Apr 5

When we come to discuss the treatment of stress breakdown, the first point to make is that correct diagnosis is essential before attempting any treatment, because treatment appropriate for stress breakdown will be of no use for the other conditions which may resemble stress breakdown. Moreover, wrongly giving a patient who in fact is suffering from stress breakdown a treatment designed for some other disorder, may well make the over-stressed patient worse.
Therefore we need to understand stress breakdown before we can treat it properly.
Understanding stress breakdown is the key to successful treatment, and the best treatment is prevention.
Firstly, I need to say that the best, most effective treatment always for stress breakdown is prevention. Stress breakdown is much more difficult to treat than to prevent, because the fact of having broken down becomes a stress in itself; further, treatment for stress breakdown may have to include the mending of hurts and strained relationships caused by the symptoms of the stress breakdown.
Secondly, before discussing treatment for stress breakdown I need to clarify exactly where the anxiety equation fits in with stage one. I don’t want to give the impression that all conditions which cause anxiety can progress on to cause further stress-breakdown symptoms.
The anxiety equation suggests that there can be a number of reasons why a person will experience anxiety. One of them is excessive overload of the nervous system. Others, for example, low blood-glucose levels and sedative drug withdrawal, might produce anxiety when the nervous system is not unduly overloaded. However, these conditions in themselves need not lead on to stage two breakdown.
The necessary precondition for stage one stress symptoms to progress to stage two is the use of will-power mechanisms to ignore the anxiety symptoms and to stay in the stressful situation.

*39/129/5*

Sep 22
There are many people who fear becoming old and ‘senile’ because once they become mentally frail they will no longer be able to tell people what their wishes are, especially in relation to medical treatment. Currently the position is that doctors dealing with the mentally frail are governed by what is known as ‘good medical practice’: because the person concerned cannot give consent, measures are taken ‘in their best interests’. Most teams of professionals dealing with the elderly in the UK would discuss the dilemma with the person’s family, although the latter have no legal force to sway the doctors one way or the other (enduring powers of attorney specifically exclude medical matters). ‘Good medical practice’ may mean that a person undergoes an operation or is given some form of treatment that his family and friends know would have been refused had the person been competent.
In the United States there has been legislation in many states to try to insist on the autonomy of the person under consideration being paramount, and to do this the person must make a statement basically saying how far he would like doctors to go in the event of him/her becoming incapable of giving informed consent. Obviously such a statement must be made before any brain damage has occurred. This statement is called a living will and describes a form of anticipated consent. The following is an example of a living will:
It is my express wish that if I develop an acute or chronic cerebral illness which results in a substantial loss of dignity, and the opinions of two independent physicians indicate that my condition is unlikely to be reversible, any separate illness which may threaten my life should not be given active treatment.
In the USA this is a legally binding document, but this is not the case in the UK. The above example is only one type of document that could be drawn up; some people would perhaps want to refuse life-support machines or mutilating operations but would want antibiotics or other ‘invasive’ medical treatments. The UK is certainly different in its treatment of the very mentally frail and few doctors here would deem it appropriate to put someone with advanced dementia onto life-support machines or subject them to major operations without much thought and significant benefit to the individual. Good medical practice, however, still leaves important decisions in the hands of comparative strangers whose moral and ethical values may differ markedly from the person they are treating.
That is not to say that good practice does not currently allow for the extremely mentally frail with other severe illness to die pain free and with dignity. The British Medical Association (BMA) was initially reluctant to acknowledge the need for living wills, and in the 1980s its Ethics Committee reported they were quasi-legal documents that could arouse fear in some people. The debate has continued, however, and new impetus has been given to the topic by the large numbers of people affected by AIDS. The Terrence Higgins Trust, a leading AIDS charity, has produced its own living will and distributes copies free of charge. Because HIV-related diseases and AIDS affects a predominantly younger population than dementia, it has focused attention away from age and onto the point at issue, personal autonomy. The latest statements from the BMA encourage debate on the issue. It is a topic arousing Parliamentary interest with a view to giving it some legal status as is now the case in the Netherlands.
The need for discussion around this very important topic is evident. I feel very strongly that many people would contemplate writing a living will because currently many institutions caring for the elderly mentally frail are so under-funded and under-staffed that the reality of life in these places fills many people with dread.
In such circumstances, however, a living will coming into effect must never be used to decrease the funding to this vital part of the health service merely because of a cynical anticipated lack of demand later. The living will debate is only valid if more resources are placed into this sector so that the reality for the elderly mentally infirm in care is of excellent architecture with enviable surroundings, single rooms with bath and toilet, and sufficient care staff properly trained to ensure life with dignity. A living will for intercurrent illness would then truly enhance a person’s autonomy.
*85/128/5*

