The Health Blog

Shingles or herpes zoster is due to the same virus which causes chicken pox, or varicella. It is

believed that the virus does not disappear after an attack of chicken pox but remains in the body, lying dormant in the nerve cells of the posterior horn of the spinal cord or in the posterior ganglia, collections of nerve tissue at the side of the spinal cord.

The cells, in the back part of the cord, are concerned with sensation. The anterior horn cells, at the front of the cord, are related to motor function. Some years later the virus multiplies, becomes active and produces the condition of shingles.

Shingles therefore develops only in those who have previously had chicken pox. When somebody has shingles, then susceptible people like his or her grand-children sometimes may develop chicken pox if they are in contact. The reverse does not appear to happen, but herpes zoster may be more common when chicken pox is prevalent in the community.

Shingles may occur at any age, even in children. However, the younger the person the less likely are complications. The frail and the elderly may suffer greatly from this condition and then it is more likely to be followed by persistent inflammation of the nerves and severe pain or neuralgia.

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If the pancreas is removed so that no insulin at all is produced, the resultant diabetes can be controlled by about 40 units of insulin daily. By contrast, many true diabetics require up to 100 units daily, so diabetes is more than lack of insulin; there is some degree of insulin resistance.

Broadly, we can classify diabetics into those who are insulin dependent and those who are non-insulin dependent.

Classically, the insulin dependent disorder, often called juvenile onset type, comes on suddenly in children, adolescents or young adults.

It is thought that this may be an auto-immune disorder where the body becomes allergic to its own tissues and manufactures antibodies which act on those tissues, causing inflammation.

The non-insulin dependent type usually develops slowly. It is often spoken of as maturity onset diabetes as it is more common in the elderly, although it may develop in some young people. It is particularly associated with obesity.

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Congenital dislocation of the hip is a,disorder once thought to occur about once in every\1000 births.

But awareness of the condition has led to earlier diagnosis that it is believed to be as common as 1 per cent, that is, 10 in every 1000.

While the cause is not known for certain, there are several predisposing factors.

It is more common in girls than boys, in those with a breech presentation rather than babies lying with the head down at birth and in those who have a family history of the disorder.

It is important to diagnose this condition in the first few days after birth. If this is done, putting the child in a special splint for about three months will result in cure. With early diagnosis and splinting, the hip develops normally.

When diagnosis is delayed, splinting may need to be prolonged and eventually an operation may be required.

Doctors who deliver babies are well aware of this condition and check the child at birth, when a few days old and again before discharge from hospital. Nurses in the hospital are also aware of the problem.

As a follow-up and to detect any babies who slip through this net, the Infant Welfare Sister will also check the baby for congenital dislocation of the hip, or CDH.

The very few, if any, who do miss out on diagnosis may not be detected until the child starts walking. Unfortunately, when this happens, treatment may be prolonged and more complicated.

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extensive cancer causes some general effects throughout the body, in addition to the symptoms due to involvement of particular organs. Weight loss is due to a combination of loss of appetite, and the fact that the cancer cells use up a lot of the available nutrients. However, many people die of cancer without ever losing much weight at all. Like pain, weight loss is by no means something that occurs in every case.

Cancer tends to also weaken and suppress the body’s immune system. This means that infections are easily caught and tend to be more serious than they are in a person without cancer. Because of this, infection, which often takes the form of pneumonia, is a frequent cause of death in cancer patients.

There are also ways in which cancer can cause sudden death. One is through bleeding, which is often internal. Another is through blood clots on the lung. Blood clots form more easily in people with cancer than in people without cancer. Blood clots can travel to the lungs and lodge there. This can completely block the blood flow through the lungs, in which case death occurs within minutes. If the clots are not big enough to block the blood flow completely, the symptoms consist of shortness of breath, chest pain and coughing of blood.

With cancer we have seen that death is often due to failure of the liver, brain or lungs to do their normal job. In the case of the lungs this may be due to cancer itself, pneumonia or blood clots. In all these instances, it is unusual for the patient to remain fully alert and conscious up until the time of death. In fact, it is most unusual for patients with cancer to suddenly drop dead, whatever i he actual cause of death. A gradual drifting into sleep and unconsciousness, usually comes first. In most cases, especially if everyone is prepared for it, this is best for both patients and their loved ones.

If you’ve read right through this chapter to here, you’re a very brave person. Stick with it! Now that we know something about what cancer is and how it behaves, let’s find out what to do about it.

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Traditional non-hormonal treatments for vaginal dryness are lubricants such as K-Y Jelly, or a newer product called Replens. These help the symptoms, but do not tackle the underlying cause. Initial penetration will be easier, but prolonged intercourse may be difficult or even impossible as the effect of the lubricant wears off.

