Your Medical e-Magazine

ECONOMIC…

HUMANISTIC…

PHYSIOLOGICAL..

From a physiological standpoint, asthma is a complex disease that cannot be cured. In most cases, however, with patient cooperation and diligent effort, it can be effectively managed - even in more severe cases - allowing the asthmatic individual to lead a relatively normal existence.   During an asthma episode, the air tubes in the lungs (bronchi and bronchioles) which lead to air sacs (alveoli) become obstructed. As airways constrict, breathing becomes more labored, and the patient will often cough or wheeze.   These attacks vary in length and interval between episodes. A single episode can be over in minutes, or go on for hours or even days. In between asthma flares the patient may be totally symptom free. Other patients may have slight symptoms manifested as chest tightness or a hacking cough. A test called spirometry measures lung function, and often provides meaningful clues in the diagnosis or assessment of asthma.   Most asthmatics are also allergic, and asthma attacks are often triggered by an allergic reaction. Some asthma patients do not have significant allergies, and even in allergic patients asthma flareups can be provoked by non-allergic irritants such as common colds, chemical fumes and cigarette smoke. Cold air and exercise can also induce symptoms.   

TRIPLE THREAT

 During an attack the lining of the bronchiole becomes inflamed. The inflammatory response causes fluid and cells to collect; the engorged lining tissue then swells, contributing to the blockage of the bronchiole.   At the same time, tiny muscles that wrap around the outside of the air tubes become “twitchy.” In an involuntary and reflexive reaction the muscles constrict, further decreasing the diameter of the airway within.   Mucus is normally present in the bronchioles to lubricate these passages. During asthma attacks, increased mucus production further adds to the obstruction of the airway. Often these mucus plugs are difficult to clear, and if they are allowed to linger afterward they can provide an opportunity for infection to set in.   Asthma is a reversible condition, as opposed to a progressive disease of the lung such as emphysema. Sometimes asthma is reversed through the use of medication, other times the reversal is spontaneous. By its nature, asthma is a chronic, and long-term, illness that must be managed carefully to prevent unexpected and severe attacks.   

“CONTROL” IS THE KEY

 In an uncontrolled, severe asthma attack, the combination of these three factors - inflammation, muscular constriction, and mucus plugs - results in critical airway blockage. The lungs can become overinflated, due to the patient’s inability to exhale normally.   

 A relatively common dermatitis that occurs in the winter and in the elderly on the legs, arms, and hands and is characterized by dry, cracked, fissured skin and pruritus. Predisposing factors include old age; a genetic tendency for dry skin; too frequent bathing in hot, soapy baths or showers; and dry, nonhumidified heated rooms. Treatment includes

(1) avoidance of overbathing with soap,

(2) room humidifiers,

(3) tepid water baths using bath oils with liberal application of emollients after drying,

(4) medium-potency corticosteroids applied BID until eczama clears, and

(5) topical alpha-hydroxy acids (such as glycolic acid or lactic acid).

Mydriasis characterizes an increase in pupil diameter, as opposed to the miosis.

Mydriasis is a normal reaction to the darkness. It is in this case bilateral and reactive (lighting in one eye results in the loss of mydriasis in both eyes). This reaction (and its opposite) requires the integrity of a circuit including:

The retina,
The optic nerve,
The cerebral areas of vision,
The pupil.
We can achieve a mydriasis by instillation of artificial eye ß2-agonists in the eye. This is used for some eye examinations (such as observing the back of the eye).

The areactive symmetrical mydriasis (both pupils are dilated and does not constrict in the light) is a sign of suffering brain important as it may be as a result of a cardio-respiratory arrest, but also in some comas Origin diverse. In argot of emergency medicine, we talk of a patient in “full headlights.”

Unilateral Mydriasis (one eye), is characterized by anisocoria. It may indicate a violation of any part of the circuit described above and may be indicative of a serious illness (compression by a tumor, intra-cerebral hematoma …). One expert advice is needed.
The observation wards and testing reflexes pupillaires form part of the evaluation of the patient’s neurological status.

Fungal keratitis is infection of the cornea of the eye caused by fungi. They are generally confused by bacterial infections and it is common that the infection reaches the ophthalmologist in poor condition, which puts them at very high risk of losing the eye.

