The Health Blog

Signs and symptoms

To pinpoint its cause, recurrent abdominal pain must be associated with other symptoms such as vomiting, diarrhea, constipation, blood or mucus in the stools, fever, and failure to gain weight, painful urination, ingesting inedible substances (pica), or anaemia. Also important is the pattern of the pain – where it is, when it occurs, how long it lasts.

In general, recurrent abdominal pain that is accompanied by no other symptoms or has no set pattern is probably not serious.

Home care

If constipation is the cause of the pain, correct it by changing your child’s diet or using a glycerin suppository. If milk seems to be the cause, eliminate milk and milk products from the diet for one or two weeks; then add milk to the diet again and observe the effects. If emotional stress is responsible, try to eliminate the stress. Most important, note and record the pattern of recurrent abdominal pain and any other symptoms that occur before consulting your doctor.

Precautions

• Recurrent abdominal pain due to emotional stress is real and requires treatment just as much as pain due to an identifiable physical condition.

• Do not try to relieve stomach pain by giving laxatives or placing ice on the stomach.

Medical treatment

Your doctor will take a careful history of your child’s recent health and perform a complete physical examination. Frequently the doctor will order urine, stool, and blood tests. If the cause of the pain still is not clear, X rays of the stomach, large and small bowels, and the urinary tract may be required. If X rays provide no clues to the problem your child may be hospitalized for extensive blood tests and an internal abdominal examination.

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• Find other things to do with your hands that will help you cope with tension. Knitting, ‘worry beads’, playing with a bunch of keys, or whatever, all work.

• Get your family and friends to sponsor you to stop smoking.

• Have a bet with someone as to how long they think you will give up for.

• In the early days of giving up, change your routine so that old trigger-points and situations don’t get at you while your urge to smoke is great.

• Keep busy. Sitting around thinking about smoking and how much you miss it will soon have you longing to go back to it.

• Be prepared for the mood swings as your body gets used to doing without the 100-400 puffs a day it has been accustomed to.

• Don’t kid yourself about how strong-willed you are-keep away from people and situations where you could be put to the test. One small slip and you will have undone all your previous efforts. One day in the distant future you might be able to enjoy the odd cigarette or cigar after a meal but in the early days this is too much to hope for. Complete abstinence is the only way.

• Give yourself a treat every day. Make sure that not all of them are in the form of foods, or you will soon get fat.

Obviously it is best never to start smoking in the first place. Here are some tips on ‘primary’ prevention:

• Breastfeed your children exclusively for at least six months and offer the breast after that whenever they need comforting. Psychiatrists and analysts have found that many smokers are ‘frozen’ at the oral stage of life during which a baby’s main pleasure comes from his or her mouth. If breastfeeding (or bottle-feeding even) goes badly and the baby is left to cry, its oral needs unfulfilled, it is thought that later in life he or she will turn to other forms of oral gratification. Undoubtedly, smoking is the most common of these, though earlier on in life dummy- and thumb-sucking are also widespread. Most normally developed adults don’t seek oral pleasure in this way and don’t respond to stress and anxiety by putting something in their mouths. Some, of course, do and these can be found at any slimming clinic or club.

• Perhaps the best preventive measure adults can take for their children is to ensure that they themselves don’t smoke. This will greatly reduce the likelihood that the children around them will want to smoke.

• Next, it’s worth trying to bring up our children to be able to resist peer pressures to take up the habit. Most young children say they don’t ever want to smoke yet obviously a percentage will be smoking by the age of 15. We should teach children that to take up smoking only because of pressure from their peers is to show that they cannot hold their own against their peers by doing only what they really want to do. They should be encouraged to think of smoking not as tough or glamorous but as an attempt to appear tough or glamorous by those who lack confidence. Such thinking has been shown in tests in California to protect children against drugs and alcohol too.

Another successful ruse is to use older young people to deliver the anti-smoking message in their own style. Play-acting helps in group work and can be fun too. Parents can also get across the message that:

1. You don’t have to be conned by smoking advertising.

2. They wish they had never taken it up because they can’t afford it.

3. They are glad they gave it up and how much better they feel.

4. It is possible to resist smoking just to go along with the crowd.

5. Smoking doesn’t make you ‘cool’.

6. By resisting smoking you will also be able to resist drugs and alcohol.

A study of 526 Californian students, who were encouraged in this way, found that those who were trained to be able to resist the pressures to start the habit began smoking at less than half the rate of those who did not have the training.