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Sep 22
Laxatives
The terms laxative, cathartic, aperient and evacuant are synonymous. Laxatives may be differentiated by the gentility or severity of their mode of action. High fibre is a gentle laxative and as a bulking agent high fibre produces a voluminous soft motion which encourages normal reflex bowel activity.
Soap like emollients such as Coloxyl soften the bowel motion and allow the retention of water. Liquid paraffin is tasteless, non digestible oil which is said to act by lubricating the bowel and increasing the water contents of bowel motions. There is some suggestion that liquid paraffin is associated with a slightly higher risk of colorectal cancer.
The more aggressive group of laxatives includes Durolax (Bisacodyl), castor oil, Cascara, Sennakot (Senna), rhubarb and Laxettes (Phenolphthalein). Ideally sufferers of constipation should start their attack on recalcitrant bowels with high fibre and add an emollient such as Coloxyl, if the problem persists. In stubborn but intermittent cases of constipation a large dose of Agarol is nearly always effective. Agarol is a mixture of Paraffin Oil and Phenolphthalein.
Laxettes
Laxettes are a brand of chocolate which acts as a laxative. The active ingredient is Phenolphthalein, which causes the large bowel to secrete copious quantities of water and to contract spasmodically. Laxettes are often used in the management.
*84/131/5*

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Jun 2
I have a deep and abiding respect for nitrates, since I believe these drugs kept me alive during my heart attack in 1978. I experienced that heart attack the night before my scheduled angiogram, and fortunately my cardiologist had put me on a high dosage of nitrates, which are designed to keep the arteries open. Without the effects of those drugs, my attack might very well have been worse.
The nitrates are used mainly for acute relief and prevention of angina pectoris. They work by relaxing the smooth muscle tissue of the blood vessels, resulting in dilation of both veins and arteries. This, in turn, yields increased blood flow and decreased oxygen consumption by the heart. Another effect may be a reduction in both systolic and diastolic blood pressure.
There are a number of ways to deliver nitrates, for either long-term or short-term benefits. Glyceryl trinitrate, more commonly known as nitroglycerin and which I’ll discuss in more detail in a moment, provides a quick burst of vasodilation, but the vessel-opening effect doesn’t last long. The long-term nitrates don’t have as dramatic an effect, but they keep the vessels open over a longer period of time. Your doctor may prescribe one or more of the nitrates, to be taken as tablets (swallow, don’t chew), ointment, skin patches or sprays.
Contraindications include severe anaemia, head trauma, cerebral haemorrhage, and hypersensitivity to nitrates. The drugs can result in postural hypotension, that is, dizziness which occurs when you change position suddenly, such as standing up from a seated position. Since alcohol makes this tendency worse, it’s best to avoid or limit drinking. Large nitrate dosage can produce headaches. Talk with your doctor if headache develops; often patients become more tolerant to nitrates.
If you experience angina pectoris, your doctor will very likely prescribe nitroglycerin, either alone or in addition to other nitrates. It enables the heart muscle to get more blood which, in turn, provides more oxygen and relieves the pain.
Unless instructed otherwise, place a nitroglycerin tablet under your tongue at the start of chest pain. You may experience a dull headache, one of the ways you know that the nitroglycerin has gotten into your bloodstream. If your chest pain doesn’t go away within five minutes, take another tablet. If pain still persists, after another five minutes take a third tablet. And if that doesn’t work, contact your physician. For severe or worsening pain, seek immediate medical attention.
Dr Nishi offers these tips regarding nitroglycerin usage:
Do not drink water with this pill, and don’t swallow it. Let it dissolve under your tongue.
It’s best to sit down or lie down when taking nitroglycerin, as it
may cause a temporary drop in blood pressure and resulting dizziness.
Don’t be concerned about normal side effects including headache, dizziness, a warm flushed feeling and a burning sensation under the tongue.
This medication can easily lose its potency. Don’t store in a hot or even very warm place, and keep it out of the sun. Keep nitroglycerin in its original, brown glass container. Studies have shown that even the heat generated by keeping the container in a shirt pocket next to the skin is enough to destroy nitroglycerin’s potency.
Replace opened bottles of nitroglycerin at least every six months. Properly stored, unopened bottles should be good until the expiration date on the label.
If you don’t get the dull headache that typically occurs when taking nitroglycerin, assume that the pills have lost their potency.
Keep the bottle top tightly closed.
As with all other medications, discuss nitroglycerin with your doctor or pharmacist. Dr Nishi recalls a patient who claimed he had no questions, and fully understood all his medications. Then the pharmacist spotted the patient’s nitroglycerin on a windowsill in direct sunlight. After mentioning that, a 15- to 20-minute discussion and Q&A session followed.
*139\85\2*
Cardio & Blood/ Cholesterol
Jun 2
This category of drugs is also designed to prevent clotting. These medications are commonly referred to as “blood thinners”. The generic name is warfarin, with brand names Coumadin and Marevan. Warfarin, like aspirin and Persantin, lengthens clotting time. It does so by affecting clotting factors in the blood, while aspirin and Persantin act by affecting the function of blood platelets.
Warfarin is often given to patients with certain types of artificial heart valves to reduce the possibility of small clots forming on the valves.
The amount you take will be determined by the results of a “pro-time” blood test. Your doctor will prescribe a standard daily dose or may give you a specific dosage schedule to follow. Take your medication at the same time each day, and do not stop taking it without consulting your physician. You may be taking warfarin for some time, perhaps indefinitely.
If bleeding from a cut continues for several minutes, contact your doctor. Talk with him about signs of unusual bleeding as well, including black stool, pink or red urine, nose bleeds, or bruising with severe swelling.
Do not take aspirin or preparations containing aspirin while taking warfarin. If you have a headache, one of the non-aspirin pain relievers such as Tylenol or Panadol may be taken instead.
Do not drink excessive amounts of alcohol. More than one or two drinks, or drinking even that amount regularly, can alter the effect of your anticoagulant. Major changes in diet, such as eating unusually large amounts of fish or leafy green vegetables, can alter your response to the drug. Try to keep your diet regular, without binges or splurges.
While these precautions and warnings may sound severe to you now, remember that anticoagulants have been prescribed for many years for thousands of patients. They have major benefits your doctor wants you to get. In a short period of time you and your doctor will work out just the right dosage, and taking this medication will become second nature to you.
*138\85\2*
Cardio & Blood/ Cholesterol
May 21

