many who like to belch often take in more air than they eliminate. Many foods, specially fizzy drinks and various sugary fruit juices and carbohydrates are notorious for increasing gas in the bowel system.
Q. What are the symptoms and how is it treated?
A. There is a feeling of fullness, maybe nausea. Belching, dyspepsia and “indigestion” are common. Much wind is passed by the bowel, a condition called flatulence. Treatment consists in avoiding the causes. Eat in a peaceful environment. Avoid fizzy drinks and alcohol with meals. Avoid gum chewing, smoking, or foods or vegetables that knowingly cause distress. Apples, grapes, raisins, bananas, leafy greens, onions, lentils, legumes and fried foods are best avoided. Experience is the best teacher. Drug therapy is not necessary. Fibre often helps, such as bran for breakfast each day.
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TUMMY TROUBLES: WORMS
Posted on December 9, 2009, under Gastrointestinal.
Q. What about worms? Are these very common?
A. Indeed they are and I guess nearly every child in Australia has suffered from worms. The most common kind here is the threadworm, also called the pin worm. It commonly affects children of school age, for eggs are readily transmitted on fingers and hands, school implements, toys and play things.
The eggs quickly hatch out in the bowel and adult worms leave the anus to deposit eggs around the anal margin at night. This causes irritation and the desire to scratch, which in turn transmits more eggs to the fingers and under the nails and so they are spread to others, either members of the family or school chums. Apart from irritation there are rarely any severe effects.
Q. What is the best treatment?
A. Ideally the whole family or the whole class or school should be treated at the same time. A variety of medications is used, Mebendazole (Vermox) is very satisfactory. One tablet, or 5 ml of liquid, is all that is required irrespective of age. If the worms recur, which is common, a further dose or two at weekly intervals will again have a beneficial effect. Other worm killers are also used with good effect.
Q. What about other worm infestations. Are these common?
A. In certain under-developed countries they are notoriously common. In Australia, in the main, they are not commonly seen. Round worm (ascariasis) sometimes occurs. There may be no symptoms, although nausea, vomiting and colic may be present. Piperazine citrate is effective treatment. Hookworm, strongyloides and tape worm are occasionally seen.
Q. What about giardiasis? This seems to have suddenly taken off in Australia in recent years.
A. True, and the parasite called giardia lamblia which came here from the Mediterranean area is now very common all around Australia, especially along the eastern seaboard. It usually comes from infected water, maybe swimming pools, is swallowed, multiplies in the duodenum and causes ongoing diarrhoea with frothy stools. The organism may be identified by material taken from the duodenum or from the contaminated stools.
Q. What about treatment?
A. This is excellent. Metronidazole (Flagyl) given three times a day for a week is curative. A simpler method is taking tinidazole (Fasigyn), four tablets of 500 mg as a single dose. These drugs should be taken under medical supervision after the diagnosis has been confirmed.
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