Sexual intercourse in the woman-on-top position gives her more control over penetration and how far the penis is inserted, and can make sex more comfortable. It’s worth trying different positions, as women who continue to have sex have fewer signs of vaginal ageing than women who don’t. Masturbation, too, helps keep the vagina moist and the muscles in good working order. Bear in mind, too, mat both men and women take longer to become aroused as they get older. He will take longer to achieve an erection; you will take longer to produce enough mucus. Foreplay may have to go on for longer than it used to, so don’t be in a hurry. Take time to reach the state of arousal mat will ensure pleasure for both of you.

Sexual feelings, and the production of mucus from die cervix, are greatly affected by how we feel. If you are tense, stressed, depressed or have drunk too much alcohol, don’t be surprised if your vagina stays dry. Some medications can alter the sex drive and can affect vaginal dryness – your doctor will be able to advise you about this. Taking more exercise may also help.

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What are the different types of fibroids and how are they removed?

Fibroids may be described as subserous, intramural or submucous depending on where they are situated in the uterus. The site of the fibroid is an important consideration when deciding how it will be removed.

Subserous fibroids protrude from the outer surface of the uterus, intramural fibroids are buried in the wall of the uterus, and submucous fibroids protrude from the endometrial lining into the interior of the uterus. A further term used to describe fibroids is pedunculated. Pedunculated fibroids, usually of the subserous or submucous variety, grow at the end of a stalk.

When myomectomy is chosen as the treatment method for fibroids, the abdominal approach to entering the uterus is chosen if the fibroid is subserous or intramural. (The abdominal approach may be open cut or by laparoscopy.) If the fibroid is submucous or pedunculated submucous and the surgeon is sufficiently skilled, a hysteroscopic myomectomy maybe carried out.

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It is thought that all of us have the ability to go into a hypnotic state when the circumstances are suitable. A hypnotist provides these suitable circumstances. To go into hypnosis, it is important for the person to focus on some idea and concentrate on it. We all go into a form of mild hypnosis when we watch a good movie. We become totally involved with the personalities of the characters and sometimes we feel as if we are part of the movie. Some of us may have tears in our eyes when there is sadness in the story, and we may become tense when there are dangerous or horrifying scenes. We can be so involved with the movie that sometimes we may not be aware of our surroundings. We are dissociating ourselves from our normal lives and we momentarily identify ourselves with the characters in the movie.

The swinging of a pocket watch by the magician allows the lady to focus all her attention on the watch. Nowadays it is possible for a person to go into hypnosis by just fixing his eyes on an imaginary point in front of him. With the appropriate suggestions from the hypnotist, the person’s scope of awareness will gradually become narrower and narrower. The appropriate suggestion is important to constrict the scope of awareness away from the surroundings. The result is that the person dissociates and detaches from his thoughts, so that his thinking then follows the suggestion of the hypnotist.

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Hysteria is a condition in which some symptom develops which acts to solve some conflict for the patient. The conflict may be conscious or unconscious, and the symptoms may solve the conflict in some realistic way or may solve it only in some symbolic fashion, but in either case it usually does the patient harm in some other way. Very often the symptom takes the form of paralysis of a limb. For instance, a soldier may be approaching the enemy position. Naturally, he is afraid. He stumbles and falls; and suddenly finds that his leg is paralyzed. He is unable to go on. The hysterical symptom has served as a means of solving the conflict between his desire to do his duty and his desire to save himself. In a similar way pain may be a hysterical symptom.

The boy who has not done his homework suddenly develops a pain in the stomach when he is about to leave for school. It is real pain. He feels it and it hurts him. He cries with it. In fact this is a feature of hysterical pain; the sufferer has to let others know about it. These examples may seem very simple, but they are real; and we must remember that the soldier in fact cannot move his leg, and the child does in fact suffer pain. It is not altogether uncommon for adults to develop a severe headache when the time comes for some task which they do not relish. The circumstances may be such that the headache excuses them from the task; or on the other hand it may provide a ready excuse to themselves or to others for not doing it well.

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Q. Now comes the important question of diagnosis. What is the story here?

A. The first essential point is that any person with any of the tell-tale symptoms which indicate a gastrointestinal disorder should seek medical attention. It is fruitless self-medicating, such as throwing down some antacid pills or mixture or powders in the hope that ‘it might go away’. Certainly, if there have been dietetic indiscretions — in short, plain stupidity in one’s eating habits, such as eating the kind of food that history has shown produces a tummy upset, then the penalty is usually patently obvious for anyone to see. Some self-medication for a day or so will often help, and eliminate the grotty stomach. But with ongoing symptoms, attending the doctor is advisable.

Q. What happens when the patient visits the doctor?

A. Usually the physician will take a fairly detailed medical history. He will try and elicit a sequential description of the symptoms suffered, how long they have been present, their intensity, and so forth.