  Risk factors

 Fungal keratitis most often occurs because the fungi that infect the eye are usually non-pathogenic, traumatic certain factors must be present to establish the body in the eye: – Farmers
– Construction workers
– Improper use of contact lenses
– Accidental eye injury
– Humidity, dust, high temperatures and wind

 Depending on the severity of infection, patients can be photophobia, pain, foreign body sensation in the eye with pus and redness of the cornea. Next, there is an ulcer in which one can observe concentric lines that correspond with the fungal filaments. The untreated progression of a corneal ulcer can be explosive for the eye.

  Diagnosis

 Fungal keratitis Treatment depends on the correct diagnosis, which in turn is based on a combination of clinical history, based on direct microscopic examination and the cultivation of corneal material taken from the affected area or ulcer exist. Because of the small amount of material available is imperative that the sample be valued in the movement and handling prior to the laboratory examination. These fungi are isolated easily in almost every way mycologycal common, particularly of Sabouraud dextrose without cicloheximidina.

  Species

 Fungal keratitis occurs most often by fungus eye infections the following agencies, which are usually saprophytes soil:

• Gender Aspergillus
  
• Gender Fusarium
  
• Gender Penicillium

Xeroftalmia or dry eye is a disease characterized by the production of tears and not by problems of vision, especially at night. It is a avitaminose caused by lack of vitamin A. Vitamin A is a vitamin liposoluble, that is, which dissolves well in oils.

Aniridia is a rare disease that is the congenital absence of the iris of the eye. It can affect one eye, but it is more frequent that affects both. It is often accompanied by other disorders as: cataracts, glaucoma, and strabismus, among others. It can also exist in parallel with other systemic changes related to the kidneys and with mental retardation.   It is a congenital and hereditary disease. It is shown as 50% of the descendants of an autosomal dominant form.   It is a result of the deletion of the gene PAX 6, located on chromosome 11, p13, causing lack of development in the eyeball

Most Americans eat much more protein than they need, so a diet that includes even moderate amounts of meat, dairy, or eggs will probably contain ample protein. It’s also possible to get adequate protein from a diet of strictly plant foods. Unlike animal proteins, however, plant proteins are “incomplete” — low in one or more of nine essential amino acids, the building blocks of protein. So for years it was believed that the only way for a total vegetarian to get enough “complete” protein was to eat specific combinations of vegetables and grains (such as beans and rice) at the same meal.  

 New research shows that this painstaking combining is unnecessary. Eating a variety of plant-based foods throughout the day will provide all the protein that’s needed. Soy foods (including burgers and franks made from soybeans) are excellent protein sources, as are legumes (dried beans, peas, and lentils), seeds, nuts, and nut butters. Vegans should eat at least two servings of these foods daily. Grains, vegetables, and fruits also contribute small but significant amounts of protein

Multiple Sclerosis (MS) differs from person to person. Like finger prints, no two people have identical symptoms. It affects many different systems of the body. Before we go further, being a nurse, I need to explain the difference in signs and symptoms. Signs are things the doctor will pick up on his examination. They are not generally something that we would notice, such as a positive babinski’s. Symptoms are things that we feel such as tingling and pain. So, now that I got that out of my system, let’s carry on and see what this disease has to offer! I will use my own definitions and words to describe these problems ….. we can all read the technical books. This is from the mouths of those with M.S. This list of problems seems very overwhelming, but there are means to minimize many of these problems and keeping in contact with a physician or neurologist you feel comfortable with is very important.

VISUAL DISORDERS

Visual problems are often the first problems seen in MS Changes can include such things as double vision, blurred vision, a blind spot in the vision, and pain in the eye itself. These episodes are usually caused by an inflammation of the optic nerve, commonly called optic neuritis.

SWALLOWING SPEECH AND PROBLEMS

Often we find ourselves tied tongue. You have certain words ready to say in your brain, but when you say them, they are not there, or they come out jumbled up. There seems to be an increase of the “it’s on the tip of my tongue” syndrome amongst those of us with MS The rhythm that we speak in can also be affected …. causing an unnatural sounding speech, with pauses or excelerations where they are not natural. Swallowing problems are not as common as the speech disorders, but are a concern for many with MS It is usually seen later in the disease progression. This particular problem should be mentioned to your physician or neurologist as swallowing problems can cause secondary respiratory problems.

