December/January 2005 Edition
Sample articles from this edition:
Febrile convulsions in children
Benign enlargement of the prostate
Tonsillectomy and adenoidectomy
 |
| |
Sample articles from this edition:
Febrile convulsions in children
Benign enlargement of the prostate
Tonsillectomy and adenoidectomy
Cataract is a loss of transparency in the fibres of the lens of the eye, usually occurring after middle age. This shows up as the need for stronger glasses, washed out colours, glare around lights at night, or double vision when looking with one eye. The loss of vision can be so slow that it may go unrecognised until someone fails a driving vision test!
Cataract never causes internal damage to the eye, it just blocks out vision.
About 1.5 million Australians have cataracts affecting their vision, and this figure is set to rise with our ageing population (31% of people aged over 50 years). Luckily, surgery to repair cataract is speedy, effective and relatively cheap. About 120,000 operations are performed in Australia each year, most under local anaesthetic and sedation.
In basic terms, a flap-like 3mm incision is made in the cornea and a fine instrument introduced into the lens capsule. This breaks up the body of the lens, which is then removed by suction to leave the capsule behind. This capsule is polished clean and a new artificial lens inserted into it.
This new lens is fully transparent, restoring vision three weeks after surgery, when healing is complete.
The replacement lens used can correct for any short or long-sightedness. Following surgery, glasses may only be needed for reading. The cataract does not come back in the new lens.
Anaesthetic techniques have improved so much that even the frail aged with heart or other problems can undergo surgery.
Of course, poor vision in the elderly interferes with self-care and increases the risk of falls, so fractured hip and nursing home admissions are more common in people with cataract.
Although cataracts are mainly age-related, preventive steps can include a diet rich in antioxidants and low in polyunsaturated fat, a high protein diet and avoidance of bright sunlight. Cataracts are more likely in diabetes and after steroid medication (whether eye drops, tablets, or nasal spray).
Febrile convulsions are fits in young children during a high fever. Suddenly, the child goes quiet, starts to jerk or twitch and may have difficulty in breathing. Clenching of the teeth and rolling back of the eyes is common.
The cause of the convulsion is a rapid change in body temperature and the effect this has on the sensitive growing brain of the child.
The fever can be due to anything, usually a viral infection, infected ear, tonsillitis or bladder infection. Sometimes, the fit comes before the fever is noticed.
The problem is fairly common and can affect any normal child - about 5 in every 100 children – with the tendency running in families. Children aged 6 months to 3 years are most often affected.
Although febrile convulsions (one or more) are frightening to parents, they do not usually cause brain damage or epilepsy. The child returns to normal soon after.
What can you do if it happens?
Place the child in the coma position - on their side, chest down, with the head turned to one side. Do not put anything into their mouth. Don’t try and restrain them. Loosen any tight clothing.
After the fit, which usually only lasts a few minutes, the child will be drowsy and disorientated. Provide reassurance.
Seek medical help straight away, even if the fit stops. It is important to search for the reason for the fever.
To prevent more attacks, manage any further fever as soon as it is noticed. Undress the child down to underwear, keep them cool, and give fluids and paracetamol.
About 1 in 4 children will have another febrile convulsion.
As our general population gets fatter, lazier and more prone to diabetes, fatty liver is on the rise.
This condition, which causes no symptoms, was originally thought to be a harmless sign of obesity. However, with one in five adults or children having fatty liver, the problem is now thought to be associated with insulin resistance, a condition that often leads on to diabetes.
And fatty liver can progress to more serious cirrhosis or scarring of the liver, especially in obese females.
Although fatigue is a reported symptom the only abnormal finding, apart perhaps from an abnormal liver blood test, may be an enlarged liver.
There is no cure except for lifestyle changes:
Non-cancerous enlargement of the prostate (called benign prostatic hypertrophy or BPH) affects the gland surrounding the tube connecting bladder and penis (urethra). This enlargement squeezes off the urethra making it harder to pass urine.
The condition is common, affecting 50% of men over 60 years. A weak stream and difficulty starting or finishing, a feeling of incomplete bladder emptying, going more often and strong urges to urinate are all tied up with BPH.
Occasionally, there may be blood in the urine or urine flow may suddenly block completely.
Ways you can help yourself include reducing alcohol intake, not drinking before bedtime, always going to pass urine when the urge comes, and ensuring the bladder is emptied each time.
Your doctor will do a digital rectal examination, blood test for prostatic antigen, urine test for infection and perhaps other tests to exclude cancer or infection.
Treating symptoms with some medications often helps. Removal of part of the prostate may be required. This involves passing a thin operating tube down inside the urethra.
Tonsils are glands on either side of the back of the throat. The adenoids are similar, hidden from view not far from the tonsils at the back of the nose. Both are the first line of defence against infections (e.g. colds) and other airborne things (e.g. allergy). So the tonsils and adenoids are most active during childhood. Inflammation and infection of the tonsils and adenoids is common.
Removal of the adenoids is sometimes recommended in children with recurrent glue ear or middle ear infection, who have hearing loss. This is because adenoid swelling is thought to affect the Eustachian tube that connects the middle ear with the back of the throat. It is through this tube that fluid drains from the middle ear. Surgery is usually a last resort, once medications or nasal sprays have not worked.
Recurrent sore throats are common in children, with most caused by viruses (not helped by antibiotics).
