What Are The Causes Of Neuropathy?

Neuropathy is nerve damage.   It creates nerve pain.  When the nerve breaks down due to disease, chemical toxins, trauma, etc., the myelin sheath begins to break down.    This creates a short circuit similar to what happens when a wire loses its insulating cover.   The damage can continue and the symptoms of this damage will get worse. 

What causes it?  Here is a list of causes………………

Alcoholism – Thiamine (B1) deficiency, in particular, is common among people with alcoholism because they often also have poor dietary habits. Thiamine deficiency can cause a painful neuropathy of the extremities. Some researchers believe that excessive alcohol consumption may, in itself, contribute directly to nerve damage, a condition referred to as alcoholic neuropathy.

Amyloidosis (metabolic disorder) an disorder where a protein called amyloid is deposited in tissues and organs. Amyloidosis can affect peripheral sensory, motor or autonomic nerves and deposition of amyloid lead to degeneration and dysfunction in these nerves.

Anemia – See Vitamin Deficiencies. A diet that lacks iron, folic acid (folate), or vitamin B12 can prevent your body from making enough red blood cells. A deficiency of iron can effect nerve conduction. A lack of B12 damages the myelin sheath that surrounds and protect nerves. Without this protection, nerves cease to function properly and conditions such as peripheral neuropathy occur. Even B12 deficiency that is relatively mild may affect the nervous system and the proper functioning of the brain. The nerve damage caused by a lack of B12 may become permanently debilitating, if the underlying condition is not treated.

Autoimmune disorders: Viral and bacterial infections can also cause indirect nerve damage by provoking conditions referred to as autoimmune disorders, in which specialized cells and antibodies of the immune system attack the body’s own tissues. These attacks typically cause destruction of the nerve’s myelin sheath or axon (the long fiber that extends out from the main nerve cell body).

Bacterial Diseases – Lyme disease, diphtheria, and leprosy are bacterial diseases characterized by extensive peripheral nerve damage. Diphtheria and leprosy are now rare in the United States, but Lyme disease is on the rise. It can cause a wide range of neuropathic disorders, including a rapidly developing, painful polyneuropathy, often within a few weeks after initial infection by a tick bite. See autoimmune responses.

Bariatric Surgery – postoperative nerve damage also known as peripheral neuropathy (PN)   Nutritional deficiencies can occur following this procedure due to patients experiencing more weight loss than expected and post operative complications.

Bell’s Palsy – Bell’s palsy results from upper respiratory infections, viral infections such as those caused by infectious mononucleosis, herpes, mumps, HIV viruses, and bacterial infections such as Lyme Disease. Facial weakness from Bell’s palsy is due to the facial nerve which is a nerve that controls the muscles on the side of the face and it a form of peripheral neuropathy.

Cancer – a tumor can press on a nerve or entrap a nerve and cause damage.  See Compression neuropathy

Cancer treatments See Chemotherapy treatments and Radiation Therapy below.

Carpal tunnel syndrome – Carpus comes from the Greek word for wrist. The wrist is surrounded by a band of fibrous tissue that normally functions as a support for the joint. The tight space between this fibrous band and the wrist bone is called the carpal tunnel. The median nerve passes through the carpal tunnel to receive sensations from the thumb, index, and middle fingers of the hand. Any condition that causes swelling or a change in position of the tissue within the carpal tunnel can squeeze and irritate the median nerve. Irritation of the median nerve in this manner causes tingling and numbness of the thumb, index, and the middle fingers, a condition known as “carpal tunnel syndrome.” Thus, it can cause nerve damage.

Charcot Marie-Tooth disease – See Inherited neuropathy

Chemotherapy Treatment – Chemotherapy drugs are poisons that attack fast growing cells (rapidly dividing cells).  The theory behind using these toxins is that it will destroy the fast growing cancer cells before it does much damage to normal cells.  Chemotherapy is hardest on the nervous system due to the fact that nerve cells are more sensitive than other cells.

Chronic kidney failure – Chronic kidney or renal failure (uremia) occurs when the kidneys gradually fail to function properly. When the kidneys are impaired, fluids and waste products accumulate in the body. In some cases, kidney failure can cause peripheral neuropathy. Many conditions can cause kidney failure; the most common are diabetes and high blood pressure.

Compression neuropathy – pressure on an area. It is an inability to transmit nerve impulses because compression has damaged nerve fibers either directly, or indirectly by restricting their supply of oxygen. Compression can come from herniated discs in the spine, osteoarthritis can cause bone spurs that can compress a nerve, severe muscle injuries can compress nerves, and even prolonged use of tight clothing such as shoes. It all depends on the nerve compressed.

Connective tissue disease (e.g., rheumatoid arthritis, lupus, sarcoidosis) Connective tissue disorders and chronic inflammation can cause direct and indirect nerve damage. When the multiple layers of protective tissue surrounding nerves become inflamed, the inflammation can spread directly into nerve fibers. Chronic inflammation also leads to the progressive destruction of connective tissue, making nerve fibers more vulnerable to compression injuries and infections. Joints can become inflamed and swollen and entrap nerves, causing pain.

Diabetes mellitus – the higher than normal sugar levels create nerve damage. Chronic neuropathy can start when the nerves are deprived of oxygen or anoxia.

Diphtheria – See Bacterial Diseases

Drugs – Certain anticancer drugs, anticonvulsants, antiviral agents, and antibiotics have side effects that can include peripheral nerve damage, thus limiting their long-term use. Metformin is a drug associated with B12 deficiency and thus nerve damage.   To check on any medications and if they cause nerve damage, go to drugs.com or rxlist.com   Note: neuropathy can be defined as nerve pain, parenthesia, tingling and numbness..etc. 

Epstein-Barr virus – See Infections

Foods that are toxic – Some foods and food additives have a direct toxic effect on the gastrointestinal tract. Food allergies and intolerance can create nerve pain – neuropathy. MSG is known to cause nerve damage.

Herniated disc – most compressed nerves will cause inflammation but will get better. This is more likely to cause problems when the nerve is squashed between the disc and an adjacent bone.

Herpes – see Infections

HIV/AIDS – The human immunodeficiency virus (HIV), which causes AIDS, also causes extensive damage to the central and peripheral nervous systems. The virus can cause several different forms of neuropathy, each strongly associated with a specific stage of active immunodeficiency disease. A rapidly progressive, painful polyneuropathy affecting the feet and hands is often the first clinically apparent sign of HIV infection.

Hormonal imbalances – can disturb normal metabolic processes and cause neuropathies. For example, an underproduction of thyroid hormones slows metabolism, leading to fluid retention and swollen tissues that can exert pressure on peripheral nerves. Overproduction of growth hormone can lead to acromegaly, a condition characterized by the abnormal enlargement of many parts of the skeleton, including the joints. Nerves running through these affected joints often become entrapped.

Idiopathic – when doctors cannot find a specific cause

Immune System – See Inflammation

Inflammation – Chronic inflammation also leads to the progressive destruction of connective tissue, making nerve fibers more vulnerable to compression injuries and infections. Joints can become inflamed and swollen and entrap nerves, causing pain.

Some neuropathies are caused by inflammation resulting from immune system activities rather than from direct damage by infectious organisms. Inflammatory neuropathies can develop quickly or slowly, and chronic forms can exhibit a pattern of alternating remission and relapse. Acute inflammatory demyelinating neuropathy, better known as Guillain-Barré syndrome, can damage motor, sensory, and autonomic nerve fibers. Most people recover from this syndrome although severe cases can be life threatening. Chronic inflammatory demyelinating polyneuropathy (CIDP), generally less dangerous, usually damages sensory and motor nerves, leaving autonomic nerves intact. Multifocal motor neuropathy is a form of inflammatory neuropathy that affects motor nerves exclusively; it may be chronic or acute.

Infectious disease (e.g., Lyme disease, HIV/AIDS, hepatitis B, leprosy)  Infections and autoimmune disorders can cause peripheral neuropathy. Viruses and bacteria that can attack nerve tissues include herpes varicella-zoster (shingles), Epstein-Barr virus, cytomegalovirus, and herpes simplex-members of the large family of human herpes viruses. These viruses severely damage sensory nerves, causing attacks of sharp, lightning-like pain. Postherpetic neuralgia often occurs after an attack of shingles and can be particularly painful.

Inherited forms of peripheral neuropathy are caused by inborn mistakes in the genetic code or by new genetic mutations. Some genetic errors lead to mild neuropathies with symptoms that begin in early adulthood and result in little, if any, significant impairment. More severe hereditary neuropathies often appear in infancy or childhood.

The most common inherited neuropathies are a group of disorders collectively referred to as Charcot-Marie-Tooth disease. These neuropathies result from flaws in genes responsible for manufacturing neurons or the myelin sheath. Hallmarks of typical Charcot-Marie-Tooth disease include extreme weakening and wasting of muscles in the lower legs and feet, gait abnormalities, loss of tendon reflexes, and numbness in the lower limbs.

The sad fact is that after a while this misfiring of the nerves can get so bad that people are unable to walk or pick things up and can get to a point where they would rather have a limb amputated then continue with this nerve pain.

Kidney Disease – can lead to abnormally high amounts of toxic substances in the blood that can severely damage nerve tissue. A majority of patients who require dialysis because of kidney failure develop polyneuropathy. Some liver diseases also lead to neuropathies as a result of chemical imbalances.

Leprosy – In all patients with leprosy, the nerve tissue is involved. The dermal nerves are infected in all skin lesions.

Liver failure –  liver disease may be associated with sensory-motor demyelinating polyneuropathy

Lupus, See Connective Tissue Diseases

Lyme Disease – See Bacterial Infection

Many Medications (such as Lyrica, Cymbalta, Duloxetine hydrochloride, Pregabalin, and more have neuropathy as a side effect, if may be listed under paresthenia, or tingling and numbness.  .

Metabolic Disorders – caused by a disruption of the chemical processes in the body. In some cases, nerve damage is caused by the inability to properly use energy in the body. In other cases, dangerous substances (toxins) build up in the body and damage nerves. Some metabolic disorders are pass down through families (inherited), while others are develop due to various diseases.

Multiple Sclerosis – During periods of multiple sclerosis activity, white blood cells are drawn to regions of the white matter. These initiate and take part in what is known as the inflammatory response.  The resulting inflammation is similar to what happens in your skin when you get a pimple.  During the inflammation, the myelin gets stripped from the axons in a process known as demyelination.

Nutritional Deficiencies – see vitamin deficiencies

Pressure on a nerve – see compression neuropathy

Radiation Treatment – effects may be delayed for many years, the radiation can injury the nerves.

Radiculopathy is a condition due to a compressed nerve in the spine that can cause pain.  See compression neuropathy

Repetitive stress – frequently leads to entrapment neuropathies, a special category of compression injury.  Cumulative damage can result from repetitive, forceful, awkward activities that require flexing of any group of joints for prolonged periods. The resulting irritation may cause ligaments, tendons, and muscles to become inflamed and swollen, constricting the narrow passageways through which some nerves pass.

Rheumatoid Athritis – See Connective Tissue Disease

Sarcoidosis – See Connective tissue diseases

Shingles – See Infections Disease

Statin Drugs – designed to block cholesterol, the cells need cholesterol to build the myelin sheath, this can cause the nerve damage.

