eThaiSORE.com - Health News

CHANGING THE HORMONE BALANCE BY HAVING TABLETS OR INJECTIONS – OESTROGEN-TYPE FEMALE HORMONES (DOSE OF OESTROGENS)

admin — Tue, 26 Jul 2011 14:16:43 +0000

The risk of serious blood clotting problems depends on the dose of oestrogens. For men, less than the equivalent of three milligrams a day of stilboestrol is probably safe. The safe dose for women is not definitely known but is probably quite a bit higher.

Oestrogens also weaken small blood vessels. You are likely to bruise easily if you take them.

Extra oestrogens cause some special problems for women. You could develop a need to pass urine frequently and/or loss of control of the bladder when coughing, sneezing, laughing etc. If you have not had your uterus removed, you could also experience bleeding from the vagina. This can happen either after you have been taking oestrogens for a long time or when you stop taking them. If the bleeding is heavy, doesn’t stop by itself or happens more than once, you can’t take it for granted that it is simply due to your oestrogen treatment. You should consider having a curette in order to be sure of the reason for such bleeding. A curette involves scraping out the lining of the uterus (womb) through the vagina, under a general anaesthetic if you wish. The lining can then be examined under the microscope to see whether the bleeding was caused just by the oestrogens or by some other problem such as cancer of the lining of the uterus.

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REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: HOW TO IMPROVE YOUR CHOLESTEROL LEVEL – EXERCISE

admin — Mon, 11 Jul 2011 14:04:13 +0000

Regular aerobic exercise often has the benefit (partly by promoting weight reduction) of reducing blood triglyceride levels and increasing the proportion of your total cholesterol that is made up of HDL cholesterol. Total and LDL choleste usually stay the same with exercise, but the ratio of LDL to HDL cholesterol is improved.

The appeal of dietary changes and increased activity is that although they can help improve lipid levels, they can also contribute lowering other cardiovascular risks such as obesity and high blood pressure. Changing your diet and exercise habits does not usually require an “all-or-nothing” approach. Anyone with the knowledge of what to do and the desire to do can make healthful changes that can rapidly become “second nature.”

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REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: HOW TO IMPROVE YOUR CHOLESTEROL LEVEL – MEDICATIONS

admin — Fri, 08 Jul 2011 13:52:24 +0000

If periodic rechecks of lipid levels show little response to changes in diet and exercise, your doctor may recommend lipid-lowering medications. Some medications have their biggest effect on LDL cholesterol, others on triglycerides, and others on HDL cholesterol. Despite their potential for being beneficial, medications are reserved for people in whom diet and activity alone have not been sufficiently successful or people with more severe hyperlipidemia. There are several reasons to be conservative with the use of medications. All entail an expense. There is always the potential for side effects, and occasionally they can be severe. Taking-medications is at least a little disruptive of daily routine activities. Nevertheless, if other measures have failed, medications are warranted.

Whether you need medications is a decision best made by you and your physician. These factors enter into the decision:

the severity of the cholesterol glyceride abnormalities

the presence of other unmodifiable risk factors (such as family history of heart attacks at a young age)

evidence of existing coronary artery disease

ineffectiveness of dietary and exercise changes

As a rule, if two risk factors are present (or if there is already evidence of coronary disease) and if dietary measures have not succeeded in changing your lipid profile out of the higher-risk range, then the use of medications is advisable.

One aspect of evaluating and treating high cholesterol and triglyceride levels is to determine whether they may be caused by another problem that can be treated itself. High blood lipids can be caused by low thyroid function, diabetes, kidney disease, and liver disease.

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LIGAMENT INJURIES: REHABILITATION TRAINING FOR LIGAMENT INJURIES

admin — Thu, 30 Jun 2011 15:25:45 +0000

What I wasn’t prepared for was the amount of pain that was involved in getting back flexibility in terms of bending and straightening my knee. It’s not easy—you have to make a commitment to therapy. I look at this as a down payment on being able to do things that I want to do for the rest of my life.