Q. Does he examine the patient?

A. The physical examination follows the history taking routine. The answers to his questions will give him a clue what to seek next. He will concentrate mainly on the abdomen, for this is the spot where symptoms are worst. He will note your reaction to his feelings and proddings (or palpation as the medics say). Always give reliable answers to his queries; it is pointless giving false ones, for the only person to suffer from this is you, the patient. If there is pain with pressure, say so. Do not try and be brave, this is foolish in the business of diagnosis. Often from the history and examination the doctor will have a pretty good idea of the diagnosis.

I might add that these days most doctors will also give the other systems of the body a quick once over — such as checking blood pressure, the heart, the urine, and other systems. Occasionally other disorders may be picked up at the same time, and this is always fruitful.

Q. What comes next?

A. If the physician suspects an ulcer, he will then proceed with the next step to confirm it. Here, there are two options open.

Q. What special examinations are carried out?

A. The first is called a barium meal x-ray of the stomach and duodenum. The second is called an endoscopic examination of the same organs.

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These are flexible plates of fibrocartilage that connect any two adjacent vertebrae in the spine, between them accounting for a fifth to a quarter of the length of the spinal column. Each disc has two main parts:

In the centre of the disk is the nucleus pulposus, a gelatinous substance; and

Surrounding the centre is a ring of very strong fibrocartilage -the annulus fibrosus – whose outer edges are made of collagen, making it much stronger than most other ligaments in the body. Apart from connecting the vertebrae in a flexible manner, the

discs also serve as a series of shock absorbers that help protect the spinal cord and the brain from the effects of impact resulting from the body’s movements. For example, were it not for the discs, the impact produced just by walking would send shock waves directly through a more or less rigid spine directly to the brain where damage would eventually result. Two key points to note about intervertebral discs:

The younger you are, the more effective they are as shock absorbers. At birth, the nucleus pulposus is extremely elastic, but as you grow older, this jelly-like centre becomes harder, some of its gelatinous substance having been replaced by cartilage.

Apart from any natural deterioration that accompanies ageing, the discs can also become damaged by accident or disease. One all too common occurrence is a prolapsed intervertebral disc (often simply referred to as PID, or a ‘slipped disc’), a condition in which the pulpy inner material of a disc protrudes through the fibrous outer ring. When this happens the protruding material can exert pressure on adjoining nerve roots and ligaments, and should this pressure affect the roots of the sciatic nerves, then one or more of the typical sciatic pains may follow. As far as what causes a disc to prolapse – incidentally, this word simply means the falling down or slipping out of place of an organ or a part of the body – this is usually the result of one of two scenarios:

As part of the natural wear and tear that marks ageing, the outer ring of a disc will gradually have become weaker and weaker until one day it is so weak that the smallest amount of extra pressure upon it allows part of the gelatinous centre to pass through it. The final precipitating incident that causes a disc’s prolapse may be quite minor – such as an awkward bending or twisting movement, or even a sneeze or a cough – and would not have had any repercussions were the disc’s outer ring not already very weak. In many ways, this can be described as an accident waiting to happen. If a disc is so weak that it prolapses because of a sneeze, then it would have done so sooner or later.

Alternatively, a disc may prolapse because it has been subjected to an unusually great amount of stress, such as can happen during a fall or a road accident. Naturally, the condition of the disc will to some extent dictate whether it prolapses or not in given circumstances, but any disc, no matter how healthy and resilient, can fail when subjected to enough force.

While a prolapsed disc is one of the major causes of sciatica, there are also several others, including:

A disc that’s become distorted or bulges. Without actually prolapsing, an intervertebral disc may just change shape sufficiently, usually because it’s affected by nearby muscles in spasm, so that it’s flattened, part of its squeezed out section creating pressure on the nerves.

Various rheumatic diseases can attack the spinal joints, causing them to swell, so putting pressure on the nerves.

Osteoporosis – a disorder that causes the loss of bony tissue, resulting in bones that are brittle and liable to fracture – can damage the vertebrae, one possible consequence of this damage being pressure upon the nerves.

Ankylosing spondylitis – the first word describes a process of fusion of the bones across a joint space and the second means ‘stiffening’ – is a disorder in which the joints of the spine become inflamed. As the initial inflammation diminishes and healing takes place, extra bone may grow out from the sides of the vertebrae and can fuse these together, leading to a spine that’s stiffened. Sciatica is a common symptom of the early stages of ankylosing spondylitis.

Spinal stenosis. This is a condition in which the spinal canal has become narrowed.

As you can see from the above, the possible root-causes of sciatica are many and varied. While the symptomatic pain is usually due to a fairly straightforward problem that can generally be resolved through some simple remedies and precautions, there is always a possibility that a more serious disorder is responsible. For that reason, it is essential that sciatic pain that persists and fails to respond rapidly to rest and ordinary analgesics be investigated promptly and its cause fully established. Naturally, the way to find out what is causing your sciatica is to consult your doctor

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