Health Issues is a general health based blog concentrating on multiple health topics.

THE INVESTIGATION OF HEADACHES: HISTORY

Author: admin

People with headaches are not only concerned with seeking relief, but are often worried that their headaches may mean something more serious, such as a brain tumour.Although nearly everyone at some time has a headache, it is only when the headaches become severe or frequent and interfere with daily living that a doctor’s advice is sought. Migraine affects approximately one in five people, but only a small percentage of these go to their doctor.
HistoryThe most important aspect of a consultation with the doctor is the taking of a history. With headaches as the chief complaint, the doctor asks about the type of headache, its duration and frequency, site, aggravating and relieving factors, accompanying symptoms such as nausea or visual disturbance, as well as the family history and information about previous illnesses. In most cases a definite diagnosis can be made at this stage and the physical examination and special investigations will merely confirm the diagnosis.
*34/152/5*

July 24th, 2011  |  Posted in Pain Relief-Muscle Relaxers  |  Comments Off

IDEAL MARRIAGE: FUNDAMENTAL EQUALITY – A REMOVAL OF SEX TABOOS

Author: admin

A removal of sex taboos would have other advantages, such as enabling boys and girls to be given a more adequate sex education than is now possible, and eliminating the taboos which part of our over-dressed civilization has developed for the naked body as it really is. It is not surprising that romantic feelings sometimes suffer a rather serious shock at marriage, when one considers how the esthetics of courtship have as their object either a clothed human being or one imagined along the lines of an art which, since ancient Greek times, has falsely idealized the human body and particularly the sexual characteristics.Thus our ideal of equality between men and women extends to practically all phases of life. As far as possible a couple should enter marriage with the same background of experience in every respect. The line must be drawn only at the point where biological differences make community of experience impossible. Here an understanding and sympathy derived from theoretical knowledge must suffice.*105\275\8*

July 18th, 2011  |  Posted in Men's Health-Erectile Dysfunction  |  Comments Off

HIV: PRACTICAL MATTERS-FINANCING MEDICAL CARE: PUBLIC PROGRAMS FOR FINANCING HEALTH CARE-MEDICAID

Author: admin

Help with financing health care is offered by both state and federal governments. One kind of help, called Medicaid, is available to those who are indigent; that is, people who are unable to support themselves. The other kind of help with finances is called Medicare. Medicare is an add-on to Social Security benefits. Therefore, if you are over sixty-five years old, or are disabled by Social Security standards, and if you are eligible for Social Security benefits, you should qualify for Medicare.     Medicaid-Medicaid is a combination of state and federal programs for medical care of those who are indigent. Both state and federal governments therefore dictate the requirements for eligibility and for benefits. Medicaid is the major third-party payer for people with HIV infection. Whether you qualify as indigent, what services are available, and how much money you are eligible to receive, all vary from state to state.     The definition of indigence is, in general, stringent. It ranges from an income that is 23 percent of the poverty level in South Dakota to one that is 97 percent of the poverty level in California; in thirty-four states, the definition is 50 percent of the poverty level. In other words, if the poverty level is around $7,000 per year for one person, then most states will find you eligible for Medicaid if your income is $3,500 per year or less. Some states have a definition of indigence with a higher income level for people with AIDS; that is, people with AIDS can qualify for financial help from public funds and still be relatively able to support themselves. Some states also have definitions of indigence that are substantially higher for women who are pregnant and for children.     In defining indigence, Medicaid also considers resources you have other than income. To be considered indigent, you may have liquid assets (for instance, a savings account), a car, a house, or other property only if their values are below a certain level. What that level is differs in different states.     Medicaid pays for most medical necessities, but pays relatively little for each one, especially for physicians’ fees. It pays for inpatient services, outpatient services, and skilled nursing home services. In some states, Medicaid also pays for home health care, private nursing, and drugs. Some states pay for as few as fourteen days of hospital care; some states have no limit. Some have special programs for people with HIV infection. Professional fees such as physicians’ bills are usually reimbursed at only about 20 percent of the physicians’ customary charges. As a result, unfortunately, many physicians do not accept patients who are on Medicaid. Home care, hospital care, and chronic care are also reimbursed at low rates, and some facilities will reject Medicaid patients on similar grounds.     Medicaid will pay for all drugs, but often restricts payment to drugs that the FDA has approved and sometimes pays only for conditions the drug is specifically approved for. This means that if a clinical trial shows a drug is useful, Medicaid will not pay for the drug until the FDA has approved it. If the FDA has approved the drug but has not approved it specifically for a certain condition, Medicaid may deny payment until the drug is approved for this condition.*207\191\2*