If I don’t do the therapy, if I don’t make the effort to get well, I’m not going to be able to play basketball with my kids, I’m not going to be able to play tennis with them. I don’t want to be limited – I guess that’s the whole issue.

Joan, thirty-six years old, ACL reconstruction

The typical patient for ACL reconstruction is someone who is very active and whose primary goal is to return to an active lifestyle.

If a patient is not committed to rehabilitation, the surgery will not be successful. The training for ACL recovery can take on average 6 months, at least three days a week for forty-five minutes a session. If possible, anyone contemplating an ACL reconstruction should consult with a physiatrist (a physician who specializes in physical medicine and rehabilitation) or a physical therapist prior to surgery so that he fully understands his role in his recovery. Some insurance companies will cover the cost of rehabilitation; however, given the increasing concerns over cost containment in this country, many patients are forced to do their therapy on their own.

The student or desk worker can return to work within a week following surgery. Patients can resume driving between four and six weeks. Use of pain medicine should be minimal after 3 weeks.

Rehabilitation for an ACL reconstruction should only be done at a center that is experienced in rehabilitating patients with ligament problems and should have special machinery geared for these patients. The staff at advanced centers should have expertise in training techniques to ensure a quick and safe return to maximum function. In addition, a center that works with ligament patients will know how far a patient can safely be pushed; more often than not, we have found that many rehab centers don’t expect enough from these patients, which can dramatically slow the patient’s recovery.

Rehabilitation for ligament reconstruction is typically broken down into four phases.

Phase 1

Getting out of bed the first day wasn’t that bad—the noninjured leg moved fine. The other one just sort of sat there like it was dead. I had to pick it up by the brace and put it on the floor.

ACL patient

Very often, ACL rehabilitation is a fight against time. After an ACL reconstruction, the knee can get very stiff, which can quickly lead to immobility. Movement can be painful and difficult. Patients are encouraged to use the CPM machine while in the hospital and also at home.

In the initial period after surgery (from week 1 to 3) the primary goal is to gain full range of motion (at least 0 to 120 degrees flexion) within 3 to 4 weeks and to relearn the normal gait cycles. Every 1 to 2 days, you should strive to increase 10 degrees of motion. Full weight bearing with crutches is encouraged immediately until you feel secure (usually by 3 weeks) at which point the crutches are no longer used. During this time, you are encouraged to do straight leg-raising exercises and active flexion and extension (bending and straightening).

You are encouraged to walk with the aid of crutches. Movement can be painful, and you may want to take an analgesic before physical therapy. This may be fine, but talk to your doctor and physical therapist before doing so. If you take painkillers before therapy, there is a risk that you may harm a structure if you push too hard. Remember, your ultimate goal is pain-free, drug-free living, and that can only be achieved through proper exercise.

Phase 2. The fourth week through about the ninth week is a critical period because the reconstructed ligament begins to weaken, which is part of the healing process. By the fifth or sixth week, you begin resistive exercises—trying to strengthen the stabilizing muscles around the knee. This can be accomplished by a technique called contract relax; for example, you attempt isometrically to contract or tense up a muscle for 5 to 6 seconds and then stretch the same muscle. Functional activities are also begun, such as stair climbing and single leg support. You usually discard the brace as soon as you are comfortable with walking without it. You may then wear a knee sleeve, which is usually a neoprene-type soft brace with a hole for the kneecap.

Phase 3. Depending on your progress, between 12 to 13 weeks and about 4 months, the emphasis shifts from strengthening to functional training. Exercises should be specifically geared to your activities; for example, if you want to return to playing tennis or basketball, you will be given exercises that can help you learn how to cut or pivot.

Phase 4. Between 4 and 5 months postsurgery, the final phase of recovery is geared to returning you to normal activity. Strength training continues; we periodically check the ligament for strength and endurance using special machines and functional tests. For example, KT 2000 testing is a pain-free test that measures forward and backward movement of the tibia relative to the femur.