BLADDER PROBLEMS

This is one of those topics that are not particularly fun to discuss. However, being that it is a prominent problem with those who have MS, here we go. Bladder problems can be frustrating, embarrassing and time consuming. Gone are the days of running in and out of the bathroom. Problems in this area are as individual as every other part of the disease. Some have to go to the bathroom all the time. Some find that they are not aware of the need to void until it is too late. Some can not urinate once they are aware they need to. Problems can result from two types of bladder problems. Spastic bladder refers to just that. The muscles of the bladder spasm and do not allow the free flow of urine. The other type is flaccid bladder where we find a decrease in the muscle tone. Here you see a loss of control and urine just dribbles out. There is also such a thing as a “mixed” bladder. This is harder to treat, as the medications and treatments oppose each other. 
Some of the treatments used for bladder problems include medication and using catheters to assist in draining the urine from the bladder. Often it becomes necessary to wear protective undergarments for those moments when we do not have adequate controls. It is a frustrating problem if you are a traveling person. Many of us have memorized the locations of the bathrooms in our favorite stores, gas stations, friends homes. It is a nuisance, but it too can be managed!

MOVEMENT, COORDINATION AND REVIEW PROBLEMS

This is a very broad category. And I will spend the least time here. It is also the most visible symptoms in those of us with MS It can cause us to appear to be very uncoordinated (more so than we may have been in the past). This can result from a lack of sensation in the hands or feet. It can also cause a type staggering gait, causing one to walk as if they have had too much to drink. Not many of us would be able to pass a sobriety test if need be. Balance can become difficult. This causes what we refer to as wall walking. Hanging on to walls to help keep us upright and prevent falls. There are many things that can be done to help in these problems. Physicians often refer patients with M.S. To therapies for assistance in managing these problems. Physical therapy for gait problems. Occupational therapists can come up with ideas or devices to make activities of daily living easier and less time consuming.

SENSORY PROBLEMS

Tingling in the extremities are most common. The feeling that an arm or leg has gone for a prolonged nap. And forgets to wake up. I refer to this as my Rip VanWinkle arm or leg. Numbness can also be a problem.

Another condition along these lines that is seen occasionally in MS Is trigeminal neuralgia (TN). TN is an inflammation of a branch of the trigeminal nerve. This can cause facial or scalp pain. It is often an intense pain that is described as having a knife stab you in the face. It can also be a dull, annoying pain or as some say, a toothache. Often people will go to their dentists thinking they have a toothache to find nothing is wrong with their teeth. Again, there are medications available that can help reduce these feelings.

COGNITIVE PROBLEMS

Ok, our favorite and most frustrating area of conversation. Every person that I have spoken to with M.S. Has some form of cognitive problems. Most of these are minor annoyances. The makes of Post-Its have made a small fortune off the MS Community. These problems are often not understood by those we know and care about. It is very hard to explain why the last months bills went unpaid. Or why we forgot our children’s birthdays. We find that we get up to go get the newspaper and half way there forget what we were doing. Now I know what you are saying. Everyone does this. But it is more prominent and more frequent in those of us with MS Comprehending something we have read often takes longer and we have to read it two or three times before we understand what it is saying. These problems are frustrating, but there are things that can be done to make these less troublesome. I have a computer program that allows me to make post it notes on it. It is very convenient and easy to use. I just start up my computer in the morning. I also have a terrible time remembering my medicine. So I have one of those containers that I set up with all my medicine in it by the day and time of day. Since I spend so much time in the bathroom, it is there and I just have to look to know whether I have taken my medicine or not! There are way around these problems. The trick is to outsmart the MonSter.

FATIGUE !!!!!!!!!!!!!!!!!!

This, for many, is the most frustrating, debilitating condition that MS Throws at us. It is not visible, therefore not understood by others. Try to explain to a little child why mom or dad can not go out roller-skating with them. In this day and age, fatigue can be a crippler. It has just been recognized by the Social Security Administration as a legitimate effect of MS The only way I can describe this to friends and family is this way. Imagine you work for 16 hours in a row. I feel this way after I have done a load of laundry. Or cooked a meal. Imagine the fatigue felt after working a full day, five days a week. That means lots and lots of overtime and not getting paid for it! This problem is also the hardest for me to manage. No longer can I put in a full day at work. Families and friends often think of us as being lazy or having given up! It is not that at all. It is self preservation. Often we must weigh the consequences of our activities and decide if going to the beach for the day is worth a week of suffering afterwards. This list just scratches the surface of what having MS Is like. It is an ever changing list and so different from person to person. So, if you are here to learn more about what a friend, partner, spouse or child is going through, please try to understand. And give them the support that is needed. This is one disease that can not be fought alone. It takes a team to fight it. And if you are the person that has MS, this list seems very overwhelming. It is an overwhelming disease. But life goes on, and so do we. Maybe not like we used to, but we will survive. Every day is a new one, and every day we wake up is a new chance to fight and beat the MonSter.