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What is it?

Spots, usually a mixture of black-leads, red or purplish spots of various sizes, pustules, scars and pits on he skin. They are mainly found on the face, the back of the neck, the back and the chest, but can be found in the armpits and on the buttocks. The complexion is often greasy and muddy and the individual usually has lank, greasy hair.

Acne is most common during adolescence and most people grow out of it in their twenties.

What causes it?

During adolescence profound hormonal changes are occurring and the oil-producing glands in the skin begin to over-produce their secretions. These secretions often become dammed up in the sebaceous glands and the topmost part of the duct blocks up with oxidized sebum to produce a blackhead. If this is squeezed a worm of sebum appears. Some women have acne or similar types of spots every month pre-menstrually and others have them when they are pregnant but these are easily explained and usually disappear quickly.

Of the specific things thought to cause acne here are just a few:

•     Refined foods, especially sweets and chocolates. Having said this, most acne researchers dismiss the effect of diet.

•     Cosmetics and oil-based make-up and thick, greasy skin creams can contribute to a mild form of acne called ‘acne cosmetica’.

•     Caffeine-containing drinks such as tea, coffee and cola.

•    Stress. Some people definitely have more spots at times of stress. This may well come about as a result of the increased levels of androgens (male hormones) produced by the adrenal glands during stress.

•     Woolly clothing next to the skin.

•     Environmental factors are not uncommon in acne. Mechanics, fast-food workers and anyone who works in a greasy atmosphere can develop acne because the atmospheric grease blocks the pores in the skin. Those who work with chlorinated hydrocarbons found in paints, varnishes, mineral oils, pesticides and roofing materials may develop a type of acne called chloracne.

•    Iodine and bromide-containing medicines. Iodized table salt contains too little iodine to worry about but some asthma medications and multivitamins contain a lot. Other drugs that cause pimples are steroids, male hormones, lithium and certain anticonvulsants.

•    Tar and oil products.

•    Infrequent washing. Ordinary oily skin has very little to do with pimples. The oil that reaches the skin is usually not the problem – it is the oil trapped in the hair follicle that produces acne. Antibacterial soaps have been found to be of little value compared with normal soaps.

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Description and Possible Medical Problems

If you frequently have trouble urinating and sometimes find that it’s almost impossible unless you turn on both faucets in the sink (plus the shower), chances are you have a problem with your prostate (see sidebar: “The Prostate”). This is one of the most common diseases of men over 50. Many times, however, the condition is temporary and caused by cold medications or blood pressure pills.

Treatment

If you are having trouble urinating, you need to see your doctor or urologist. He will conduct a full physical exam, take blood tests, ask you if your father had a severe case of prostate disease, and do a digital exam to check the degree of the enlargement. In this procedure, the physician will insert a gloved finger into the rectum in order to feel the prostate. He may also elect to do a sonogram to get an image of the enlarged prostate and maybe even take a biopsy if he suspects cancer.

If you have an enlarged prostate, your doctor will prescribe Proscar, which will shrink your prostate and make it easier for you to urinate. If, however, you have prostate cancer, your doctor will take one of several different routes. He may decide to wait it out and regularly monitor the growth, or he may choose to perform a transurethral prostate resection, which, in effect, creates more room for the urethra by removing the part of the prostate that is constricting it. In rare cases, where the cancer is in an advanced stage, he may want to remove the prostate to prevent the cancer from spreading throughout your body.

Even though the idea of prostate cancer can be daunting, rest assured that the vast majority of men who have prostate cancer eventually die of another cause: old age.

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One of the common benchmarks of success in corporate America is the news that you have an ulcer. “Ah, welcome to the club!” your colleagues will say, raising their bottles of Mylanta in a toast.

Although the stress and anxiety of the modern world are something that we all accept, the truth is that if you feel a burning pain in the middle of your abdomen just below the rib cage, your first instinct is probably not going to be “I’ve arrived!” no matter what your position is at the office. An ulcer occurs when the lining of the stomach begins to break down because the stomach acid is eating away at it.

However, sometimes what you think is an ulcer really isn’t. You might be experiencing a high output of acid in your stomach or a condition called gastritis, an irritation of the stomach lining that is considered by many physicians to be a precursor of an actual ulcer.