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OTHER APPROACHES TO EPILEPSY THERAPY: THE KETOGENIC DIET – WHAT ARE THE COMPLICATIONS OF THE KETOGENIC DIET? IS THE DIET ALWAYS A LAST RESORT TO CONTROL SEIZURES?

admin — Mon, 13 Jun 2011 14:30:28 +0000

“What are the complications of the ketogenic diet?”

During the starvation phase of the diet, the child’s blood sugar may drop, with symptoms like weakness, dizziness, paleness, sweating, and sleepiness. If these occur, it is imperative to measure the blood sugar and to give a small amount of glucose before continuing starvation. We have mentioned that supplementary vitamins and calcium are needed to prevent deficiencies. Your child should gain little weight on the diet if it is properly calculated, and growth may be slightly slowed. However, both will catch up when the diet eventually is discontinued. Despite the high fat content, the diet does not appear to cause atherosclerosis. Kidney stones can occur, but may be prevented by appropriate fluid intake.

“Is the diet always a last resort to control seizures?”

This diet has been used mainly as a last resort. However, since it is so effective when nothing else works, perhaps it should be used earlier in the course of epilepsy, if you and your child are willing to try it as an alternative to medication.

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TYPE 1 DIABETES: KEY POINTS

admin — Fri, 03 Jun 2011 12:50:52 +0000

Autoimmune destruction of the pancreatic beta cells is the major cause of type 1 diabetes.

Type 1 diabetes is a genetically determined disorder; the genes responsible are within the major histocompatibility complex locate on chromosome 6.

Evidence of residual insulin secretion is present in 45% of adult (ages 18-39 years) within 5 years after the onset of type 1 diabetes and 11% retain some secretory capacity after 5 years of type 1 diabetes.

Intensive hypoglycemic therapy may result in the maintenance of some inssulin secretory capacity. This is associated with improved metabolic control, less hypoglycemia, and slower progression of retinopathy than in intensively managed patients with no insulin secretory capacity.

Intensive team management of type 1 diabetic patients with no retinopathy, with a therapeutic goal of normoglycemia, results in 76% reduction in the risk for the development of clinically significant retinopathy compared with conventional management. A beneficial effect on retinopathy progression is maintained for least 4 years after a prolonged period (mean: 6.5 years) of intensive management.

Significant effects of intensive management include a decrease urinary albumin excretion (an index of nephropathy) and a reduction in clinical evidence of peripheral sensory and autonomic neuropathy.

Favorable trends occur in macrovascular endpoints with intensive management of type 1 diabetes.

Intensive management improves outcomes of pregnancy in type diabetes.

Although transient increases in retinopathy progression occur during pregnancy and in some patients with intensive management. the long-term risk of progression of retinopathy is not affected.

Increased ophthalmologic surveillance during pregnancy in type diabetes is indicated.

The two main adverse effects of intensive management of type diabetes are weight gain and an increased incidence of severe hypoglycemia.

Intensive treatment methods of type 1 diabetes have been under study since the completion of the DCCT with goals of decreasing the risks of excessive weight gain and severe hypoglycemia

Long-term follow-up of the DCCT cohort in the EDIC Trial will provide valuable natural history data and information on the effects of a defined period of intensive glycemic management on microvascular and macrovascular complications.

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BREAST CANCER EXPLAINED: SELF-EXAMINATION

admin — Sun, 22 May 2011 12:33:37 +0000

There is some controversy on the subject of self-examination. Advocates say that it encourages early diagnosis and therefore an increased chance of early treatment. Those against it say that self-examination does nothing to prevent the disease in the first place and also leads to a lot of unnecessary worry for the great majority who find symptoms which turn out to be benign. I fall into the first camp and believe wholeheartedly that self-awareness in relation to physical symptoms is an integral part of taking responsibility for your own health.

One of the purposes of self-examination is to become aware of what is normal for your body. The object is not to compare yourself to what is normal for other women. Everyone is a different size and shape, with a different nipple type, and the person who is best placed to diagnose changes is the expert – you! Ninety per cent of breast cancers are detected by the women themselves. Mammography in the fifty-plus age group detects very early stage breast cancers, but by far the majority of tumours are still found by the women themselves.