Swollen blood vessels – see compression neuropathy

Surgeries that damage a nerve

Systemic Diseases – disorders that affect the entire body —often cause peripheral neuropathy. These disorders may include: Metabolic and endocrine disorders. Nerve tissues are highly vulnerable to damage from diseases that impair the body’s ability to transform nutrients into energy, process waste products, or manufacture the substances that make up living tissue. Diabetes mellitus, characterized by chronically high blood glucose levels, is a leading cause of peripheral neuropathy in the United States. About 60 percent to 70 percent of people with diabetes have mild to severe forms of nervous system damage.

Toxins – can cause peripheral nerve damage. People who are exposed to heavy metals (arsenic, lead, mercury, thallium), industrial drugs, or environmental toxins frequently develop neuropathy.

Trauma – Physical Injuries – is the most common cause of injury to a nerve. Injury or sudden trauma, such as from automobile accidents, falls, and sports-related activities, can cause nerves to be partially or completely severed, crushed, compressed, or stretched, sometimes so forcefully that they are partially or completely detached from the spinal cord. Broken or dislocated bones can exert damaging pressure on neighboring nerves, and slipped disks between vertebrae can compress nerve fibers where they emerge from the spinal cord.

Tumors causing pressure on a nerve – Cancers and benign tumors can infiltrate or exert damaging pressure on nerve fibers. Tumors also can arise directly from nerve tissue cells.  See compression neuropathy.

Vascular damage and blood diseases can decrease oxygen supply to the peripheral nerves and quickly lead to serious damage to or death of nerve tissues, much as a sudden lack of oxygen to the brain can cause a stroke. Diabetes frequently leads to blood vessel constriction. Various forms of vasculitis (blood vessel inflammation) frequently cause vessel walls to harden, thicken, and develop scar tissue, decreasing their diameter and impeding blood flow. This category of nerve damage, in which isolated nerves in different areas are damaged, is called mononeuropathy multiplex or multifocal mononeuropathy.

Viral Infection – See Infections above.

Viral and bacterial infections can also cause indirect nerve damage by provoking conditions referred to as autoimmune disorders, in which specialized cells and antibodies of the immune system attack the body’s own tissues. These attacks typically cause destruction of the nerve’s myelin sheath or axon (the long fiber that extends out from the main nerve cell body).

Vitamin deficiencies (e.g., pernicious anemia, etc.) can cause widespread damage to nerve tissue. Vitamins E, B1, B6, B12, and niacin are essential to healthy nerve function. See also alcoholic neuropathy. A lack of B12 damages the myelin sheath that surrounds and protect nerves. Without this protection, nerves cease to function properly and conditions such as peripheral neuropathy occur. Even B12 deficiency that is relatively mild may affect the nervous system and the proper functioning of the brain. The nerve damage caused by a lack of B12 may become permanently debilitating, if the underlying condition is not treated.

Zinc induced copper deficiency (denture adhesive creams)  These adhesive creams have a large amount of zinc in them which can induce a copper deficiency and then nerve damage.   See vitamin deficiencies.

Can Diabetes Trigger Mood Swings?

People who suffer from diabetes have many challenges to deal with. Diabetes is disease that influences not only the sufferer but also those around him, as well as his relatives and friends

It is an autoimmune disease that spoils insulin-producing cells and can affect everyone not considering gender or age.  But is there any relation between diabetes and mood swings?  And how can this be controlled?

Knowing diabetes and your emotions

Diabetes is characterized by the body’s inability to produce insulin.  Insulin is a substance that occur naturally in the body. It regulates the absorption of sugar by the cells.  If the body does not obtain sufficient supply of insulin, sugar that is exist in the system is collected in the urine and the blood. This then leads to abnormal thirst, hunger and frequent urination.  The problem here is that these reactions of the body have effect on normal cellular functions.

Someone who has diabetes will frequently experience frequent  and strong mood swings.They could, for instance, lose their temper, lash out, become introverted or express  positive emotions in a very unusual and chaotic manner.  Outbursts among people who have diabetes can also become fairly common.

The problem here is that they may not even be aware of these outbursts and may in fact even have no memory of it.  When confronted, they could even react with anxiety or guilt. Occasionally, emotions can be expressed as melancholy, wherein the person suffering from diabetes shows extreme sadness.  This indicate strong emotions can be very unpredictable, something that can often surprise and offend family members and close associates.

Mood swings and diabetic men

Based on research in 2006 indicated that other than diabetes-associated disorders such as impotence, men also have to contend with mood swings.  This is particularly true as the man advances in age, when his levels of testosterone begin to decline.  Combined with the rise and fall of blood sugar levels associated in Type 2 diabetes, it would not be uncommon for the person to experience fluctuations in moods as well.

Other than that, there is also a propensity for men and women alike to feel anxiety, anger, remorse and guilt as a effect of their condition.  This is particularly true if the type of diabetes they have is adult-onset, one that could have been prevented by changes in their lifestyle.

Mood swings in people who suffer from diabetes are also influenced by other factors. Knowing that the disease is something they will have to deal with for the rest of their lives can dampen their spirits, causing them to feel apprehension and depression.

Managing mood swings associated to diabetes

It’s a must for diabetics to regularly test their blood sugar levels.  The results often hold the first clue as to what may be causing their mood swings.  Changes in the diet, along with the proper medications must be maintained to ensure that the person’s health is at its optimum and that any instability in his temperament are controlled.  Getting education about the disease is also important so he or she will really understand what to anticipate and what to act.

It might be difficult to cure diabetes but mood swings linked with it don’t have to be difficult to control. With the right care, control of sugar intake, diet, exercise and medication, people who suffer from diabetes can still live a normal, happy life and get success in his career.

Dog Rat Poison Symptoms, Treatment and Prevention

Rat poison is a rodenticide that contains dangerous toxin chemical name bromethalin or warfarin which can cause illness symptoms such as hemorrhaging and internal bleeding inside important organs of dog body.

Dog eating poison is a very common case because these dangerous chemical are often left around the areas where dogs can get it easily.

Dogs can also get poisoned if they eat rats that has bromethalin inside the body and this case is called secondary poisoning in dog.

Dog rat poison symptoms

hemorrhaging
internal bleeding
muscle tremors
seizures
impaired movement
loss of appetite (anorexia)
paralysis of the hind limbs
depression

If a dog has ingested extremely high dose then rat poison can cause sa sudden onset of muscle tremors and seizures.

These signs and symptoms mentioned above are usually develop within 2 to 7 days after rat poison ingestion but there are some case that illness signs developed after 2 weeks if the ingested poison is mild.

Rat poison diagnosis

The test that veterinarian often use for analysis are urine test, magnetic resonance imaging (MRI) to scan the brain, computed tomography (CT) scan for viewing the excess fluid inside the brain (cerebral edema).

Rat poison treatmentIf you dog is not feeling well and you suspect that your dog has eaten rat poison the try to induce vomiting by using hydrogen peroxide given to the mouth.

Induce vomiting should be done every 4 to 8 hours for at least 2 to 3 days after the ingestion but it is always better to take your dog to your local veterinarian to get the right and effective treatments.

Since eating rat poison can causes dogs to have symptom such as loss of appetite so supplement food is need during the initial period of rat poison treatment.

It may take up to 1 month to recover from mild poisoning and must be monitored frequently to avoid further damage that can be done to your dog.

Rat poison prevention

Keep all the objects that contain bromethalin out of reach from your dog. In case you use rodent poisons to kill rat in your house then you should stay alert for mouse corpse to avoid secondary poisoning.

Causes of Epilepsy, Symptoms and Treatment

Epilepsy is a condition in which people have epileptic attacks (also known as seizures). It is one of the more common neurological conditions, affecting 0.5-1 per cent of the population. Epilepsy is not a single condition, but a group of conditions with differing causes, treatments and prognoses Epilepsy is not a single medical condition in itself. It is a symptom of a range of other conditions that cause somebody to have repeated fits, which are also known as seizures.

Symptoms

There are many signs and symptoms of epilepsy. In many cases, the symptoms are unnoticeable. The most common symptom is a seizure. Seizures are classified as grand mal or petit mal. Grand mal seizures may consist of rapid pulse, whole body spasms, jerking muscles, biting of the tongue, bladder and bowel incontinence, and dilated pupils. Petit mal seizures are less severe and typically include temporary lack of awareness. Sufferers may appear to have a blank expression on their face, or temporarily “space out.” Once the seizure concludes, the sufferer is usually unaware of their previous condition. For this reason, petit mal seizures can often overlooked.

Causes

Causes of seizures (and sometimes epilepsy) are further divided into acute and remote causes. This subclassification depends on whether there is active brain disease (an acute cause) or whether the brain abnormality is the result of an injury caused by a previous event (in which case it would be called remote). For example, if a child with meningitis experiences seizures during the illness, they would be termed acute symptomatic seizures. If that same child developed seizures that persisted for years afterwards, she would be diagnosed as having remote symptomatic epilepsy

Epilepsy stems from dozens of causes: genetics, heredity, brain tumours, viral infections, head trauma from accidents or falls, alchoholism, Alzheimer’s disease, trauma during birth, strokes, heart attacks, high blood pressure, AIDS, poison or environmental conditions, nicotine from cigarette smoke, overmedicating from certain types of drugs, hormonal changes and even lack of sleep. Epilepsy is also associated with other disorders like autism, TB, and cerebral palsy. This is one reason why the disease is often difficult to diagnose, and why, for some, it remains such a confusing disease.

Treatment

Many people have their seizures successfully controlled with anti-epileptic drugs (AEDs). This is the most common way that epilepsy is treated. AEDs do not cure epilepsy. At the moment there is no cure for epilepsy. The aim of AEDs is to prevent seizures by controlling the excitability of the brain. How they do this is not totally understood. Despite this, their effectiveness in treating epilepsy has been scientifically proven.

Vagus nerve stimulation

Vagus nerve stimulation (VNS) can reduce seizures in some people. This is when an electrical device, implanted in the chest, regularly stimulates a nerve in your neck called the vagus nerve. The vagus nerve then sends signals to areas of the brain. This treatment is only available if other medicines haven’t helped and neurosurgery (brain surgery) isn’t possible.

Surgery

You may be offered neurosurgery if your epilepsy is severe and is not controlled after trying several different epilepsy medicines. This can only take place if the epilepsy is associated with a specific area of your brain. Your specialist will be able to explain your options to you.

KILLER CORSETS

KILLER CORSETS: DEATH TO DRAG QUEENS

By Madeline Rose

Two actresses of the American stage, circa 1900, were Anna Held and Lillian Russell. These two were heralded as beautiful women, and indeed they were. They wore the most fashionable gowns of the era, keeping their hour-glass figures perfect with tight whale-bone corsets.

Rumor had it, that Held and Russell often went to their corset makers, accompanied by their friend Julian Eltinge, who advertised corsets which he used in his female impersonation act.

One advertisement showing Eltinge as a beautiful bride inquired,” If a Nemo corset will produce this perfection of figure for a fully proportioned man, such as Mr. Julian Eltinge with a waist of thirty-eight inches – an no natural lines of womanly grace – what will it do for your figure, Madame, who have all the graceful womanly lines to assist? We are headquarters for Nemo Self-Reducing Corsets – complete lines of all new models, O’Connor, Moffat & Company.”

The advertisement for corsets, along with other products such as Eltinge’s cold cream, were serious attempts to commercially exploit Eltinge’s popularity. Such beauties as Anna Held and Lillian Russell were always beautiful women, so their secret beauty tips probably would not help the average woman. However, Eltinge could work wonders with his beauty secrets.