Some people find that their ulcers get worse when the seasons change, as well as during times of stress. Certain foods—especially spicy ones—can also trigger the pain. The pain of an ulcer can wake a person from sleep, which can result in a feverish rush to the refrigerator to quickly eat some food and quell it. And I’ve seen a few patients who developed ulcers because of their prodigious intake of vitamin C—in excess of 5 grams per day.

A bleeding ulcer can cause vomiting of a substance that resembles coffee grounds as well as a stool that is black, tarry, and puttylike in its consistency. A bleeding ulcer is a major cause of anemia, and it can make an elderly person more prone to falls and passing out because of the low blood count. And in recent years, we’ve discovered that a strain of bacteria called H. pylori can actually be responsible for causing an ulcer.

Ulcers occur most often in men between the ages of 45 and 64, and in women who ate 55 and older. Twice as many men as women have ulcers. People who have emphysema, liver disease, coronary disease, or rheumatoid arthritis ate more prone to developing an ulcer. Unfortunately, once you have an ulcer and it cleats up, you are always prone to developing another.

In people who are over 60, medication is the primary cause of an ulcer. In fact, I frequently receive calls from a family member telling me that an elderly relative is weak and has just vomited blood. This is quite common, since my older patients take more aspirin, Motrin, and Advil than younger people do because of their arthritic pain. Working like stomach acid, these medications can start to break down the stomach lining.

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Of course, anyone who’s had asthma since childhood is familiar with its various medications, such as the Ventolin inhaler, which is used during an attack, and theophylline which is taken in pill form and provides longer-lasting relief.

If you have had asthma for many years but have kept it under control with medications, you are still prone to developing an occasional respiratory tract infection caused by a virus or bacterium or exposure to chemicals, paints, or insecticides. This can bring on an acute wheezing episode that’s known as a bronchospasm. If you have such an infection, your doctor will prescribe antibiotics and a bronchodilator spray such as Ventolin. If you are 40 or older, you might also be given an injection of epinephrine as long as you don’t have a history of cardiac disease. Epinephrine is a bronchodilator and decongestant that will help keep spasms from occurring in the lung and bronchial tissue.

But again, most asthmatics are comfortable with self-treatment, and their disease usually doesn’t progress past the point where more serious treatment is necessary. If the usual inhalers and medication fail to work, however, or the wheezing is accompanied by shortness of breath, you should seek medical attention, especially if you’re over 50.

During the initial exam, your doctor will do a physical exam and check your health history. He may also choose to take a chest X ray if he believes an infection is present. A handheld peak-flow meter, a device you exhale into that measures the volume of air you’re able to exhale quickly, will also help your doctor to tailor your treatment.

Sometimes the wheezing is very pronounced and the typical therapies aren’t effective. If this is the case, you may have to be hospitalized. You will be given oxygen, and the amount of oxygen in your blood will be monitored with either regular blood tests or an oximeter, a device that measures the blood oxygen level in your earlobe or finger without piercing the skin.

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It’s not uncommon for the muscles in your back and shoulders to ache after doing work where you have to hunch over, such as gardening or other work around the house. If you’ve also been twisting yout body and bending over, your hips may be painful after any exertion that you don’t do every day. As a result, there’s a good chance that, the morning after, you may feel as though you don’t have the strength to get out of bed.

Muscle ache that’s accompanied by weakness is a common occurrence. But if you have a constant, dull ache in the muscles around your shoulders and/or the backs of your hips and you don’t have the strength you once did, you may have a rare, progressive disease called polymyositis. This disorder is a variation of dermatomyositis, in which the muscle pain and lack of strength are frequently accompanied by a deep red rash that may be scaly. The rash most often appears around the eyes or on the neck, chest, hands, or elbows.

Both polymyositis and dermatomyositis are arthritic disorders, but they affect primarily the muscles, which become inflamed and swollen, not the joints, as do other forms of arthritis. Doctors believe that polymyositis and dermatomyositis occur due to a defect in the immune system. Two thirds of the people with polymyositis and dermatomyositis are women between the ages of 30 and 60.