In order to monitor the health of your breasts it is advisable to do a breast check yourself once a month. Ideally, women should start this routine in their late teens or early twenties and continue the habit for life. Breast examination is free, encourages self-awareness, and is the way that most breast lumps are found. This is how to do it:

1. Examine your breasts when you have a quiet moment and the time to do the check properly. It is best to examine your breasts in the week after your period, as hormonal changes prior to your period will probably make the tissue thicker or lumpier, and thus less easy to notice irregularities. Post-menopausal women can make a routine of examining their breasts on the same day every month – the first is easy to remember. If you have had a hysterectomy which has left your ovaries intact, you may be experiencing the stages of your menstrual cycle without accompanying bleeding – in this case choose a regular monthly time when your breasts are not swollen or sensitive.

2. First stand in front of a mirror with your arms by your side, observe the shape of your breasts and determine if there is any change from the last examination. Lean forward and observe any changes. Come upright again and move your arms horizontally to the side and then over your head. All the time you are looking for changes in how your breasts move, in the texture of the skin, for any dimpling or puckering. Look for changes in the nipples as well, such as change of direction or pulling-in.

3. While standing in front of the mirror, physically examine your breasts. This can be done either in quadrants, like the slices of a pie, or in ever-larger circles from the nipples out. Remember to feel under the armpits and also to examine the nipple by pushing downwards with one finger and gently squeezing the nipple to check for any discharge. You should also check above your

collar-bone.

4. Repeat the physical examination while lying down on your back. Raise one arm, rest it comfortably under your head and use the opposite hand to check your breast. Many women find it ideal to examine their breasts in the bath or shower as the skin is then slippery. The whole procedure may take a bit of time at first, but after three or four months you will find it can be done much faster

- but not too fast! Thoroughness is important and the examination is a few minutes of time well invested.

5. If you do find a lump or any other symptom, it is important to have it checked by your doctor as early as possible. Early diagnosis is one of the key factors in increasing the chance of survival. However, do not panic – for every five lumps one is cancerous, and the remainder are benign and harmless. Even if a lump is cancerous, six or seven out of ten will be treated without the removal of the breast – the greatest fear for some women.

It is important, for the best chance of early diagnosis, to get away from the idea that you are always looking for a lump. Symptoms that can be a warning of breast cancer are:

- A lump in the breast or any area of thickening

- A lump in the armpit

- Change in the size or shape of the breast

- Inversion (pulling-in) or puckering of the nipple

- A rash around the nipple

- Bleeding or discharge from the nipple (especially one-sided)

- Dimpling or puckering of the breast skin

- Swelling of the arm

- Ulceration of the skin

- Breast pain or persistent tenderness

- Unusually prominent veins on the breast

Even if you have had symptoms where breast cancer has been ruled out previously, say

non-malignant breast lumps, you should follow through with any concerns since benign breast disease can co-exist with breast cancer. One does not indicate the other, but neither does one preclude the other.

If you are pregnant, or breast-feeding, your breasts will be undergoing many changes, but monthly examinations are still wise as 3 per cent of all breast cancers are found in women who are either pregnant or breast-feeding. If there are any symptoms that concern you it is best to seek your doctor’s advice.

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ALCOHOLISM TREATMENT TECHNIQUES AND APPROACHES: RECOVERY AND THE FAMILY

admin — Fri, 13 May 2011 11:05:58 +0000

A common mistake when working with an alcoholic family is to assume that once the drinking stops things will get better. Yet when the alcoholic stops drinking the family again faces a crisis and time of transition. Such crises can lead to growth and positive changes, but not automatically or inevitably. In the alcoholic family there has been a long period of storing up anger, of mistrust and miscommunication. This may have been the children’s only experience of family life. At times children who previously were well behaved may begin acting out when a parent becomes sober. Children may feel that earlier their father loved alcohol more than them, and that now he loves AA more. He may have stopped drinking, but in the children’s eyes they’re still in second place.