Although his carriage received great assistance and support from a taut-laced corset, while in drag, Eltinge was not immune to the same health problems women suffered from wearing corsets. While appearing at the Majestic Theatre in Chicago in February 1921, Eltinge informed the audience that “Old Ironsides”, the nickname he gave to his corsets, were hurting him.

The corset forced the wearer’s bones and organs to contort, squeezing blood vessels and causing pain and health problems. Many people, men and women, died from wearing such devices. In 1898, fifty-three year old Bernhard Rank died from wearing corsets. Rank was a 250-lb specialist in German-speaking dame roles. It was reported his death from apoplexy, a sudden hemorrhage of a blood vessel or organ rupture, was caused by his corsets.

Tight lacing also resulted in the death of Joseph Hennella, a female impersonator. He collapsed on the stage of a South Side Vaudeville theatre in St Louis on November 4, 1912. In order to add to his feminine illusion, he wore a corset tightly laced giving the effect of a small waist.

Hennella fell unconscious on the stage during his act, dying three hours later. The attending doctors stated the tight corset caused a kidney trouble and induced apoplexy. Hennella was of medium height and stout. At the time of his death, he was forty years old. When he was younger, it was easier for him to appear feminine, but with an increasing girth, that became more difficult. Usually, he made several changes of costume in his drag act, and the constriction caused by the corset rendered this a fatiguing and laborious process.

Julian Eltinge also changed his costume several times during his act, keeping on his corset whether in drag or dressed as a man. He would wear out a corset per show and would use a new one for each show, if not for every other performance. Anguished with back and kidney problems later in life, Eltinge died in 1941. Official cause of his death was cerebral hemorrhage at the age of 57. However, because of his numerous health problems and the lack of drag work and loss of three fortunes, tabloids suggested the cause of death as suicide from an overdose of sleeping pills.

http://www.lulu.com/content/paperback-book/julian-eltinge-a-drag-fashion-show/7502705

Stroke– Causes, Symptoms, the Risk Factors, Types, Prevention and Treatment

Besides cancer and heart diseases, stroke is the third leading cause of death. Approximate 1/4 of all stroke victims die as a direct result of the stroke or it’s complications. Stroke is caused by uncontrolled diet that is high in saturated and trans fats resulting in cholesterol build up in the arteries and high blood pressure. In other words, if cholesterol building up in the arteries is blocking the circulation of blood in any part of the body causing oxygen not to be delivered to the brain, resulting in some cells in the brain to die off and are unable reproduce, then we have stroke. Other strokes happen when a blood vessel in the brain ruptures causing the cells in your brain to be deprived of oxygen in your blood, they die and never come back.

I. Causes of Stroke
There are similar causes of stroke and heart diseases, but in stroke the result is more severe. Any delay of rescuing will result in death of the victim. Here are some causes of stroke:

1. Unhealthy diet
A diet high in saturated and trans fats causes bad cholesterol to build up in your blood vessels in the brain, blocking oxygen needed for the cells thus increasing the risk of stroke. Also unhealthy diet causes high blood pressure making your heart work harder to pump blood to your body in result of heart diseases. High blood pressure also causes the blood vessels in your brain to harden and thin, increasing the risk of stroke.

2. Smoking
Smoking not only has a devastating effect on the health of the smoker but also to anyone that inhales its toxic fumes. Cigarettes contain high levels of cadmium that causes the blood to clot activity of cells in result of blocking blood flow and damaging the blood vessels in the brain.

3. Excessive drinking
Moderate drinking is good for your heart, but excessive drinking can raise levels of some fats in your blood causing cholesterol to build up in the arteries and blood vessels in the brain resulting in increase of the risk of stroke.

4. Diabetes
People with diabetes tend to develop heart disease or have strokes at an earlier age than other people. Diabetes with unhealthy diet causes high blood glucose levels that damage nerves and blood vessels, leading to complications such as heart disease and stroke, the leading causes of death among people with diabetes.

5. Obesity – a body mass index of 30 or higher
Study shows that even after adjusting for other stroke risk factors such as high blood pressure, diabetes, high cholesterol, smoking, cardiac diseases, moderate alcohol consumption, and physical activity; obesity is still associated with a greatest risk of stroke in men and women.

6. Use of birth control pills
Birth control pills contain estrogen and one of two other hormones, lynestrenol or norethisterone that increase the risk of blood clotting, which can lead to ischemic stroke especially in woman who smoke and who are older than 35.

There are many other causes of stroke such as heart diseases that we have discussed lengthily in the heart diseases articles.

II. Symptoms of Stroke
Here are some symptoms of strokes:

1. Sudden trouble in standing
Sudden trouble in standing is an early symptom of stroke as a result of circulation of blood that carries oxygen to suddenly deplete caused by narrowing of arteries and high blood pressure.

2. Dizziness and loss of balance
The brain coordinates information from the eyes, the inner ear, and the body’s sense to maintain balance. If the cells of that part of the brain get damaged in result of depleted oxygen will cause dizziness and loss of balance.

3. Sudden confusion
A sudden onset of confusion means that something is potentially going wrong with the brain. Almost all conditions that affect the brain are life-threatening. It might be caused by a tumor or low levels of oxygen in the cells of the cerebral cortex in your brain that affect your ability to think with your usual speed or clarity. It might also be caused by lowered blood sugar, as is the case of diabetes.

4. Having trouble speaking and understanding
Having trouble speaking and understanding occurs when the brain cells in the area of the broca, wernicke and angular ayrus in the left hemisphere area begin to die because they stop getting the oxygen and nutrients they need to function.

6. Sudden severe headaches
Headache is a condition of pain in the head, sometimes neck or upper back pain may also be interpreted as a headache. It ranks amongst the most common local pain complaints and may be frequent for many people but sudden severe headaches may be caused by an early symptom of heart disease as we mentioned in previous articles, by rupturing a brain vessel or depletion of oxygen in some parts of the brain.

7. Sudden trouble seeing
This may be an early indication of stroke when the oxygen in the blood supply to the part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into cells that control the vision area of the cerebral cortex in the brain.

III. The Risk Factors
1. Age
Human aging is the biological process that is unavoidable but controllable. Starting at age 40, the cells in our body begin this process causing the deterioration of some functions of our body. Most people of this age group already have some form of cholesterol building up in their arteries and high blood pressure resulting in an increased risk of stroke.

2. Heredity
People with a family history of stroke have a greater chance of stroke than those do not have such a family history.

3. Race
Because of frequent high blood pressure in African Americans, they have a significantly higher risk of stroke than their Caucasian counterparts.

4. High blood pressure
High blood pressure causes hardening and thinning of arterial walls and makes our heart work harder to pump blood throughout our body resulting in heart diseases as well as increasing the risk of stroke.

5. Smoking
Smokers may be exposed to toxic cadmium, causing high blood pressure and heart diseases as well as contributing to a higher risk of stroke.

6. Excessive alcohol consumption
Drinking one cup of wine for women and 2 cups of wine for men might help to increase the circulation of blood as well as providing more oxygen for cells. However, excessive drinking not only damages the normal function of liver but also raises high blood pressure, increasing the risk of stroke.

7. Diabetes
Diabetes with unhealthy diet causes high levels of glucose in the bloodstream. Diabetics have a greater risk of stroke, because high levels of glucose damage the arterial wall as well as clotting the arteries and blood vessels.

8. Gender
Males have a 20% greater risk of stroke than females.

IV. Types of Strokes
There are 2 types of strokes:

  1. Ischemic stroke caused by a clot or other blockage within an artery leading to the brain.
  2. Hemorrhagic stroke caused by the vessel in the brain rupturing in result of blood leaking into the brain.

1. Ischemic stroke
This is the most common type of stroke accounting for almost 80% of all strokes. The brain depends on its arteries to bring fresh blood from the heart and lungs. The blood carries oxygen and nutrients to the brain, and takes away carbon dioxide and cellular waste. If an artery is blocked then the brain cells may not receive enough oxygen. They then cannot make enough energy and will eventually stop working.
There are 2 types of Ischemic stroke

a)Thrombotic stroke.
If blood clots from the inside of the arteries of the brain, we have thrombic stroke.
Study shows that this type of stroke is responsible for almost 50% of all strokes. The most common problem is narrowing off the arteries in the neck or head. Thrombotic stroke are also sometimes referred to as large-artery strokes. The process leading to thrombotic stroke is complex and occurs over time. Thrombotic stroke might be caused by the arterial walls slowly thickening and hardening as a result of arteries being injured. Such injures signal the immune system to release white blood cells to the site causing stroke. Thrombotic stroke also occurs when the inner wall of arteries were injured in result of less nitric oxide being produced, causing the hardening of the arteries. If the blood clot then blocks the already narrowed artery and shuts off oxygen to part of the brain, we have a thrombotic stroke.

b) Embolic stroke
If blood clotted in other parts of the body’s arteries subsequently entering the brain, we have embolic stroke. In this case the clot was formed somewhere other than in the brain itself.
The clot then travels the bloodstream until they become lodged and can not travel any further. This naturally restricts the flow of blood to the brain and results in embolic stroke. An embolic stroke occurs when a blood clot or other particle forms in a blood vessel away from your brain. It is usually caused by a dislodged blood clot that has traveled through the blood vessels until it becomes wedged in an artery. It is also caused by irregular beating in the heart’s two upper chambers. This abnormal heart rhythm can lead to poor blood flow and the formation of a blood clot.

2. Hemorrhagic stroke
Hemorrhagic stroke occurs when a blood vessel bursts inside the brain, causing an increase of the fluid pressure on the brain and harms the brain by pressing it against the skull. Hemorrhagic stroke is associated with high blood pressure, which stresses the arterial walls until they break.
There are 2 types of hemorrhagic strokes:

a) Intracerebral hemorrhage:
Intracerebral hemorrhage is internal bleeding that can happen in any part of the brain. Blood may accumulate in the brain tissues itself, or in the space between the brain and the membranes covering it. Most commonly the problem arises in the small arterial inside the brain which have been diseased causing these tiny blood vessels to start to leak. Since the actual source of the bleeding is often small, it can take time for the blood to build up resulting in symptoms of an intracerebral hemorrhage and often increases over minutes or hours. People may not notice the problems associated with bleeding into the brain and ischemic strokes.

b) Subarachnoid hemorrhage
Hemorrhagic strokes that cause bleeding into the fluid filled spaces located deep in the brain are called subarachnoid hemorrhage. Subarachnoid hemorrhage may occur at any age but is most common from age 40 to 65. It is caused by the presence of blood within the subarachnoid space from some pathological processes a result of ruptured aneurysms and bleeding may stop spontaneously. Other causes include vascular malformation, tumors and infection.The most effective treatment is to proceed with microsurgical clipping of the lesion. This stroke causes paralysis of all limbs, unconsciousness and bleeding into the cerebellum produceing typical signs of in coordination with headache and stiffness of the neck.
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V. Prevention and Treatment
A. With Foods
1. Cold water fish
Cold water fish such as salmon and tuna contains high amounts of omega 3 and 6 fatty acids that can help to reduce the cholesterol clotting up in the arteries and blood vessels in the brain in result of lowering blood pressure and the risk of stroke.

2. Almonds
Almonds contain high amounts of vitamin E and other minerals that can help to reduce the levels of bad cholesterol and maintain healthy blood flow in the body.

3. Blueberries
Blueberries contain the highest antioxidant capacity because of their large anthocyanin concentration that helps to prevent heart disease and stroke by reducing the build up of bad cholesterol LDL.