Bacterial tonsillitis is different. Pus appears on the tonsils, swallowing is painful, neck glands are enlarged and the sore throat is intense with fever and general malaise. The usual runny nose, cough and sore eyes seen with colds are usually absent.
Unfortunately, just looking at the tonsils may not be enough for diagnosis of bacterial tonsillitis. Your doctor may do a throat swab and wait for results before treating.
Generally speaking, there is no consensus on when tonsils should be removed. More than six bouts of tonsillitis in a year is a start. The severity of episodes, the amount of time off school or work, and the presence of complications all come into it as well.
One such complication is sleep apnoea, more common in children aged between 2 and 8. In a child who snores during sleep, enlarged tonsils and adenoids may be partly blocking off the airway, depriving the brain of oxygen during sleep. As a result, the child becomes listless, has a poor appetite, performs poorly at school and is irritable and tired.
Further investigation is needed.
The surgery to remove tonsils is not without risks. These include haemorrhage, anaesthetic complications, infection. They can be life-threatening. As with any medical procedure, risks must be weighed up against the benefits. Your doctor can advise.
Amphetamine use is on the increase. The stimulant drug comes in different forms, available as liquid, powder or tablet to be swallowed, snorted or injected to produce an effect on the body similar to the natural hormone adrenalin. Most of the speed in Australia comes in powder form as methamphetamine. A more pure potent crystalline form has emerged on the black market in recent times (called “ice”, which is smoked using a glass pipe).
Over 20% of people aged between 20-34 years say they have tried speed to stay awake at parties, to study, or for sport. The age of first use is decreasing. A higher proportion of people using speed are recreational drug users who do not necessarily mix with the heavier drug scene (e.g. heroin users).
Amphetamine gives a sense of euphoria and well-being, along with increased energy. People on speed talk fast, move around a lot, eat less, and sleep less. Then as the drug wears off they crash, sleeping long hours.
Repeated use leads to extreme mood swings, anxiety, cravings, depression, panic attacks, fatigue, compulsive repetitive actions and paranoia.
Binge and crash cycles are common amongst amphetamine users, many of whom have emotional or mental problems such as anxiety or depression.
Heavy amphetamine use can bring on severe mental changes called amphetamine psychosis. Psychosis symptoms start anywhere between 1 and 48 hours after taking the drug. As well as the symptoms listed above, there are hallucinations (seeing, touching or smelling things that are not there), tremors, confused or incoherent behaviour and aggressive or violent behaviour.
Amphetamine users not uncommonly inject the drug and are therefore at risk of HIV or Hepatitis viruses from sharing contaminated syringes or drug preparation equipment.
People who rely on speed to get them through life usually end up with social and financial problems. They often take other ‘designer drugs’ based on amphetamine, such as “ecstacy” or “Eve”.
Common names for amphetamines: speed, go-ee, crystal, crystal meth, base, pure, ice, shabu, buzz, dexies, uppers, rev, whiz and ox blood.
[Did you know? During World War II and the Korean and Vietnam Wars, soldiers on all sides of the conflicts were given amphetamine to keep them awake, to give them more energy and to suppress their appetite.]
Be prepared and informed. Learn about what recreational drugs are around, what they do and the risks involved – honest, factual information is better than vague fear and concern.
Support and encourage them towards decisions to avoid self harm. Don’t panic if you discover they have tried something.
Discuss drugs whenever the moment allows. What they think – in response to a TV program or newspaper article. What your teen’s friends think and do.
Listen to their point of view, don’t judge. Tell them your concerns but don’t expect them to make a decision straight away.
Make a safety plan. Discuss what they can do to avoid harm. Offer to extricate them anytime from any risky party scene using a pre-arranged excuse.
Set clear rules and boundaries in your home – accept that your teen will make mistakes.
Pregnancy brings on some unique situations that require forward planning when travelling. Always get advice from your family doctor or obstetrician if you are in doubt. Ensure your blood pressure and blood count is normal and the baby’s growth is on track, before setting off.
Vaccination. Some travel vaccinations are not recommended at all in pregnancy. Others are safe if given after the first three months of pregnancy. Get advice.
Air travel. Most airlines require a doctor’s certificate if you are going to travel after 36 weeks, especially longer flights. Prolonged siting when pregnant increases the risk of clots in the leg veins (DVT) – compression stockings, plenty of fluids and regular leg movements are essential. Anaemia in pregnancy, plus the lower air pressure in plane cabin can put the baby at risk of oxygen starvation – extra oxygen may be required.
Travel sickness. Nausea and vomiting in pregnancy can be made much worse by travel sickness. If this is not overcome quickly, dehydration can put mother and baby at risk.
Malaria prevention. Some drugs, depending on which area you are travelling to, are not recommended in pregnancy. Against this must be weighed the risk of infection or the need to travel. Discuss with your doctor.
Activities. Avoid scuba diving or high altitude trekking. Avoid prolonged tiring journeys. Always drink plenty of water to stay hydrated.
Cut watermelon into cubes (remove seeds) and place in bowl.
Add 2 handfuls each of coriander, rocket, mint leaves, and 1 small bunch radishes finely sliced.
Dressing
Peel & grate thumb-sized piece of ginger, add finely sliced chilli, 2tbls soy sauce, ½ cup olive oil, 1tspn sesame oil, and just enough lime juice to cut through the oil (approx 3 to 4 limes). Season to taste with salt and pepper. Sprinkle with toasted sunflower seeds and crumbled feta cheese.