Recovering families have a number of tasks to accomplish before they return to healthy functioning. They must strengthen generational boundaries. They must reassume age- and sex-appropriate roles in the family. They must learn to communicate in direct and honest ways with one another. They must learn to trust one another. And finally they must learn to express both anger and love appropriately.

It might be expected, if one considers the family as a unit, that there are stages or patterns of a family’s recovery from alcoholism. This has not yet been adequately studied. No one has developed a “valley chart” that plots family disintegration and recovery. Counselors who have had considerable involvement with families of recovering alcoholics have noticed and are now beginning to discuss some common themes of the family’s recovery.

One observation suggests that the family unit may experience growth pains that parallel those facing the alcoholic. It has long been a part of the folk wisdom that the alcoholic’s psychological and emotional growth ceases when the heavy drinking begins. So when sobriety comes, the alcoholic is going to have to face some growing-up issues that the drinking prevented him from attending to. In the family system, what may be the equivalent of this Rip Van Winkle experience? Consider an example of a family in which the father is an alcoholic, whose heavy drinking occurred during his children’s adolescence, and who begins recovery just as the children are entering adulthood. If he was basically “out of it” during their teenage years, they grew up as best they could, without very much fathering from him. When he “comes to,” they are no longer children but adults. In effect, he was deprived of an important chunk of family life. There may be regrets. There may be unrealistic expectations on the father’s part about his present relationship with his children. There may be inappropriate attempts by him to “make it up,” regain the missing part. Depending on the situation, the counselor may need to help him grieve. There may be the need to help him recognize that his expectations are not in keeping with his children’s adult status. He may be able to find other outlets to experience a parenting role or reestablish and enjoy appropriate contacts with his children.

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CAUSES OF CONTACT ALLERGIC DERMATITIS: SUNSCREENS, TOPICAL MEDICATION CREAMS, ETC

admin — Mon, 25 Apr 2011 09:36:32 +0000

Sunscreens

With the increased use of sunscreens and their incorporation into many cosmetics, allergic reactions to their various ingredients are on the rise. Although many people are aware that PABA can produce allergic reactions, other sunscreen components, especially benzophenones, may also cause the same reactions.

If an allergic reaction to a particular sunscreen occurs, patch testing should be done so that an alternative sunscreen can be found. The titanium dioxide-containing make-ups or sunscreens are a good alternative and include Ego Sunsensitive, Clinique City Block, Clinique Continuous Coverage and UV Low Allergenic Formula.

Topical medication creams

Many over-the-counter soothing creams can cause allergic reactions, the majority being either anesthetic or antihistamine creams. If you have an itch or a burn it is better to use a cream specific to your problem rather than a general anti-itch or soothing cream.

Rubber

Rubber allergy is commonly seen in people who frequently wear rubber gloves. Again, hairdressers are especially likely to develop it. Rubber in the form of elastic is also present in some clothing, especially underwear and lycra gymnasium tights. Rubber condoms are another source of rubber allergy. If this allergy develops, a non-rubber condom should be worn inside a rubber condom.

Shoes

Shoes can produce a most uncomfortable dermatitis on the feet, which is often wrongly diagnosed as tinea. It is usually either the glue or the rubber which causes this problem. If the allergy is to glue, custom-made shoes in which the shoe leather is stitched to the soles are necessary.

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TYPES OF SURGERY FOR TREATMENT OF RHEUMATOID ARTHRITIS: ARTHROSCOPIC SURGERY AND SYNOVECTOMY

admin — Mon, 28 Mar 2011 09:18:51 +0000

Arthroscopic Surgery

By inserting a pencil-sized telescope called an arthroscope through a small incision in the skin, a surgeon or rheumatologist is able to look inside the joint without putting the patient through major surgery. Being able to see the inside joint structures helps the surgeon determine what conditions are creating problems. And, at the same time the surgeon is examining the inside of the joint, he or she can take a biopsy of tissue within the joint to confirm a diagnosis or perform simple corrective procedures such as removing damaged cartilage.