4. Apples
Apples are loaded with brain-protecting quercetin. It also contains high amounts of antioxidants and chemicals that help to protect cells throughout the body, particularly the brain and the heart.

5. Apricots
Phytochemicals in apricots can help to protect the heart and eye as well prevent stroke. The beta carotene as we mentioned in a previous article can help to lower the level of bad cholesterol in the arteries, thus reducing the risk of heart diseases and stroke.

6. Carrot
(See Apricots)

7. Kiwi Fruit
Kiwi fruit contains high amounts of vitamin C, potassium, magnesium and antioxidants that are good for the heart and immune system as well as preventing stroke.

8. Rice bran
Rice bran contains high amounts of omega 3 and 6 fatty acids and nutritional dietary fiber that help to lower levels of cholesterol in the arteries and reduce the risk of stroke and heart diseases.

9. Oat bran
Oat bran is high in beta glucans that has proven effective in lowering the LDL as well as reducing the risk of stoke

B. With Nutritional Supplements
1. B-complex
Three B-vitamins: folate, B-6, and B-12 can lower homocysteine, an amino acid that is found naturally in the body and study shows that the higher the level of homocysteine in the blood, the higher the risk of stroke.

2. Beta-carotene
Beta-carotene is an antioxidant that may reduce oxidative stress to brain cells. Such stress occurs when highly volatile forms of oxygen damage cell structure. Study shows that beta- carotene helps to reduce the risk against cerebral infraction and stroke.

3. Vitamin E
Vitamin E is an antioxidant that helps to reduce arterial clotting.

4. Selenium
Selenium is a powerful agent that helps to keep tissues and arteries elastic. It also helps to reduce the stickiness of the blood and decreases the risk of clotting, in turn lowering the risk of heart attack and stroke. Selenium increases the ratio of HDL (good) cholesterol to LDL (bad) cholesterol.

5. Pycnogenol
Pycnogenol helps to keep collagen elastic and soften the blood platelets, making blood flow more efficiently.

6. Co enzyme Q-10
Co enzyme is a strong antioxidant that not only protects low density lipoprotein LDL against oxidants, but also helps for getting oxygen to the cells.

7. Lecithin
Lecithin is a fat-like substance called a phospholipid that helps to remove bad cholesterol and other lipids from the body. It also protects the arteries and organs from the build up of fatty tissue that can lead to stroke or heart attack.

8. Melatonin
Melatonin is a neurohormone produced in our body by the pineal gland. It is a powerful antioxidant that easily penetrates the blood-brain barrier and is used to treat thrombotic stroke.

9. Vitamin C
Vitamin C helps to strengthen the arterial wall, lowering the risk of heart diseases and stroke.

C. With Herbs
1.Ginkgo biloba
The herb is extracted from the leaves of the ginkgo biloba tree and was first used medicinally in China more than 4,000 years ago. Ginkgo biloba has the ability to increase the oxygen content to the brain and other bodily tissues, improving circulation of blood and improving cerebral tolerance to hypoxia. Study shows that taking Ginkgo and other blood thinner medications together may increase the risk of heart diseases and stroke. Be sure to consult with your doctor before taking ginkgo biloba.

2. Hawthorn
Hawthorn contains cardiotonic amines, polyphenols, and is a source of Vitamins C, B, and many other nutrients that help in relaxing and dilating arteries, increasing the flow of blood and oxygen to and from the heart and maintaining healthy blood pressure resulting in lowered risk of stroke.

3. Garlic
Garlic contains high amounts of antioxidants and elements that help to improve blood circulation. It is dangerous to take garlic extract together with blood thinner medications as we mentioned in a previous article.

4. Cayenne
Cayenne contains an active ingredient called capsaicin that has the abilities to lower blood pressure and cholesterol levels as well as preventing heart diseases and stroke.

5. Blueberries
Blueberries are one of the richest food sources of natural antioxidants readily available, having more than twice the levels of other berries that helps to prevent heart disease, stroke and internal bleeding.

6. Pigweed
Pigweed is an excellent plant-source of calcium. It helps lower one-third of the risk of succumbing to heart attack. Personally, I believe these results also apply to ischemic strokes, because they are biologically so similar to heart attack.

7. Willow bark
Willow bark has been shown in several studies to reduce the risk of ischemic stroke by about 18 percent. Study shows that willow bark has the aspirin’s ability to prevent heart attacks, and also shows a slight increase in risk of hemorrhagic stroke from taking willow bark daily but the increase was small and not statistically significant.

8. Ginger
This is another herb proven to have anti-clotting abilities and has the same function as garlic.

D. With Chinese Acupuncture and Herbs
1. Acupuncture
Acupuncture is the most popular treatment modality for stroke patients in China, used effectively on 85% of the stroke patients there. The recently acceptance of acupuncture by western medical practitioners allows one more effective method in curing diseases especially stroke. Study shows that acupuncture helps to facilitate nerve regeneration, decrease blood viscosity, as well as helping surviving nerve cells find new pathways, effectively bypassing damaged parts of the brain resulting in decreased risk of stroke.

2. Ginkgo biloba (bai guo ye).
Ginkgo biloba improves mental functioning as well as preventing blood cells from forming blood clots in the brain. Study shows that ginkgo improves blood circulation and lowers plasma cholesterol concentrations that help to lower the risk of stroke.

3. Gastrodia
Gastrodia was listed in the ancient Shennong Bencao Jing (ca. 100 A.D.) and was later classified by Tao Hong as a superior herb, meaning that it could be taken for a long time to protect health and prolong life, as well as for treating illnesses. Gastrodia is used by Chinese herbalist in treating stroke and chronic weaknesses of Qi that eventually blocks the flow of blood to the brain.

4. Cinnamon bark
True Cinnamon is one form of the common spice. As we discussed before, cinnamon helps to lower blood sugar by mimicking insulin, activating insulin receptors and working with insulin in the cells to reduce blood sugar by up to 20%. Also cinnamon has some antioxidant benefits that helps to find new pathways for surviving nerve cells after stroke.

5. Angelica
Angelica can help to warm up the chest-yang to remove obstruction of blood flow in the heart vessels as well as brain vessels.

6. Dragon’s Blood
Dragon’s Blood is used for increased power, purification, protection, consecration, and the development of strong ritual energy. It also helps to relieve pain in the heart due to blood stagnation and stimulate blood circulation to the brain resulting in decreased risk of stroke.

There are many other Chinese herbs that can help to prevent and treat stroke such as ginger root, mantis egg case, and tortoise plastron. Please consult with your doctor before taking any Chinese herb because some of these herbs may have side effects.

E. With Common Sense Approaches

1. A healthy Diet
Uncontrolled diet that is high in saturated fat and trans fat results in cholesterol building up in the arteries and blood vessels obstructing the flow of blood and damaging brain cells because of lack of oxygen causing stroke. If we can consume less of processed foods, fatty animal meats and avoid artificial chemicals and consume more healthy vegetables and fruits, we can reduce the risk of stroke.

2. Put on a happy face
Study shows that people with depression have an increased risk of stroke. Experts also found that people with elevated levels of depression will increase the risk of stroke by 73%.

3. Exercise
Regular moderate exercise will help to improve circulation of blood flow and lessen the risk of stroke that is caused by clogged blood vessels by 30% because regular walking helps to lower high blood pressure and increase levels of HDL.

4. Quit Smoking
Cigarettes contain toxic chemicals cadmium together with heavy metals that cause blood clotting in the arteries resulting in increased high blood pressure and risk of heart diseases as well as stroke.

5. Reduce intake of alcohol
Excessive drinking increases high blood pressure, thus increasing the likelihood of stroke.

I hope this information will help. If you need more information of the above subject, please visit my home page at:
Kyle J. Norton
http://medicaladvisorjournals.blogspot.com/
http://strokeorbrianattacks.blogspot.com/
All rights reserved. Any reproducing of this article must have all the links intact

Schizophrenia and Related Psychoses

Schizophrenia and Related Psychoses

  

Schizophrenia:

Introduction:

Of all the psychiatric syndrome, schizophrenia is the most difficult to define and describe. Over the last 100 years widely divergent concepts have been held in different countries and by different psychiatrists.

Basic concepts are (over simplified)

Acute schizophrenia (Type 1):

Predominated by positive symptoms such as delusions, hallucinations and interference with thinking. Good prognosis

Chronic schizophrenia (Type II):

Negative symptoms: apathy, lack of drive (diminished volition), slowness and social withdrawal. Poor prognosis.

Recent studies proposed more complex delineations correlating to cerebral and psychological symptoms

  1. Reality disturbance: delusions and hallucinations, left medial temporal lobe and cingulated cortex. Disorder of self monitoring.
  1. Disorganization: Formal thought disorder, inappropriate affect, bizarre behaviour, anterior cingulated, right ventral frontal cortex, bilateral parietal regions. Disorder of selective attention (suppression).
  1. Psychomotor poverty: Flat affect, poverty of speech, decreased spontaneous movement, under activity of pre-frontal cortex. Disorder of word generation and planning (initiation)

Other aspect of the clinical syndrome:

  •  Depressive symptoms: may be part of the syndrome, post psychotic phase or side-effect of the antipsychotic.
  • Cognitive features: impairment in learning, memory and attention.
  • Neurological signs: so cold soft signs. Abnormality in sensory integration, coordination, and catatonic features.
  • Olfactory dysfunction: affecting the identification, sensitivity and memory for odours usually worse in the left nostril. Clinically may contribute to lack of social drive.
  • Water intoxication: in few chronic patient water intoxication characterized by polyuria and hyponatraemia. May indicate hypothalamic regulation abnormality esp. related to antidiuretic hormone.

Diagnosis:

ICD-10:

At least one clear symptom (similar to Schneider’s first rank symptoms i.e. break down of self boundary)

a. Thought echo, insertion, withdrawal, broadcast

b. Delusions of control (passivity), delusional perception

c. Voices discussing in the third person, running commentary, voices from some part of the body.

d. Other persistent delusions that are completely impossible

Or at lease 2 symptoms:

a. Persistent hallucinations ± delusions (e.g. persecutory, reference, religious etc).

b. Formal thought disorders (flight of ideas, perseveration, loosening of association, widening of concept)

c. Catatonic behaviour e.g. posturing, stupor

d. Negative symptoms

e. Change in overall quality of personal behaviour

Illness for 1 month (DSM-IV 6 months).

Sub types:

  • Paranoid: stable delusions and usually hallucinations
  • Hebephrenic: formal thought disorder, inappropriate affect, bizarre behaviour, fleeting delusions and hallucinations, severe illness.
  • Catatonic: motor symptoms predominate
  • Undifferentiated
  • Residual: chronic stage, predominantly negative symptoms
  • Simple: only negative symptoms
  • Post-schizophrenic depression
  • Other schizophrenia
  • Unspecified schizophrenia

 (In DSM-IV: Paranoid, Disorganised, Catatonic, Undifferentiated, Residual)

Differences between the ICD-10 and DSM-IV):

  • ICD-10 places greater weight on first rank symptoms
  • ICD 10 requires 1 month vs. 6 month in DSM-IV
  • ICD 10 has more additional sub-types
  • Disorganised in DSM-IV is called Hebephrenic in ICD-10.