July 2nd, 2011  |  Posted in HIV  |  Comments Off

UPPER RESPIRATORY TRACT INFECTIONS: VIRAL RHINOSINUSITIS

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Viral rhinosinusitis, otherwise known as the common cold, is a viral infection of the sinuses and nasal mucosa. Most adults have, on average, two to four infections each year, and children average six to eight of these infections annually. Transmission may occur through direct contactor by aerosol spread. The viral incubation time is typically 24 hours to 72 hours.Clinical features include nasal congestion and discharge, cough, headache, sneezing, and sore throat. General malaise is common, but more severe systemic symptoms are often minimal. High-grade fevers are rare and should raise suspicion of an alternative diagnosis. Symptoms typically last less than 7 days; however, up to 25% of patients may continue to be symptomatic at 14 days. Examination of the nasal mucosa reveals erythema and edema, often with prominent watery discharge. Other physical examination findings are scarce. When symptoms persist beyond 7 days, the clinician should begin to consider complications such as bronchitis, secondary bacterial sinusitis, or otitis media.Treatment of viral rhinosinusitis is supportive. There is no role for the use of antibiotics in this setting. Oral decongestants may be used (pseudoephedrine, 30 mg to 60 mg every 6 hours) to alleviate rhinorrhea and nasal congestion in otherwise healthy adults, and acetaminophen may be used to reduce fever, headache, and other systemic symptoms. Children should not be treated with aspirin, owing to concerns for the development of Reye’s syndrome. The oral decongestant phenylpropanolamine should not be used because of recent concerns of a small risk of hemorrhagic stroke associated with its use. Intranasal ipratropium bromide has been shown to reduce the severity of rhinorrhea.Many therapies for the common cold have been studied, with conflicting or confusing results. Zinc lozenges, vitamin C, and echinacea have all been studied for the treatment of the common cold. Data on the utility of these therapies are currently inconclusive. One study found that zinc was useful in reducing the length of symptoms, but side effects including bad taste and nausea, were common. A recent meta-analysis showed conflicting results. Based on available evidence, the use of zinc and echinacea is not recommended for the treatment of the common cold. Vitamin С may produce a little benefit in reducing cold symptoms but is not effective in preventing the onset of cold if taken daily.*34/348/5*

June 29th, 2011  |  Posted in Anti-Infectives  |  Comments Off

WOMEN’S PROBLEMS: TREATMENT OF BREAST CANCER

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If a positive diagnosis of breast cancer is made, the treatment that follows depends on many factors. It will depend on the ‘stage’ that the growth has reached. The more advanced the disease (and the higher the stage, which is numbered from 1 to 4), the poorer the outlook. Surgery depends on the subsequent chances of a cure. Poor prognosis cases will benefit little from any form of therapy, and major surgery is often not undertaken. In those with a low stage disease, surgery may be highly valuable, for the chances of a cure are dramatically increased.Certain breast cancers contain what are called hormone receptors. If present, these patients may benefit greatly from the use of certain hormones, or from the surgical removal of other body organs that produce certain hormones. In certain cases, this has improved the longevity outlook.In recent years, an enormous amount of work has been carried out in search of drugs that may improve a patient’s future. Treatment with drugs in conjunction with surgery or radiotherapy is termed adjuvant therapy. Better results in the future may result from improvements in drug therapy. This seems to be the way in which current research is heading.Some researchers have found that many women will not visit their doctor for breast checking for fear of the consequences. Even if they have discovered a lump themselves, they still refuse to seek attention. A major reason is the fear of a mutilating surgical operation. Many feel this will totally destroy their appearance and rob them of their femininity. Procrastination can only spell doom and disaster, if the lump is malignant.*132\45\4*