Wax is normally secreted by glands which lie in the ear canal. When first secreted it is soft and colourless, but with exposure to air becomes hardened and acquires a brown colour. Its function is to act as a filter for the ear, trapping particles of dust and dirt when they enter the ear canal. Usually the actions of chewing and the constant renewal of the ear canal’s lining ensures that wax is moved outward. Sometimes a build up of wax can block the ear canal, and may cause discomfort or interfere with hearing. Earwax can be softened by placing 2 drops of paraffin oil in the ear for 3 consecutive nights. Never use a cotton bud to remove wax inside the ear canal, as this can easily cause damage by pushing the wax deeper inside the ear. Some children may have to use ear drops on a regular basis to prevent a build up of wax. The doctor may sometimes have to use a special syringe to flush out wax that is blocking the ear.

*228\90\8*

May 19

Respiratory distress syndrome refers to breathing difficulty experienced by many premature babies, due to underdevelopment of their lungs. The earlier a baby is born the more likely he is to suffer from RDS. Babies born at 28 weeks have a 70% chance of developing RDS. This figure drops to around 10% for babies born at 34 weeks gestation.

Cause

Because the lungs of premature babies are immature they do not produce a substance called surfactant, which lines the lung surface and prevents collapse of the smallest airways (alveoli) used for oxygen exchange. This substance starts being produced when the baby is around 28 weeks gestation.

Clinical features

A baby suffering from RDS will have difficulty breathing, having to work very hard with each breath. His chest may be drawn in and he will grunt when he tries to breathe out.

Investigations

Diagnosis of RDS is usually confirmed by chest X-ray.

Treatment

Babies with RDS require highly specialised treatment in a special care nursery. They will be nursed in a humidicrib and will require oxygen administered through a special hood. Sometimes they will require oxygen through a tube passed into their windpipe, and some babies may be hooked up to a special breathing machine (ventilator) for days or even weeks. Artificial surfactant is also now available, and this helps those babies with respiratory distress due to immature lungs.

*61\90\8*

May 18

ABUSE?

    ”When I read about sexual abuse, I knew it was the same for

me. Will I, does anyone, get over the terrible scars of the

abuse?”

ANSWER: No, nobody “gets over” them, but one learns to put them to work in favor of a new intimacy. Those who have suffered abuse learn the contrast between sharing and abusing, and they seem all the stronger for the pain, for they have seen both sides of the issue. They have felt the guilt, self-blame, and anger of sexual abuse and learned the contrast between that and the love, trust, and safety of sex in marriage. Just as someone who never has been really sick may never fully know what it is to be very healthy or at least fully appreciate and value health every day, so it is with sexual abuse. You have seen and felt the pain, so the joy and freedom is all the more valued.

*252\97\8*

May 18

Many species of birds, marsupials, mammals and other animals on our planet become extinct every year.

The main reason for their extinction is that their organisms cannot cope with the increasing levels of pollution in their food and their environment.

Nature gives us a fair warning. If we keep polluting our planet, it may soon be our turn.

So far into our “civilised evolution” we continue to develop more and more diseases, allergies etc. and have increasing difficulty maintaining good health.

However, when we understand the reasons for this, we have a choice. Rather than waiting for governments and the industry to do something about it, WE THE CONSUMERS should make a choice first.

No industry will produce articles consumers do not want.

*42\96\8*

May 15

There is some confusion about influenza and this may come about because many people talk about the flu when what they are referring to is the common cold or other mild respiratory infections.

Real influenza is certainly not a mild illness. Epidemics and pandemics (that is, a worldwide epidemic) of influenza have spread even in ancient times.

The great pandemic of 1918-1919 claimed an estimated 20 million people, more than died in the Great War.

Influenza is caused by a virus of which there are three sub-groubs, À, Â and Ñ. Ñ virus is rarely isolated and does not cause epidemic influenza. Â virus may cause epidemics which tend to be milder than those caused by A virus and it is this last which causes the pandemics.

The incubation is short, some two to three days. The onset of the infection is abrupt with fever, headache, malaise, shivering and severe aches and pains in the limbs and back.

This is followed by a dry cough, a sore throat and other symptoms of a respiratory infection.

*457/71/1*

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