Duration in DSM-IV:

1 day to 1 monthà Brief Psychotic Disorder

1 month to 6 monthsà Schizophreniform Disorder

More than 6 month à Schizophrenia

Differential Diagnoses

  • Organic syndromes “Organic Psychosis” ( as opposed to so called Functional psychosis such as schizophrenia)

e.g. TLE, carcinomas, CVA, AIDS, CJD, CO Poisoning, Fahr’s disease, Huntington’s, Syphilis, Wilson’s and many others.

(ALWAYS EXCLUDE ORGANICITY/MEDICAL CAUSES!!)

  • Drug induced psychosis
  • Mood disorders with Psychotic Features
  • Delusional Disorders
  • Personality Disorders

Epidemiology of Schizophrenia

Lifetime risk 1%

Incidence: 0.5 per 1000

Prevalence: 3 per 1000

Median age of onset: M=28 yr, Females 32 yr (but anywhere between 15 to 55)

Gender M=F (early is more common in males, late (Paraphrenia) is more common in Females)

Higher rate in urban than rural areas

Higher rate in immigrant

Aetiology

Very complex, controversial, however the whole range of  biological, psychological and social factors are important.

  • Genes: e.g. Neuregulin, Dysbindin
  • Environmental: Obstetric complications, maternal influenza, winter birth, early cannabis use, paternal age.
  • Social: Migration, urban birth and upbringing, recent life events
  • Structural :smaller brain size, reduced synaptic markers
  • Functional imaging: Hypofrontality
  • Neurophysiological: Abnormal eye tracking, Abnormal esenory evoked potential
  • Neurochemical: Dopamine, Glutamate
  • Psychological: cognitive impairment, personality factors, psychodynamic theories, family dynamic and communications

Main hypothesis are the Neurodevelopmental (The pathological changes are laid down early in life, presumably through genetic influences and then modified by maturational and environmental factors), aberrant connectivity, Stress-vulnerability.

Key aspect of the present consensus regarding the aetiology are summarised as follows:

The most important influence is genetic, with about 80% of the risk being hereditary. The mode of inheritance is complex and the genes, some of which have been recently identified, act as a risk factor, not determinant of illness. A number of environmental factors contribute too, many of which appear to act prenatally, and which interact with the genetic predisposition. Together these and subsequent risk factors lead to neurodevelopmental disturbance which either causes, or renders the individual vulnerable to,, the later emergence of symptoms, and which manifests itself premorbidly in a range of behavioural, intellectual and neuroanatomical features. In schizophrenia, the brain is slightly smaller than normal, and there are localized differences in its structure and function, leading to the view that the syndrome is a disorder of connectivity within and between brain regions. Acute psychosis is associated with excess dopamine, whereas the persistent cognitive impairment may result from deficient dopamine function in the prefrontal cortex, both maybe secondary to abnormality to the glutamate system.

Course and prognosis

Generally agreed that the outcome of schizophrenia is worse than that of most psychiatric disorders, however, prognosis may not be as bad as previously thought!

 After 13 years follow up:

  • 15-20% of first episodes will not recur
  • 50% are without psychotic symptoms
  • 50% are without negative symptoms
  • 55% show good social function.

Mortality and morbidity is much higher than normal population and suicide up to 10%.

Good prognostic Factors:

  • Sudden onset
  • Short episode
  • No previous psychiatric history
  • Prominent affective symptoms
  • Paranoid type
  • Older age of onset
  • Married
  • Good psychosexual adjustment
  • Good premorbid personality
  • Good work record
  • Good social relationships
  • Good compliance.
  • Normal brain morphology (e.g. normal ventricles)

 Factors’ acting after the illness has been established

  • Cultural background: incidence is similar in different countries but the course and outcome is different, studies suggest that patient in developing countries have favourable course compared to developed ones (after emission).
  • Life events (stress)
  • Social stimulation: under stimulation associated with worsening of the negative symptoms and over stimulation with worsening of the positive symptoms.
  • Social background and belief
  • Expressed Emotion (hostility, criticism, emotional over involvement) extremely important cause for relapse. Patient living in families with high level of E.E have 2 to 3 times increased risk of relapse.

Management and treatment:

History

MSE

Physical Examination

Investigation (physical and psychological)

Treatment:

  • v Pharmacological

Antipsychotic Medications:

1. Conventional antipsychotics:

Chlorpromazine, Thioridazine, Haloperidol (all act to reduce dopamine levels)

Side effects:

  •   EPSE (extrapyramidal side effects)

-Acute Dystonia: contraction of muscles to maximal limit, typically sternocleidomastoid and tongue, although can be widespread (e.g. opisthoclonus); eye muscles involvement (oculogyric crises) may occur. Very distressing. Treatment with procyclidine i.v

-Parkinsonism: tremor, rigidity and bradykinesia occurring >1 week after admission. Consider dose reduction or procyclidine oral.

Akathisia: restlessness, usually of lower limbs, and drive to move. Occurs usually > 1 month after treatment. BDZ and propranolol used for treatment. Often goes undiagnosed. Associated with risk of violence and suicide.

Tardive dyskinesia: continuous slow writhing movements and sudden involuntary movements, typically of the oral region. Symptoms tend to be irreversible (the older the patient the more likely). Treatment is difficult, procyclidine worsen the condition or reduction of the antipsychotic can make it worse. Vit E may prevent deterioration.

  • Anticholinergic side-effects: Dry mouth, blurred vision, difficulty passing urine, urinary retention, constipation, glaucoma, confusion, cognitive impairment.
  • Antiadrenergic side-effect: Postural hypotension, tachycardia, sexual dysfunction.
  • Antihistaminic side-effect: Sedation, weight gain
  • Hyperprolactinemia.
  • Cardiovascular risk: prolongation of QTc interval, sudden death (Pimozide)
  •  Idiosyncratic: Cholestatic jaundice, altered glucose tolerance, hypersensitivity reaction, skin photosensitivity, yellow pigmentation of the skin, Neuroleptic Malignant Syndrome (rigidity, fluctuating consciousness, and pyrexia. May be fatal , requires ICU admission).

 2.Newer antipsychotic (so called atypical):

 e.g. Olanzapine, Quetiapine, Resperidone, Ziprasidone and many others.

 Safer than the ‘older generation’. Very expensive. Not devoted of serious side effect, depends on the agent. Recently linked to causing DM and hypercholesterolemia. In high doses (and some times within normal dose, could have similar side effect as typical antipsychotic). Other side effect depends on the drug e.g. Olanzapineà weight gain.

All antipsychotics (typical or atypical) have similar clinical effect. None is superior clinically. The exception is Clozapine (only agent licensed for resistant schizophrenia).

Need continuous blood monitoring, weekly for 18 w and then regularly (depends on which guidelines). Risk of agranulocytosis and neutropenia. 

  •  Psychosocial approach:

Effective psychosocial interventions include:

  • Family Therapy
  • Cognitive behavioural therapy
  • Social skills training
  • Social support
  • Illness management skills
  • Assertive community treatment.

Delusional Disorder:

The patient present with circumscribed symptoms of non-bizarre delusions, but with absence of prominent hallucinations and no thought disorder or mood disorder. Symptoms should have been present for at least 1 month in The DSM-IV and 3 months in The ICD-10.

Relatively uncommon (0.03% ), but account for up to 2% of hospital admission

Sub-types:

Erotomania (Delusion of Love/ de Clérambault Syndrome)

Patient present with the belief that some important person is secretly in love with them. Clinical samples are often females and forensic samples often males. Patient may make efforts to contact the person, and some cases are associated with dangerous or assaultive behaviour. Stalking.

Grandiose

Patient believes they fill some special role, have some special relationship, or possess some special ability. They may be involved with social or religious organisations.

Jealous (morbid jealousy/ Othello syndrome)

Patient possesses the fixed belief that their spouse or partner has been unfaithful. Often patient try to collect evidence or attempt to restrict their partner’s activities. This type of delusional disorder has been associated with forensic cases involving murder.

Persecutory

This is the most common type. Patient are convinced that others are attempting to do them harm. Often they obtain legal recourse, and they sometimes may resort to violence.

Somatic

Varying presentation, from those who have repeat contact with physicians requesting various forms of medical or surgical treatment to patients who are concerned with bodily infestation, or deformity (dysmorphophobia), or odour

Induced or shared delusional disorders (Folie a deux/ Communicated insanity)

A paranoid delusional system which appears to have developed in a person as a result of a close relationship with another person who already has an established delusions. Could be more than one person (e.g. a family, ‘cult’). 90% of cases are members of same family, dominant partner and isolated. F>M. usually separation improve the recipient but not the inducer. Subtypes:

  • Folie imposée: primary psychotic illness in one adopted by another
  • Folie simultanée: primary psychotic illness in both with identical delusions
  • Folie communiqué: primary psychotic illness in both at different times with delusions shared or passed on.
  • Folie induite: pre-existing primary psychosis in one patient, adopts fellow patient’s delusions.

Delusional misidentifications syndromes:

?Capgras delusions:

The patient believes others have been replaced by identical or near identical impostors. Can apply to animals and other objects, and often associated with aggressive behaviour

?Fregoli delusions:

Patient identifies a familiar person (usually his persecutor) in various other people he encounters (psychologically only).

?Intermetamorphosis syndrome:

The patient believes they can see others change into someone else (both external and internal appearance). Physically and psychologically  

?Subjective doubles delusions (Doppelganger):

The patient believes there is a double who exist and functions independently  

?Reversed subjective double syndrome:

The patient believes that they are an impostor in the process of being physically and psychologically replaced.

Autoscopic syndrome:

The patient sees a double of themselves projected onto other people or objects nearby

  

  

References:

1. Stevens L, Rodin I, Psychiatry: An illustrated colour text, Churchill Livingstone 2001

2. Steple D. Oxford Handbook of Psychiatry, Oxford University Press, 2006

3. World Health Organisation (WHO): ICD10 Classification of Mental and Behavioural Disorders (1992)

4. American Psychiatric Association. The Diagnostic and statistical Manual of Mental Disorders (DSM-IV).1994

  

  

  

  

  

  

  

Migraine – Causes, Symptoms and Treatment

Migraine is a neurological disease of which the most common symptom is an intense and disabling episodic headache. Migraine headaches are usually characterized by severe pain on one or both sides of the head. Absent serious head injuries, stroke, and tumors, the recurring severity of the pain indicates a vascular headache rather than a tension headache . More than 28 million Americans three times more women than men suffer from migraine headaches, a type of headache that’s often severe. In some cases, these painful headaches are preceded or accompanied by a sensory warning sign such as flashes of light, blind spots or tingling in your arm or leg. A migraine headache is also often accompanied by other signs and symptoms, such as nausea, vomiting, and extreme sensitivity to light and sound. Migraine pain can be excruciating and may incapacitate you for hours or even days. Fortunately, management of migraine headache pain has improved dramatically in the last decade. If you’ve seen a doctor in the past and had no success, it’s time to make another appointment. Although there’s still no cure, medications can help reduce the frequency of migraine headaches and stop the pain once it has started. The right medicines combined with self-help remedies and changes in lifestyle may make a tremendous difference for you.

A migraine headache is a throbbing or pulsating headache that is often one sided (unilateral) and associated with nausea; vomiting; sensitivity to light, sound, and smells; sleep disruption; and depression. Attacks are often recurrent and tend to become less severe as the migraine sufferer ages. Migraine headaches seem to be caused in part by changes in the level of a body chemical called serotonin. Serotonin plays many roles in the body, and it can have an effect on the blood vessels. When serotonin levels are high, blood vessels constrict (shrink). When serotonin levels fall, the blood vessels dilate (swell). This swelling can cause pain or other problems. Many things can affect the level of serotonin in your body, including your level of blood sugar, certain foods and changes in your estrogen level if you’re a woman.