June 15th, 2011  |  Posted in Women's Health  |  Comments Off

DIAGNOSING OCD: MENTAL COMPULSIONS

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When I was in medical school I suffered the obsession of a phlebotomy needle suddenly plunging into my skin. It was a startling image that shook me to my bones, like fingernails raking across a blackboard. To lessen its effect I developed the habit of immediately bringing to mind a certain protective image: my skin being covered by a soothing, impenetrable cream.That was a mental compulsion, an attempt to escape an obsession by employing a special, counteractive idea. With mental compulsions, as with behavioral compulsions, something is done repeatedly, mechanically, for no purpose other than to lessen the discomfort of an obsession. As one person may repeatedly check the stove, another may habitually conjure up a corrective fantasy.Ten years ago, mental compulsions were not even known to most mental health professionals. The last edition of the official manual of American Psychiatry, the DSM-II1-R, published in 1987, defined compulsions as “intentional behaviors that are performed in response to an obsession.” It is now recognized, however, that compulsions occurring in the form of thoughts are extremely common, probably even more common than behavioral compulsions. How far our knowledge of OCD has come in just a decade!
Counter-imageperhaps the most prevalent type of mental compulsion is the type I developed in med school, the counter-image. In my OCD group, a student described her counter-images in this way:I get pictures ill my mind of knives being stabbed into my grandmother These thoughts cause me so much anxiety that I have to rethink them whenever they occur. I have to get a good image of my grandmother in my mind, one where she doesn’t have the knife sticking in her. So I see the knife going in, and then I have to pull it out. But as soon as 1 pull the knife out, it’s there again. So this goes on and on. I think a bad thought, then I have to think a good one.
Repeating of Prayersanother common type of mental compulsion is the rote repetition of a prayer. The words no longer have real meaning, they have been reduced to ritualistic incantations performed exclusively to drive away an obsession. A Catholic woman in her fifties described her ritual:I say to myself “Holy Mary mother of God have grace on us sinners” over and over. It’s because an awful thought keeps coming into my mind. A thought to stab Jesus. God knows why it happens. The prayer used to work to make it go away; but now 1 say it over and over, for hours, and the terrible thought keeps on coming back anyway.
Countingthis compulsion includes numbering objects as well as repetitively counting to a certain number. The key is that the compulsion is in the process of counting itself. A thirty-five-year-old man, totally disabled by OCD, needed to count anything in sight. In my waiting room, he counted the tiles in the ceiling. In my office, he counted the books on the bookshelf. He said he just had “an urge to do it.”
Ruminationsalthough there is little written about this type of compulsion, it seems to be fairly common, especially in students. A rumination has been defined as “a train of thought, unproductive and prolonged, on a particular topic or theme.” Sometimes, ruminations clearly represent mental compulsions. An engineering student described his unwanted musings:I constantly over-think things. I’ll be out with my girlfriend, and suddenly I say to myself, “Oh no, here come the thoughts!” I know then that I’m going to get carried away with thinking things over. The thought comes that I’m not real. I’ll have to answer endless questions regarding whether my girlfriend and I are actually here or not. The metaphysical analysis goes on and on and on. I get an isolated, alone feeling. Then I may start questioning why I’m thinking these crazy thoughts in the first place. My whole evening will be ruined.
Mental compulsions, like behavioral compulsions, in the long run only worsen obsessions. A particularly devastating outcome is when the obsession itself starts to be triggered by the very images used to counteract it. A gentle, civic-minded man described how this happened to him:
I’d kill myself before I’d harm a kid. I have kids myself. I’m a Scout leader, for God’s sake. Yet I will be walking along and I’ll see a little boy across the street, and then the thought will come into my mind to run over and strangle him. Nothing will get rid of the awful idea. I used to play a trick to try to get rid it. When the terrible idea would hit, I’d immediately imagine myself teaching the child how to play baseball. This worked for a while; but now things are even worse, because now whenever I see a baseball game on TV, it brings the terrible thoughts right into my mind.
The compulsions mentioned above—washing, checking, reassurance, hoarding, repeating, ordering, and various mental rituals—do not exhaust all possibilities, but they are the types most commonly seen. All of them share one feature: They are defensive, done solely to lessen the torment of obsessions. Yet, from the extreme checking rituals developed by Howard Hughes, to my own more modest protective fantasies, compulsions in the long run only guarantee that the self-tormenting thought that caused them will return again and again.