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The treatment for goiter depends on its cause, which your doctor will detetmine after a blood test and possibly a consultation with an endocrinologist. In the case of hypo- or hyperthyroidism, in which the thyroid gland produces too little or too much thyroxine, your doctor will first do a physical examination and check yout medical history. She will specifically check for any body tremors, nervousness, an intolerance to heat, or a weight gain or loss, all of which are signs of a thyroid condition. She will also place your fingers on your neck and ask you to swallow, which will help her check for a goiter or nodule on your thyroid. Your doctor will also conduct a blood test and perform a scan of your thyroid with a radioactive substance, which will help her to check both the activity and the structure of your thyroid.

If you have hypothyroidism, in which the thyroid doesn’t produce enough of the hormone, treatment with replacement thyroxine medication usually eases the problem.

If the enlargement is due to a growth on the gland, surgery is usually recommended. In a few cases, the growth may turn out to be cancerous, so if it does not disappear after a week, you should see your doctor immediately. If surgery is required, the growth will be removed and you will feel better in several weeks.

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A check-up for cancer requires a thorough examination. This must include the skin, the rectum, the genital organs, and the internal organs of the chest and abdomen. Examination of the breasts and the vagina is essential for women.

Everyone should have routine examinations periodically (see Chapter 9). When there is a danger signal or any doubt concerning a possible danger signal, be sure to have an immediate examination.

X-rays

It is advisable to have a chest X-ray made every year, since early lung cancers, as well as tuberculosis and some diseases of the heart, can sometimes be detected in this way.

For examination of the stomach and intestines, the X-ray involves special techniques that seem fairly complicated, including the use of barium sulphate that is either swallowed or inserted through the rectum. When barium is in the stomach or large intestine, the organ is revealed as a silhouette on the X-ray film.

Special examinations

Your doctor has available highly specialized instruments that are extremely valuable in studying the internal organs and locating small cancers in their early, curable stages. These instruments work on the principle of a periscope. A slender, usually flexible, tube is inserted into the region to be studied. A tiny bulb at the end lights up the area of the body that is being examined.

Radioisotopes

These are used widely in diagnosing cancer in certain organs, such as the thyroid gland and the liver. Radio-active forms of iodine, phosphorus, gold, iron, or cobalt tend to concentrate in certain organs, making it easier for doctors to diagnose the state of the organ.

Biopsy

This is the definite way of determining whether or not even a tiny growth is cancerous or precancerous. A bit of tissue is removed and examined under the microscope. This examination is made by a pathologist, a doctor who specializes in determining from the appearance of tissue whether it is normal or shows signs of a tumour or other disease.

Sometimes it is not possible to perform a biopsy until the time of the actual operation on a rumour. In such a case, a small piece of tissue is removed during the operation and given to the waiting pathologist, who freezes it immediately, examines it under the microscope, and gives the report to the surgeon. This procedure is called the frozen section technique.

Papanicolaou (Pap) smear test

This simple test is used in detecting cancers of the lung, the stomach, and, particularly, the cervix (the mouth of the uterus). Fluid from one of these parts of the body is put on a slide and placed under the microscope.

Blood test

The blood is tested chemically for cancer of the prostate and for a rare malignancy of the bone marrow called multiple myeloma. A blood smear and blood count help in the diagnosis of leukaemias, but this is not a chemical test.

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I describe worm (more properly called intestinal parasite) infections at this point because parents so often blame them for convulsions in children. It is a safe rule that convulsions are never caused by worms.

Another misconception about intestinal parasites is that they are contracted from an infected household pet or other animal. The chief worm infections of children are contracted from human beings.

Roundworm infection (ascariasis)

These worms look like earthworms and may sometimes be seen in the bowel movements or in the child’s bed. Occasionally, one may be vomited. The worm should be saved to show the doctor.

A child infected with roundworms may become irritable and restless at night; he will probably develop an erratic or poor appetite.

The worms can be discharged from the intestine by special medicines that must be administered under a doctor’s care. Do not try to treat worms by getting medicines at a pharmacy.

Pinworm infection

The pinworm, also called the seatworm, is the most common worm to infect children. Pinworm infections occur in the intestine. The tiny worms measure less than a half inch in length. They do not debilitate a child as do heavy infestations of roundworms. But they cause trouble by their habit of coming out around the anal region during sleep. The worms irritate the region around the anus, leading to painful scratching and restless sleep. Occasionally, a pinworm will migrate into the tiny vaginal opening in a female child, where it will cause intense itching. Do not treat pinworm infections yourself.

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