Causes of Migraine

The cause of migraine is unknown. The condition may result from a series of reactions in the central nervous system caused by changes in the body or in the environment. There is often a family history of the disorder, suggesting that migraine sufferers may inherit sensitivity to triggers that produce inflammation in the blood vessels and nerves around the brain, causing pain. Many factors can trigger migraines, including tiredness, stress, dehydration, missed or delayed meals, and certain food and drinks, such as cheese, chocolate, coffee, tea and alcohol.

Symptoms of Migraine

1. Anxiety

2. Exposure to light

3. Sensitivity to light and sound

4. Lack of food or sleep

5. Nausea with or without vomiting

6. Stress

Treatment of Migraine

1. Try avoiding any food which seems implicated and at a later stage take a small trial dose of the food again to see whether it genuinely is involved.

2. Sometimes bathing your head in cold water or using a cold compress on the forehead is helpful.

3. At the first symptom of an attack take a pain killer eg aspirin or paracetamol, even if this means waking yourself up when you notice symptoms while half asleep in the early hours of the morning. (Often by getting up time it is too late to abort the attack.)

4. Sometimes relaxation and meditation techniques may be helpful as may some of the complementary therapies.

5. There are some over the counter preparations which contain a pain killer and a medication which stops nausea and vomiting (antiemetic). These are often even more effective than the pain killer alone, as migraine is associated with poor absorption from the stomach and a tendency for food and drink to stay in the stomach much longer than usual (prior to being sick).

Alopecia (baldness or Hair Loss)

What is Alopecia?

Alopecia (also known as baldness or hair loss) refers to loss or lack of hair on part of or the entire scalp and in some cases, other parts of the body. Hair loss can be temporary or permanent and can affect people of all ages. Although alopecia can occur anywhere on the body, it is most distressing when it affects the scalp. It can range from a small bare patch, which is easily masked by hairstyling to a more diffuse and obvious pattern [3, 4].

Causes of Alopecia
Causes of alopecia include,
1. Genetics
2. Prolonged fever
3. Hormonal changes, such as childbirth, use of birth control pills or thyroid disease
4. Treatment for cancer, such as chemotherapy
5. Continual hair pulling or scalp rubbing
6. Burns or radiation therapy
7. Emotional or physical stress
8. Ringworm of the scalp (Tinea capitas)
9. Some prescription medicine

(To mention a few)

Types of Alopecia
The different types of alopecia associated with loss of hair on the scalp include,
1. Androgenetic alopecia (Genetic hair loss)
Androgenetic alopecia, also known as male pattern hair loss is a major problem affecting men and is such that by the age of 50, up to 50% of men who are genetically predisposed will be affected. It is characterised by progressive, patterned hair loss from the scalp and its prerequisites are a genetic predisposition and sufficient circulating androgens (steroid hormone such as testosterone or androsterone, which promotes male characteristics). According to Sinclair (1998) every Caucasian male possesses the autosomal inherited predisposition, and as such, 96% lose hair to some degree. Sinclair also mentions that Caucasian men are four times more likely to develop premature balding than Black men. Hair loss does not usually start until after puberty with an extremely variable rate of progression [1, 5].

The condition is also fairly common in women and is referred to as female pattern hair loss. In women, “it is characterised by a diffuse reduction in hair density over the crown and frontal scalp with retention of the frontal hairline” [6]. Birch et al (2002) make mention of the fact that in some women, the hair loss may affect a small area of the frontal scalp whilst in others the entire scalp is involved. In advanced female pattern hair loss, the hair becomes very sparse over the top of the scalp bit a rim of hair is retained along the frontal margin. The vertex (crown or top of the head) balding seen in men is rare in women; however, a female pattern of balding is not uncommon in men [6]. The androgen-dependent nature or the genetic basis of female pattern hair loss has not been clearly established, although a study carried out by Sinclair et al (2005) showed that androgens play an important role in the development of female pattern hair loss.

2. Alopecia areata (AA)
Alopecia areata (AA) is a common, immune-mediated, nonscarring form of hair loss, which occurs in all ethnic groups, ages (more common in children and young adults), and both sexes, and affects approximately 1.7% of the population [8, 9]. Alopecia areata is unpredictable and patients usually present with several episodes of hair loss and regrowth during their lifetime. Recovery from hair loss may be complete, partial, or nonexistent. It is thought that 34 to 50% of patients with AA will recover within a year whilst 15 to 25% will progress to total loss of scalp hair or loss of the entire scalp and body hair where full recovery is unusual [8, 11]. It usually presents as a single oval patch or multiple confluent patches of asymptomatic (without obvious signs or symptoms of disease), well circumscribed alopecia with severity ranging from a small bare patch to loss of hair on the entire scalp. Frequent features of AA patches are exclamation mark hairs, which may be present at its margin; the exclamation mark hairs are broken, short hairs, which taper proximally. The hair loss from AA may be the only obvious clinical abnormality or there may be associated nail abnormalities. Other less common associated diseases include thyroid disease and vitiligo [4, 10, 11].

Clinical presentation of AA is subcategorised based on the pattern and extent of the hair loss. If categorised according to pattern, the following are seen;
a. patchy AA, which consists of round or oval patches of hair loss and is the most common,
b. reticular AA, which is a reticulated (networked) pattern of patchy hair loss,
c. ophiasis band-like AA, which is hair loss in parieto-temporo-occipital scalp (middle-side-back of scalp),
d. ophiasis inversus, which is a rare band-like pattern of hair loss in fronto-parieto-temporal scalp (front-middle-side of scalp), and
e. diffuse AA, which is a diffuse decrease in hair density.
[Taken from Shapiro J and Madani S, 1999]

If categorised according to the extent of involvement, the following are seen;
a. alopecia areata, which is the partial loss of scalp hair,
b. alopecia totalis, which is 100% loss of scalp hair, and
c. alopecia universalis, which is 100% loss of body hair.
[Taken from Shapiro J and Madani S, 1999]

3. Telogen Effluvium (TE)
Telogen effluvium is an abnormality of hair cycling, which results in excessive loss of telogen (resting phase of hair cycles) hairs and is most common in women. Women with this disorder would usually notice an increased amount of loose hairs on their hairbrush or shower floor. Daily loss of hair may range from 100 to 300 hairs. It is thought that TE may unmask previously unrecognised androgenetic alopecia. The most common underlying cause of TE is stress; other causes include certain diseases such as thyroid and pituitary diseases, some medication and child birth, to mention a few. In many cases however, no cause can be found. TE usually begins two to four months after the causative event and can last for several months [4, 12]. Unlike some other hair loss conditions, TE is temporary and hair regrowth is possible [4]. Telogen effluvium presents in about three forms;
a. Acute telogen effluvium, where shedding of hair is expected to cease within 3 to 6 month
b. Chronic diffuse telogen hair loss, which is telogen hair shedding persisting longer than 6 months. Common causes include thyroid disorders, acrodermatitis, profound iron deficiency anaemia, and malnutrition.
c. Chronic telogen effluvium (CTE) is the most common cause of hair loss in women, affecting 30% of females, between the ages of 30 and 60 years old, in the UK. CTE is such that there is a relative change in the proportion of growing to resting hair and in most cases, excessive shedding of hair has been present for at least 6 months. According to Rushton et al (2002) studies have shown that 95% of CTE cases arise from a nutritional imbalance involving the essential amino acid L-lysine and iron. Other common causes of CTE include drugs, thyroid disease and childbirth [1, 11].

4. Cicatricial alopecia (scarring alopecia)
Circatricial alopecia, also known as scarring alopecia, refers to a group of rare hair disorders resulting from a condition that damages the scalp and hair follicle. They present as areas of hair loss in which the underlying scalp is scarred, sclerosed, or atrophic. In other words, the disorders destroy the hair follicle and replace the follicles with a scar tissue consequently causing permanent hair loss. Conditions associated with circatricial alopecia include autoimmune diseases such as discoid lupus erythematosus, scalp trauma, infections such as tuberculosis and syphilis, and radiation therapy. Circatricial alopecia affects both adults and children, and may present as primary or secondary circatricial alopecia [4, 13].

5. Chemotherapy-related alopecia
Alopecia caused by chemotherapy may vary from slight thinning of the hair to complete baldness. The extent of alopecia depends on the choice of drugs and its dose. Drugs which cause severe alopecia include methotrexate, vinblastine, adriamycin, ifosphamide, vincristine, and taxoids to mention a few. When drugs are used in combination, which is usually the case with many treatment regimes, the incidence and severity of alopecia can be greater than usual. According to Randall et al (2005) “chemotherapy-related alopecia has been rated by patients as one of the most severe, troublesome and traumatic chemotherapy-related side effects”. Hair loss due to chemotherapy is not permanent and as such, the hair will grow back once treatment has ended [14].

6. Traumatic alopecia
This is usually a very common cause of hair loss in women of some ethnic backgrounds (particularly women of African/Caribbean descent). It is caused as a result of hair grooming techniques by the use of hair reshaping products such as relaxers, straighteners, hot combs, foam rollers and permanent wave products, as well as hair braiding methods. These techniques damage hair follicles over time [15]. Traumatic alopecia is divided into three categories;
a. Traction alopecia, which results from persistent pulling of the hair by tight rollers, tight braiding or ponytails. The use of blow-dryers, vigorous combing or brushing and bleaching of the hair can also contribute to hair breakage. Thinning begins above the ears and the forehand, and if the causative styling methods are not stopped, irreversible hair loss can result as the hair follicles are destroyed [15, 16].
b. Chemical alopecia, which results from the use of commercial relaxer and styling products. These products contain chemicals such as thioglycolates, which create curls or straighten the hair by destroying the disulphide bonds of keratin. Apart from curling or straightening the hair, these chemicals may have irritant effects on the scalp, which can result in hair shaft damage, inflammation of the scalp and loss of hair roots. All these can lead to irreversible damage of the hair follicles [15, 16].
c. Hot-comb alopecia, also known as follicular degeneration syndrome, results from the excessive use of pomades with a hot comb or iron, which leads to a gradual destruction of hair follicles. When pomade comes in contact with a hot comb or hot iron, it liquefies and drips down the hair shaft into the follicle. This results in chronic inflammatory folliculitis, which can lead to scarring alopecia and consequently permanent hair loss. Thinning usually begins at the crown and then spread evenly throughout the head. The condition is irreversible [15, 16].

Common baldness/hair loss myths
Several myths about hair loss exist, some serious, others not so serious. These myths include;
1. Male pattern baldness (as well as female pattern baldness) is inherited from the mother’s side of the family: This is not true as studies have been conducted, which conclusively suggest that it can come from either side of the family.
2. Cutting the hair can make it grow faster and stronger. When hair grows longer, it is worn down by normal wear and tear and as such gets slightly thinner around the diameter of the shaft. Cutting the hair cuts it back to where there is less wear and tear and subsequently the hair shaft is slightly thicker, giving the impression that cutting the hair makes it thicker. It would also not grow faster as hair grows almost exactly half an inch per month regardless of whether it is cut or not.
3. Wearing a hat can cause hair loss. This can only happen if the hat is prohibitively tight as any form of pulling or tightening of the hair can have some effect on hair loss; however, wearing a hat on its own cannot cause hair loss.
4. Towel drying your hair rigorously will make your hair fall out faster. This can only occur if the hair was due to fall out anyway; however you won’t be promoting additional hair loss by towelling rigorously
5. Rubbing curry on the head will help hair loss. Not only will it not work, you’re likely to smell afterwards as well.
6. Split ends can be repaired. This is not true as split ends cannot be repaired and should be cut off immediately to avoid them splitting higher and causing more damage to the hair.
7. Having a cow lick the top of your head can help hair loss. This would not help your hair loss, but might be entertaining to watch.
8. Standing on your head, or hanging upside down will increase the blood flow to the head and reduce hair loss. It is true that standing on your head or hanging upside down will increase the blood flow to the head; however, it won’t do anything to hair loss.