the diagnosis of obsessive-compulsive disorder presented no major difficulties in the cases of Raymond, Sherry, Jeff, and Melissa. All four had typical obsessions and common compulsions. Usually OCD is like that, very easy to diagnose. Anyone who has obsessions and compulsions that are interfering in their lives has obsessive-compulsive disorder, unless proven otherwise. Occasionally, however, there are times when it is not completely clear whether a person suffers from OCD or from another somewhat similar psychiatric disorder, such as hypochondriasis or body dysmorphic disorder, or from a related neurological disorder, such as Tourette’s syndrome. Phobias can also overlap with OCD. These more complicated situations will be discussed in chapters 9 and 10.To put the whole process of psychiatric diagnosis in broader context, it has been observed that medicine has three levels of diagnostic sophistication. The first stands on the recognition of specific symptoms (“pneumonia is a cough with a fever”). The second level founds diagnosis on measurable biochemical changes in the body (“pneumonia is congestion in the lungs”). The third, the highest level of diagnostic refinement, fixes diagnosis firmly on the ultimate cause of a disorder (“pneumonia is a bacterial infection of the lungs”). Psychiatry, for the most part, is still in the first stage, whereas the other branches of medicine have advanced to levels two and three.Later in the book it will become clear that psychiatry, in the case of OCD, is on the threshold of moving up one or two levels in diagnostic sophistication. For now, though, OCD continues to be diagnosed completely on the basis of the recognition of its symptoms, obsessions and compulsions.*14/338/2*

June 2nd, 2011  |  Posted in Anti-Psychotics  |  Comments Off

TUBERCULIN SKIN TESTING

Author: admin

The Mantoux tuberculin skin test is the only preferred method of testing patients for latent tuberculosis infections. An intradermal injection of 0.1 ml of purified protein derivative (PPD), which contains 5 tuberculin units, is applied to the forearm. Trained health care workers should read the reaction 48 to 72 hours after the injection. If the patient fails to return before 72 hours, a positive result can be interpreted up to 1 week after the injection; however, if the result is negative after 72 hours, the test should be repeated.It is the diameter of induration, and not the diameter of erythema, that determines the result of the tuberculin skin test. The diameter of induration perpendicular to the long axis of the forearm should be recorded. Interpretation of the result is dependent upon the size of the induration and the characteristics of the patient.Tuberculin testing in patients with a prior history of bacillus Calmette-Guerin vaccination is not contraindicated. In these patients, the tuberculin skin test should be interpreted in the same fashion as patients without prior vaccination, and the prior history of bacillus Calmette-Guerin vaccination should be ignored for purposes of interpreting the skin test.Two-stage skin testing should be considered in instances in which patients are tested regularly. The reactivity to the skin testing may decrease over time but may be boosted by regular skin testing. If this effect is unrecognized, a patient may be incorrectly classified as a recent converter. If the first tuberculin skin test result is negative or is reactive but less than 10 mm in diameter, a repeat skin test in 1 week is recommended. If the skin test is greater than or equal to 10 mm at that time, the patient is not considered a recent converter.Anergy panels are no longer used in the interpretation of the results, even in those infected with HIV. Patients with HIV who have a negative tuberculin skin test and a negative anergy panel result do not benefit from treatment with isoniazid. The results of a negative anergy panel, therefore, do not aid in the decision of treatment. In patients with no known risk factors, a reaction greater than or equal to 15 mm is considered positive. However, targeted testing programs should exclude these patients from being tested.*54/348/5*