There are a number of ways to help yourself fall asleep more easily. These include exercising during the day, going for a stroll an hour or so before bedtime, taking a warm bath or drinking a glass of warm milk (milk contains an amino acid that is converted to a sleep-enhancing compound in the brain). Sexual intercourse has a relaxing effect for many people. Relaxation techniques, including muscle-relaxation exercises and meditation, may also be useful. If these or similar tension-reducing exercises fail, it is often possible to break the cycle of insomnia by deliberately staying awake for an entire night. If insomnia is persistent, consult a doctor. Often, reassurance that the problem results from normal anxieties or from a treatable disorder reliefs physical distress and helps restore a normal sleeping pattern. Elderly people who are experiencing the change in sleeping patterns normal with advancing years might find similar reassurance helpful. Treatment of any underlying emotional problem or alteration of living habits is necessary if one or the other is causing insomnia, above all, it is important to create a situation that is appropriate for sound sleep.

DRUG TREATMENT

Drugs may be prescribed when the cause of insomnia includes a particularly stressful situation (a bereavement or the loss of a job, for example) or a pain from some physical condition, or if a person’s efficiency and sense of well-being are seriously impaired by sleeplessness. Hypnotic (sleep-inducing) drugs should never be combined with even a small amount of alcohol, a sedative that enhances gastrointestinal absorption of the drugs and their effects compounds. In any instance, you should follow your doctor’s specific instructions for treating insomnia.

SUMMING UP

Nearly half of all Americans have some kind of sleep disorder, insomnia with being the most common. Worry, anxiety, unconscious tensions and major and minor health problems can all affect the quality of sleep.

Simple tension-reducing measures, such as a warm bath or moderate exercise, often help restore normal sleeping patterns. If they do not and insomnia becomes a chronic problem, seek medical help. Sleep inducing medications should be considered a temporary solution when great emotional stress, physical pain or significantly prolonged sleeplessness seriously affect the quality of a person’s life.

Insomnia - the inability to sleep, or to sleep satisfactorily - is the most common sleep disorder. It varies from restless or disturbed sleep to a reduction in the usual time spent sleeping and, in the extreme, may involve complete wakefulness. Requirements for sleep vary widely. Most adults need the traditional seven or eight hours of sleep a night, but some adults are “short sleepers” and function well on only three or four hours. Many people overestimate the amount of sleep they need and underestimate the amount they actually get during a restless night. Generally, there is no need for concern, even if an unbroken night’s sleep is rare. However, if loss of sleep impairs a person’s ability to function well during the day, it might indicate a problem.

ROLE OF SLEEP

The mechanism that induces sleep is not known. What happens to mind and body during sleep that makes it necessary for good mental health and efficient functioning also is unknown. It is known, however, that sleep consists of two very different states. In one state, rapid-eye movement (REM) sleep, the eyelids move under the lids closed, the heartbeat quickens and all body processes speedup. Dreams occur during REM sleep and sexual arousal is common, even if the dreams themselves are not sexual in content. Periods of REM sleep last about 20 minutes and occur four or five times during the night. They alternate with longer periods of non-REM sleep, when the body functions slow down. Non-REM sleep has four stages; during stages 3 and 4, the deepest of the stages, it is hard to arouse a sleeper. As the night goes on, the periods of non-REM sleep become progressively lighter.

SLEEPING PATTERNS

Insomnia can take a variety of forms: difficulty falling asleep (initial insomnia), difficulty staying asleep, and early wakening. Sleeplessness is also common during pregnancy, especially in the later weeks. The elderly typically sleep lightly (stage 4 of non-REM sleep tends to be absent) and fitfully.
Some people are kept awake by painful conditions such as arthritis, others are disturbed by the need to urinate frequently or by leg cramps. People with serious conditions such as asthma are unable to sleep because they fear dying in their sleep. For still others, the cause of insomnia may be attributed to their social environment. Arguing with family members; exciting watching programs on television late at night, and consuming caffeine (found in tea, coffee or cola drinks), great amounts of alcohol or a large meal close to bedtime, may interfere with sleep. In the majority of cases, however, the core problem is emotional. Anxiety and internalized, unexpressed anger are common causes of sleeplessness. Depression is also implicated in producing some forms of insomnia, waking in the early morning is common in some depressed individuals.
Paradoxically, insomnia may result from the use of a sedative prescribed to relieve it. Some people, especially the elderly, develop an inverted sleep rhythm: drowsiness in the morning, sleep during the day, at night and wakefulness.