Quality of life and psychological aspects
The hair constitutes an integral part of our self and our identity and as such hair loss may cause a wide range of psychological problems related to our identity. Alopecia in itself has few physically harmful effects; however, it may lead to problems such as high levels of anxiety, social phobia, paranoid disorder and serious depressive episodes. The extent of alopecia is one of the predictors of the severity of psychological distress [12, 17].

There is an important link between hair and identity, especially for women. Feminity, sexuality, attractiveness, and personality, as reiterated by Hunt et al (2005), are symbolically linked to a woman’s hair and as such hair loss can seriously affect self esteem and body image. Hunt et al (2005) also stated that about 40% of women with alopecia have had marital problems as a consequence whilst about 63% claim to have had career related problems [18].

Psychological problems can also be experienced by children affected by alopecia.

Management of Alopecia
Alopecia can be managed in different ways, depending on type and severity. The various methods of management include;
1. Medical treatment such as the use of topical minoxidil, oral finasteride, topical tretinoin, exogenous estrogen, spironolactone and anti-androgens for androgenetic alopecia. The type of treatment and dose may vary depending on gender and age (i.e. adult or children).
2. Medical treatment such as the use of immunomodulatory agents (e.g corticosteroids, 5% minoxidil, and anthralin cream) and topical immunotherapeutic agents (e.g dinitrochlorobenzene and diphenylcyclopropene) for alopecia areata.
3. For hair loss caused by telogen effluvium, the underlying cause is usually treated first.
4. Cicatricial alopecia is sometimes managed using both systemic and topical therapy, this includes the use of hydroxychloroquine, topical immunomodulators (e.g tacrolimus and pimecrolimus), intralesional injections of triamcinolone, mycophenolate mofetil, cyclosporine, and isotretinoin, to mention a few.
5. When hair loss is extensive, wigs may be worn; there is also the option of hair transplantation (using minigrafts).
6. To reduce the risk of traumatic alopecia, techniques for hair grooming should be used with caution bearing in mind the sensitivity of the scalp and hair follicles. Discontinuance of styling practices may result in an abatement of hair loss and partial hair growth; this depends on the length of insult to the roots. Complete re-growth is possible if hair loss is managed early [15].
7. The use of laser phototherapy, which offers a respite from drugs, chemicals, lotions, visits to hospitals, dermatologist centres and surgery, is non-toxic, safe and can be used at home (see our new Hairbeam Phototherapy product).

Recommended Products for Hair loss

References
1. Rushton DH, Norris MJ, Busuttil N.Causes of hair loss and the developments in hair rejuvenation. Int J Cosmet Sci 2002; 24: 17-23.
2. Biondo S, Goble D, Sinclair R. Women who present with female pattern hair loss tend to underestimate the severity of their hair loss. Br J Dermatol 2004; 150: 750-752.
3. Anonymous. What should I know about hair loss? Am Fam Physician 2003; 68(1):107-108.
4. Thiedke CC. Alopecia in Women. Am Fam Physician 2003; 67(5): 1007-1014.
5. Sinclair R. Male pattern androgenetic alopecia. Br Med J 1998; 317: 865-869.
6. Birch MP, Lalla SC, Messenger AG. Female pattern hair loss. Clin Dermatol 2002; 27: 383-388.
7. Sinclair R, Wewerinke M, Jolley D. Treatment of female pattern hair loss with oral antiandrogen. Br J Dermatol 2005; 152: 466-473.
8. Tosti A, Bellavista S, Iorizzo M. Alopecia areata: A long term follow-up study of 191 patients. J Am Acad Dermatol 2006; doi:10.1016/j.jaad.2006.05.008.
9. Kaelin U, Hassan AS, Braathen LR. Treatment of alopecia areata partim universalis with efalizumab. J Am Acad Dermatol 2006; doi: 10.1016/j.jaad.2006.05.062.
10. Olsen et al. Alopecia areata investigational assessment guidelines. J Am Acad Dermal 1999; 40: 242-246.
11. Shapiro J, Madani S. Alopecia areata: diagnosis and management. Int J Dermatol 1999; 38 (Suppl. 1): 19-24.
12. Harrison S, Sinclair R. Telogen effluvium. Clin Exp Dermatol 2002; 27: 389-395.
13. Whiting DA. Cicatricial Alopecia: Clinico-Pathological Findings and Treatment. Clin Dermatol 2001; 19: 211-225.
14. Randall J, Ream E. Hair loss with chemotherapy: at a loss over its management? Eur J Cancer Care 2005; 14: 223-231
15. Goodheart HP. Hair and Scalp Disorders. Women’s health in primary care 1999; 2(5): 338, 343.
16. Women’s Institute for Fine and Thinning Hair. Traumatic Alopecia. Rogaine 2003. Available via: http://www.womenshairinstitute.com/th_wcth_ta.asp [Accessed on 05/07/2007].
17. Schmidt S, Fischer TW, Chren MM, Strauss BM, Elsner P. Strategies of coping and quality of life in women with alopecia. Br J Dermatol 2001; 144: 1038-1043.
18. Hunt N, McHale S. The psychological impact of alopecia. BMJ 2005; 331:951-953.
19. Understanding hair loss. Hair loss myths. Available via: http://www.understanding-hair-loss.net/hair-loss-myths.htm [Accessed on 05/07/2007].
20. Hair Styles. Top 10 Hair Myths. Available via: http://www.hair-styles.org/top-10-hair-myths.html [Accessed on: 05/07/2007].

Disclaimer

This article is only for informative purposes. It is not intended to be a medical advice and is not a substitute for professional medical advice. Please consult your doctor for all your medical concerns. Kindly follow any information given in this article only after consulting your doctor or qualified medical professional. The author is not liable for any outcome or damage resulting from any information obtained from this article.

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Malignant Otitis Externa Treatment Information

Malignant otitis externa is a condition involving inflammation and damage to the bone and cartilage of the base of skull. Otitis Externa malignancy is caused by the spread of infection from an infection of the external ear. Malignes (necrotizing) otitis externa is a life-threatening extension of otitis externa mastoid bone and temporal. It is generally caused by P. Aeruginosa or S. Aureus. Malignant external otitis is a rare complication of both acute swimmer’s chronic ear and swimmer’s ear. OE is a very common disease that occurs in all regions of the United States. The infection appears to be more prevalent in warm, humid conditions.

People with diabetes and weakened immune systems are especially vulnerable to malignant otitis externa. Otitis externa is often caused by hard-to-treat bacteria such as pseudomonas. The bones can be damaged or destroyed by the continued infection and inflammation. OE affects both sexes equally. Symptoms of malignant otitis externa include drainage from the ear – yellow, yellow-green, foul smelling, persistent, hearing loss ear pain – felt deep inside the ear and may get worse when moving head . itching of the ear or ear canal and fever. Worsening is also common in the vacationer who continues swimming.

The goal of treatment is to cure the infection. Treatment of necrotizing otitis externa include the correction of immunosuppression (when possible), the local treatment of ear canal, long-term systemic antibiotic therapy and, in some patients, surgery. Antibiotics effective against micro-organisms are given for prolonged periods. To prevent infection of the external ear, the ear hair carefully after exposure to moisture. Avoid swimming in polluted water and protect the ear canal with a cotton or lamb’ s during the implementation of wool or hair dye hair. Otitis externa is almost always predominantly bacterial or fungal predominant.

Malignant Otitis Externa Treatment and Prevention Tips

1. Avoid swimming in polluted water.

2. Dry the ear thoroughly after exposure to moisture.

3. By intravenous (IV), antibiotics are used for individuals with NOE.

4. Avoid swimming in polluted water and protect the ear canal with a cotton.

5. Topical acidifying agents and drying can be used in mild cases or resolve.

6. Do not wash their hair or swimming if very slight symptoms of acute otitis externa begin.

7. 1 or 2 drops of a mixture of 50% alcohol and 50% vinegar in each ear will help to dry the ear.

Hearing Problems in Children Deafness & Hearing Loss Guide

It can be very difficult to determine if a child under the age of 19 months has a problem with their hearing because very young children and babies will respond to their environment by touch more than sound. Listed below are a number of questions of signs that you should watch out for in your child and ask yourself if they apply to your child. If you answer no to any of them then it might be wise to visit your doctor or mention to your health visitor that you think there may be a problem with your child’s hearing.

From birth to 4 months of age

At this stage your baby should:

* Be startled when they hear a sudden loud noise such as a shout, hand clap or dog barking nearby?

* When asleep does your baby wake up at the sound of loud noises?

* If your baby is crying does he/she stop crying if they hear your voice while you’re still out of site, or quieten down if you play music?

* By the time your baby is around 4 months old he/she should be turning their head towards sounds they hear.

4 to 8 months of age

At this stage your baby should:

* Does your babies eyes widen at the sound of a voice or loud noise?

* Does your baby notice sounds that are outside of the peripheral vision?

* Does your baby enjoy a sound mobile, rattle or any other toy which makes noises?

* Around the age of 6 months your baby should be gurgling or babbling back to people who speak to them.

* Around the age of 6 months your baby should be making different sounds when babbling.

8 to 12 months of age

At this stage your baby should:

* Your baby should be responding to soft noises and turning their head towards them.

* Your baby should be able to respond to their own name.

* Their voice should alter in pitch when babbling.

* Your baby should be adding constants to their babbling, such as m, b, p and g.

* Your baby should respond to music by bouncing and jigging up and down.

* Your baby should understand the word no.

Of course every child develops at a different pace and the above is only a very rough guide, your child may respond earlier or a little later to any of the above but it is usually around the ages stated above. If you suspect that your child may have problems with their hearing then consult your doctor or health care visitor.

Hearing loss overview

Deafness & hearing loss guide

There are four main types of hearing loss; conductive hearing loss, sensorineural hearing loss, central hearing loss and mixed hearing loss. Hearing loss and deafness can affect anyone at any age with some people being born deaf while for others hearing loss is a gradual or sudden occurrence depending on the circumstances which brought about the deafness or hearing loss. Deafness or hearing loss can also occur for many different reasons ranging from ear infections to trauma of the ear drum.

Conductive hearing loss

Conductive hearing loss is usually associated with obstructions to the outer or middle ear and can also be caused by certain diseases, this type of hearing loss will affect all frequencies and the loss usually isn’t severe. The person suffering from conductive hearing loss will usually be able to be helped surgically or has great success when using a hearing aid.

Sensorineural hearing loss

This type of hearing loss is usually brought about by damage to the sensory hair cells or nerves of the inner ear, hearing loss due to this will normally be more profound than conductive hearing loss and it usually affects only certain frequencies. Even when wearing a hearing aid the person affected by sensorineural hearing loss may still have great difficulty in hearing certain sounds.