May 27th, 2011  |  Posted in Anti-Infectives  |  Comments Off

EPILEPSY, EMPLOYMENT AND THE LAW: EPILEPSY AND EMPLOYMENT

Author: admin

There were two schools of thought about employers and epilepsy, Tom would say when any of his friends asked him if he had had any luck getting a job yet. One is that if you don’t tell them you have epilepsy and they find out you ’11 get sacked on the spot. The other is that if you do tell them, the chances are that they won’t employ you anyway. Tom was quite clear about where he stood. He was an up-front sort of chap, and he didn’t like anything that smacked of deception. So he always made it quite clear to any prospective employer that he had had epilepsy since he was a small boy and that he had to take drugs all the time to control it — in fact that he was likely to be quite a liability to any firm willing to employ him.The next time Tom went to see his doctor, he was asked the same question: ‘Isn’t it time you got a job, Tom? It’s over two years since you left school. You can’t spend the rest of your life hanging about.’ Tom was aggrieved. You couldn’t say he hadn’t tried. But he had to be honest about his epilepsy, didn’t he? Otherwise it wouldn’t be fair.’That’s all very well, Tom,’ said his doctor. ‘But don’t you think you might paint a slightly rosier picture for a prospective employer? Can I remind you that your seizures are well under control? You haven’t had one in two years, have you? And two seizure-free years means that you don’t actually have epilepsy. You could do pretty much any job you wanted to — I’m assuming you don’t want to be a steeplejack. Is it possible that you are actually not too keen to find a job? Think about it . . .’
If your seizures are well controlled, there is no reason why you should not work, or why you should have to seek ‘safe’ or sheltered employment, why you should be passed over for promotion, or why you should not work near machinery.Prejudice and misconceptions about epilepsy account for most of the difficulties you may have in getting employment. For example, although the drugs you are taking may make you less alert, your epilepsy itself will not affect your ability to handle machines. Much is made of the dangers of falling forward onto machinery during a fit, but in fact most people who fall during a fit fall backwards, not forwards.Unless your epilepsy is very severe or caused by serious brain damage there is no reason why your employment prospects should be limited. Probably about 85 per cent of people who have epilepsy should be able to find employment in normal jobs in the normal way. One study from Canada showed that when local doctors, social workers and epilepsy associations were prepared to support local business firms, it was very much easier for people with epilepsy to obtain employment, partly because such co-operation led to greater understanding and lack of prejudice. More important, local employers found that employees with epilepsy were more likely to be reliable as they valued their jobs and did not want to lose them.
RESTRICTIONS IN EMPLOYMENTThere are only a few occupations you will not be able to follow, including heavy goods vehicle or public service driving, becoming a commercial pilot or joining the armed services. A few potentially hazardous jobs, such as a steeplejack or deep-sea diver are also obviously precluded.You will not be able to become a merchant seaman if you have had any history of fits after the age of 5 years. If you are already a merchant seaman and then develop epilepsy you will be able to continue your employment once you have remained seizure-free for at least two years provided that you are working on a ship carrying a medical officer and are not directly involved with the safety of the ship or passengers.If you are currently having seizures you cannot be recruited for the police, or as a traffic warden. However, those with a past history of epilepsy are considered individually. Applicants for teacher training should have been free from seizures for two years at the time of applying.
SEEKING HELPIf your epilepsy is disabling, and you have problems finding work, you can seek help from the PACT — Placing, Assessment and Counselling Team. PACT can be contacted through your local Job Centre. One of their specially trained Disability Employment Advisors will help you decide what job you want to do and help you find it, and offer advice on a wide range of services, including job training, rehabilitation courses, and travel grants for getting to and from work.
VOLUNTARY WORKIf you have been trying, and failing, to get work for some time, it is worth thinking about the possibility of doing unpaid voluntary work for a while. This keeps you in touch with people and with the working world, and may also give you experience which will be valuable in your future job-seeking. Your local Council for Voluntary Services or Social Services office are the people to contact if the idea of voluntary work appeals to you.
APPLYING FOR A JOBWhen you are applying for a new job, you have to keep two clear aims in mind. First you must convince your prospective employer that you are perfectly capable of doing the job in question. Second, you must make them believe that your epilepsy does not play a particularly important part in your life; that for you it is no big deal.Unfortunately, many people with epilepsy have learnt through bitter experience that even to mention that you have epilepsy may lose them the job, but that not mentioning it may eventually have the same effect. It can be a no-win situation, but perhaps the best approach is to sell yourself and your abilities before even mentioning the fact that you have epilepsy. So do not mention it on your application form, unless you are specifically asked, or even during the initial phase of the interview. It should be your final disclosure, and when you make it, do so briefly and casually, as an aside. Then, if your interviewer asks you any further questions, answer them as honestly and straightforwardly as you can.’I take the attitude,’ one woman says, ‘that if a firm don’t want to employ me and my epilepsy, then I’m sure I don’t want to work for them.’
PENSION SCHEMESThe fact that you have epilepsy should make no difference to your inclusion in your employer’s pension scheme. The general advice of the Occupational Pensions Board is that if someone is suitable for a job, then they are also suitable for inclusion in the pension scheme.
ACCIDENT INSURANCEEmployers’ liability policies cover all employees. Those with epilepsy are no exception. Provided you have declared your epilepsy and you are not employed in a job for which your epilepsy makes you quite unsuitable, accident insurance should not be a problem for you or your employer.