More extensive surgical procedures such as ligament and tendon repairs can also be performed through an arthroscope. Arthroscopic synovectomy, in which inflamed synovial lining is removed, is another common procedure.

Synovectomy

Synovectomy is the name of the procedure in which destructive synovitis is removed. This inflamed joint lining (synovium) is removed surgically to prevent it from damaging cartilage and other joint structures. Although very effective in reducing joint pain and swelling, synovectomy should not be viewed as providing a permanent cure because the synovium can grow back, and complete removal of all synovial tissue is not possible.

As discussed above, synovectomy can be performed through an arthroscope. This approach has an advantage over open surgical synovectomy in that it avoids cutting and opening the joint capsule surgically. For this reason, recovery from arthroscopic synovectomy is generally quite rapid.

Although it is more invasive, an open surgical synovectomy also has certain advantages. It provides the surgeon a better view of, and improved access into, the total joint, thereby facilitating thorough removal of the inflamed synovial tissue.

On the horizon are other forms of synovectomy which may be available. One is a form of laser synovectomy which is presently being developed. Using the arthroscope, the surgeon vaporizes the inflamed synovium with the laser. Care must be taken not to injure ligaments or underlying cartilage.

The second measure is radiation synovectomy. This form of therapy has been used extensively in Europe and in a few academic centers in the United States. The procedure consists of injecting a radioactive substance directly into the joint to eliminate synovitis. It has not been widely accepted in this country because of concerns about radioactive leakage from the joint. New forms of joint injection therapy are being developed, though, as researchers are trying to design a chemical that will react exclusively with rheumatoid synovium. This form of chemical synovectomy may be extremely effective if a chemical can be formulated to seek out and destroy only the destructive tissues while preserving the healthy and important ones.

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TYPES OF SURGERY FOR TREATMENT OF RHEUMATOID ARTHRITIS: ARTHROSCOPIC SURGERY AND SYNOVECTOMYArthroscopic SurgeryBy inserting a pencil-sized telescope called an arthroscope through a small incision in the skin, a surgeon or rheumatologist is able to look inside the joint without putting the patient through major surgery. Being able to see the inside joint structures helps the surgeon determine what conditions are creating problems. And, at the same time the surgeon is examining the inside of the joint, he or she can take a biopsy of tissue within the joint to confirm a diagnosis or perform simple corrective procedures such as removing damaged cartilage.More extensive surgical procedures such as ligament and tendon repairs can also be performed through an arthroscope. Arthroscopic synovectomy, in which inflamed synovial lining is removed, is another common procedure.
SynovectomySynovectomy is the name of the procedure in which destructive synovitis is removed. This inflamed joint lining (synovium) is removed surgically to prevent it from damaging cartilage and other joint structures. Although very effective in reducing joint pain and swelling, synovectomy should not be viewed as providing a permanent cure because the synovium can grow back, and complete removal of all synovial tissue is not possible.As discussed above, synovectomy can be performed through an arthroscope. This approach has an advantage over open surgical synovectomy in that it avoids cutting and opening the joint capsule surgically. For this reason, recovery from arthroscopic synovectomy is generally quite rapid.Although it is more invasive, an open surgical synovectomy also has certain advantages. It provides the surgeon a better view of, and improved access into, the total joint, thereby facilitating thorough removal of the inflamed synovial tissue.On the horizon are other forms of synovectomy which may be available. One is a form of laser synovectomy which is presently being developed. Using the arthroscope, the surgeon vaporizes the inflamed synovium with the laser. Care must be taken not to injure ligaments or underlying cartilage.The second measure is radiation synovectomy. This form of therapy has been used extensively in Europe and in a few academic centers in the United States. The procedure consists of injecting a radioactive substance directly into the joint to eliminate synovitis. It has not been widely accepted in this country because of concerns about radioactive leakage from the joint. New forms of joint injection therapy are being developed, though, as researchers are trying to design a chemical that will react exclusively with rheumatoid synovium. This form of chemical synovectomy may be extremely effective if a chemical can be formulated to seek out and destroy only the destructive tissues while preserving the healthy and important ones.*112/209/5*