Central hearing loss

This type of hearing loss is usually done by damaging the nerves of the central nervous system; this can be either in the brain itself or the pathways leading to the brain.

Mixed hearing loss

This type of hearing loss is a combination of conductive hearing loss and sensorineural hearing loss, this means that the person can suffer from problems relating to both the middle and outer ear as well as the inner ear.

What can be done to help those hard of hearing?

There are many things that can be done to help the hard of hearing, people who have been hard of hearing or deaf for a number of years will usually have learnt to lip read or even sign. They may also wear a hearing aid to help them hear more clearly and there are several steps a person can take to make life easier for them.

* Always make sure the person knows when you are going to speak by facing them.

* Make sure you talk in good lighting conditions.

* Try to have your conversation away from distractions, such as heavy traffic or loud background noise.

* Don’t mumble or use a lot of slang words.

* Speak in a clear voice but don’t shout at the person.

* Remember that just because the person cant hear it doesn’t affect their intellectual capacity.

For hearing-impaired children, the mode of communication used in the classroom varies according to the children’s ages and needs. Although a mainly oral approach is used, and effective listening skills encouraged, lipreading and gestural support are provided. We are doing all efforts with the disabled to join them to the mainstream without any help from any sector of the society. And we are looking for a positive support.

Miracles Performed by Jesus Christ!

Water Made Wine: John 2:1-11.

The Nobleman’s Son: John 4, 48-54.

The Draught of Fishes: Luke 5, 1-11.

The Cure of the Demoniac: Mark 1, 23-28; Luke 4, 33-37.

Peter’s Mother-in-law: Matt. 8, 14-15; Mark 1, 29-31; Luke 4, 38-39.

The Leper: Matt. 8, 1-4; Mark 1, 40-45; Luke 5, 12-19.

The Paralytic Cured: Matt. 9, 1-8; Mark 2, 1-12; Luke 5, 18-26.

The Cure at Bethsaida: John 5, 1-15.

The Withered Hand: Matt. 12, 9-13; Mark 3, 1-6; Luke 6, 6-11.

The Centurion’s Servant: Matt. 8, 5-13; Luke 7, 2-10.

The Widow’s Son: Luke 7, 11-17.

The Blind and Mute Demoniac: Matt. 12, 22.

The Tempest Stilled: Matt. 8, 23-27; Mark 4, 35-41; Luke 8, 22-25.

Expulsion of Devils: Matt. 8, 29-34; Mark 5, 1-20; Luke 8, 26-39.

Jairus’ Daughter: Matt. 9, 18-26; Mark 5, 21-43; Luke 8, 40-56.

The Woman In the Crowd: Matt. 9, 20-22; Mark 5, 24-34; Luke 8, 43-48.

Two Blind Men: Matt. 9, 27-31.

The Mute Spirit: Matt. 9, 32-34.

Five Thousand Fed: Matt. 14, 13-21; Mark 6, 34-44; Luke 9, 12-17; John 6, 1-15.

Jesus Walks on the Water: Matt. 14, 22-33; Mark 6, 45-52; John 6, 16-21.

The Chanaanite Woman: Matt. 15, 21-28; Mark 7, 24-30.

The Deaf Mute: Mark 7, 31-37.

Four Thousand Fed: Matt. 15, 32-38; Mark 8, 1-9.

The Blind Man: Mark 8, 22-25.

A Possessed Boy: Matt. 17, 14-21; Mark 9, 13-30; Luke 9, 37-43.

Tribute Money Provided: Matt. 17, 24-28.

The Man Born Blind: John 9, 1-38.

The Mute, Lame, and Blind: Matt. 15, 29-31.

A Woman Cured: Luke 13, 10-17.

The Man with the Dropsy: Luke 14, 1-6.

The Raising of Lasarus: John 11, 1-44.

Ten Lepers: Luke 17, 11-19.

The Blind Men at Jericho: Matt. 20, 29-34; Mark 10, 46-52; Luke 18, 35-43.

The Fig Tree Blasted: Matt. 21, 18-22; Mark 11, 12-25.

The Servant’s Ear Healed: Luke 22, 49-51.

The Draught of Fishes: John 21, 1-14.

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The Affects of Stammering/stuttering – How Having a Speech Impediment Can Impact One’s Life

If I were to describe what my life was like during this period I would just say that it was ‘a battle’. In this article I am going to be writing about some of the struggles that I had to deal with and about how the stammer affected my life.

The average fluent person does not realise just how lucky they are. Having a stammer affects your ability to carry out what should be the most simplest of tasks. As an example, I will never forget the time when I was around eighteen years of age, when I went to purchase some petrol. After filling up the car I proceeded to enter the shop to pay etc. The lady behind the counter asked me which petrol pump I had used, for whatever reason I had not even looked and therefore had to take a quick check. I saw that it was pump number seven and straight away a demon came into my head and informed me that I would not be able to say the word. I have always attempted to ignore these voices from my head; however this is easier said than done. The lady asked me again and guess what? Yes, I could not say the word and it came out as ssssssssssssssseven. I felt totally humiliated, not for the first time of course, but tried to act as if I had said it fluently. From that day forward I made sure that I did not use pump number seven again!

Similar things would happen to me when ordering items such as drinks from a bar. I would revert to pointing at a certain bottle of beer and would hold up three fingers to signal that I wanted three bottles, as a way of coping. I should be enjoying going out socialising with my friends but instead it would turn into one big choir.

Attending an interview, making a phone call, answering the phone, reading out aloud from a book at school and general conversation were other areas of weakness. Surely life should not be this difficult.

I took heart from the fact that I would not stammer when I was singing, when I was shouting or when I was drunk. I felt confident that I would one day achieve fluency, this day arrived twelve years ago when I was aged twenty two. Life now seems so easy!

By: blueboy

Skills Of The Stay-At-Home-Mom

I’ve been a “stay-at-home-mom”, or a sahm, since March 2009. I know first hand that it’s hard to make the switch from full-time employment to full-time mothering. After working and socializing with other adults on a regular basis, the shock of suddenly being left alone at home with the children, housekeeping, and cooking can be depressing and isolating.

I’m happy to say that I haven’t withered away or become a reclusive hermit like I originally feared! I have kept mothering as my top priority, but I’ve also managed to find several projects that keep my brain working and help me stay in contact with the rest of the adult world. I even tend to forget that I’m a sahm because I’m so busy!

An important thing I’ve learned is that being a sahm doesn’t turn you into a cookie-cutter “Susie Homemaker”. Every sahm is still the unique person they were before they left the career world. They have the same talents that made them valuable to the outside world. Many women may fear that their education and experience is being wasted if they stay at home, but that’s never the case unless you plan to become a mute zombie mother. ( I have faith you won’t).

I recently attended a talk about how the skills of a sahm translates to work place skills. It was refreshing to be reminded that I’m still a valuable person and maybe even more so because I’m a sahm. Here’s some of the skills and experiences that a sahm has in professional terms:

  • Adept at scheduling appointments and handling overlapping activities
  • Excellent multitasker
  • Experience organizing and maintaining records
  • Annual budget management, checkbook balancing, diverse purchasing and regular financial decision making
  • Meal planning and chore management for multiple people
  • Educator, motivator, and moral advisor

Most likely, sahms are also highly involved community members and regular volunteers. Really, us sahms are very valuable people although most of us don’t realize it!

I’ve discovered a secret: you don’t have to work a 40-hour work week in an office to use your skills. If you use your imagination you’ll find ways to use your skills at home or in the community. You may not get paid for those skills, but you never know what will come down the road.

I have a new personal rule that I will only take on a job or project if I can do it with my daughter on my hip! You may roll your eyes because that sounds rather absurd, but you’d be surprised how successful I’ve been. You’d also be impressed how flexible an employer will be about your determination to work from home when they need your skills. I’m not getting rich this way, but I’m not useless or unappreciated either.

The woman who gave the talk I mentioned above volunteered in community organizations for many years and was then offered a paid position with a non-profit organization because of her experiences and connections in the non-profit sector. Basically, her lifestyle as a sahm led her to a career! Why not the rest of us?

Possibly the best advice I received from that speaker was that sahms should stay involved in the world outside their home. Volunteer. Raise your hand when someone asks “Who will do this?” Don’t shy away from new experiences. Take classes. Talk to people. The more you reach out, the more chances you’ll have to exercise your unique talents and be recognized for it. It may lead you someplace great!

British Cambridge – Speech Therapy for the Hearing Impaired

Hearing is conversely associated with speech in that initial communication and hence understanding, arises primarily from learning spoken language through listening and building up symbolic thinking processes. This is why speech therapy is a must for people with hearing impairment.

1.Developing Auditory Awareness
Auditory awareness is the ability to be conscious of the fact that sound is present. During this period, the child is to learn to wear appropriate amplification. Therapy involves playing with toys that make sounds and listening to music.

2.Developing Auditory Attention or Listening
Auditory attention is the ability to give some real notice or interest to the sound that is heard.

The clinician focuses the child’s attention to the sound by saying two or three times: Listen, I hear something. What is that? The clinician pats his ears, but does not show the source of the sound until the child is listening. The clinician rewards the child’s attention by showing the source of the sound.

3.Developing Auditory Localization and Distance Hearing
Auditory localization is the ability to recognize the direction from which the sound is coming from. Distance hearing, on the other hand, is the ability to hear the sound even from afar.

The therapist shows the child how to respond whenever he hears a sound. Some of the activities are opening the door when someone knocks, dancing to music, clapping to music, building blocks when a sound is heard, marching to a drum and picking the phone up when it rings.

4.Developing Vocal Play
Vocal play is the ability to use the speech structures to produce various sounds that are not necessarily meaningful but are sound productions nonetheless. This stage requires making lots of sounds when playing with toys, especially animal and vehicle noises: growl for the teddy bear, meow for the cat, or click tongue for the horse.

5.Developing Auditory Discrimination
Auditory discrimination is the ability to identify one sound from another. Activities include reviewing vowel sounds and varying pitch, loudness and rhythm: oo— vs. oo-oo. For example, the therapist can build a train with blocks and say oo-oo or oo—, as the train is being pushed on the table. For older infants, they can look at books, making similar sounds for the pictures.

6.Developing Auditory Discrimination and Short-Term Memory
Activities include teaching discrimination of noise makers in audition and incorporation of phonemes into words in use.

7.Developing Auditory Processing
Auditory processing is the ability to associate sounds with memories of past events. Activities include naming of abstract ideas like sadness and joy. The therapist also starts to teach the child to call the names of the people that he has constant contact with.

8.Developing Auditory Processing of Patterns and Auditory Memory Span
Activities for the child’s audition include testing the child’s recognition of words and testing of auditory memory span. Auditory memory span is the ability of the child to remember in sequence the things that he has heard. An example would be the sequence of the instructions that the therapist gave to him.

9.Developing Auditory Figure-Ground Discrimination
Auditory figure-ground discrimination is the ability to choose among the sounds that are present in the environment and to focus on that one sound alone without being distracted by the rest of the surrounding sounds.

Activities for the child’s auditory skills include clapping or dancing to different rhythms, learning to count from one to ten, saying the alphabets, days of the week, nursery rhymes, holiday songs, prayers, his own address or telephone number, and also remembering two or three directions at a time.

10.Auditory Tracking
Auditory tracking is the act of listening closely to a material to be able to follow what is being stated in the said material. Auditory tracking using a tape recorder is included in the activities. Also included are reading aloud, practicing using the telephone, listening for information and using internal repetition.