May 19th, 2011  |  Posted in Epilepsy  |  Comments Off

YOUR SUCCESS STORY: LOOKING WITHIN – GET IN TOUCH WITH YOUR DEMONS

Author: admin

Eating for emotional reasons happens more when we are unsure about what’s bothering us. Once we get a clear picture of what’s really going on, the urge to take solace in food is likely to diminish and eventually disappear. Clinical psychologist Dr. Edward Abramson therefore encourages his patients to pay close attention to events that precipitate eating episodes: “I frequently ask people, ‘What were you thinking about before you started eating?’ Not just ‘Where did I leave the peanut butter?’ but ‘What was I thinking about before I asked where I left the peanut butter?’” This method helps people identify what was going on in their head at the time and enables them to connect a particular feeling to the urge to eat. It may be an upcoming job interview or other work-related situations that cause anxiety, for example, or the memory of someone who is absent that precipitates loneliness.It’s important to realize that most of us have been conditioned to cover our feelings, and if we’re not turning to chocolate cake for comfort, we’re turning to Prozac or other antidepressants that mask an uncomfortable state of mind. Instead of shutting down our mind’s internal message, we need to become more aware of what our inner voice is saying and learn to live in accordance with that voice. Ask yourself honestly what it is that makes you feel anxious about your job, or why a particular person’s absence makes you feel lonely. Don’t be embarrassed and don’t shut out the answers that come to you. Once you acknowledge these feelings, you can begin to work through and overcome them.One method for tuning in to yourself is to get involved in something creative. Using art is a simple way to open the door to better self-understanding and self-expression. You don’t have to be Picasso; just the act of generating images that are meaningful to you through sketching, painting, or doing collage can help. The expression through-art technique is especially good for people who have difficulty talking about their problems, and the process actually can start a flow of dialogue as you begin to open up. It’s inexpensive, without side effects, and can be extremely beneficial. For example, you might use art to explore the circumstances in your life that compelled you to gain weight in the first place.Note that, in addition to visual art, music, drama, dance, and creative writing are other avenues of artistic expression that can lead to better self-understanding. *271\233\8*

May 5th, 2011  |  Posted in Weight Loss  |  Comments Off

COSMETIC SURGERY FOR AGEING SKIN: LASER SURGERY

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The use of lasers over the last ten years has attracted a lot of media attention. Lasers have revolutionized cosmetic dermatology, so that many procedures can now be performed with less bruising and bleeding, and quicker recovery. Applications in areas such as eyelid surgery, skin resurfacing and face-lifting are slowly replacing traditional surgical techniques. Disfiguring birthmarks, which prior to lasers could not be treated satisfactorily, can now be vastly improved. Despite the effectiveness of laser surgery, however, it is not a panacea for every skin blemish.Laser stands for Light Amplification Stimulated by Electromagnetic Radiation. So laser is a light energy derived from a heat source which can selectively destroy certain components of the skin. Laser energy behaves like a magnet – it is attracted to a specific target and does not damage nearby healthy tissue. The great attraction of lasers, then, is that they are very selective as well as clean and bloodless. In this era of AIDS, hepatitis and other serious communicable diseases, lasers provide a very safe alternative to conventional forms of surgery. Using lasers does, however, require a degree of specialized training and experience which is different to that for traditional surgery. It is therefore important to check a doctor’s credentials if you are contemplating any sort of laser surgery. In addition, because the equipment is so costly, laser treatments can be very expensive.
*108/150/5*

April 23rd, 2011  |  Posted in Skin Care  |  Comments Off