Health Guide

Identifying Asthma

Q: How do I know if I might have asthma?

A: The small airways in your lungs both swell up and become smaller when an asthma attack strikes. This leads to increased mucus production and decreased flow of the air in the lungs. Wheezing, shortness of breath, and coughing result. In mild cases, these symptoms may be mild and infrequent. If your case is moderate or severe, they may come often.

You should ask your doctor whether you may have asthma if you cough after exercise or after exposure to cold winter air. If you commonly have a cough that persists for more than 2 weeks after a common cold, you may have a mild form of asthma. Likewise, you may have asthma if you wheeze or cough after exposure to dust, animal hair, cigarette smoke, or pollen.

If you experience shortness of breath unrelated to extreme exertion, you should contact your doctor. This requires prompt medical evaluation, because there are many serious causes for shortness of breath other than asthma.

Asthma may develop for the first time at any age, even in people in their 60s or 70s. At older ages, however, patients and their physicians must carefully consider the possibility of other explanations for cough, shortness of breath, or wheezing. These include cardiac disease, chronic lung diseases (such as emphysema), anemia, respiratory infection, and cancer.

This information, prepared by physicians at Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, is not medical advice and should not replace consultation with your doctor. Staff at BIDMC provide Ask an Expert responses to consumers for educational purposes only. Always consult your own doctor about any opinions or recommendations with respect to your symptoms or medical condition.

 

Statistics and Risk Surrounding Breast Cancer

Q: As each year passes, I seem to know more and more women with breast cancer. What is the chance that I will develop breast cancer myself?

 

Multiple Pregnancy Week by Week

There are two distinct camps in the multiple pregnancy debate, is it better to have or to have not?

To many in the general population, multiple pregnancy resulting from infertility treatment sounds like a wonderful outcome, the "instant family" after years of involuntary childlessness. This is reinforced by magazine articles and television programmes in which readers and viewers are invited to marvel at the rows of beds, shoes, school lunches etc., in families coping with raising triplets, quads, quintuplets or more.

As an IVF embryologist, I fell into this category. After the couple had a positive pregnancy test it was not common to hear any more about them. In the absence of any further information, it was normal to assume that things were running smoothly, and that the worst the parents would have to cope with, would be a few sleepless nights after the children were born. But over the past ten or so years, I have come to understand exactly what a multiple pregnancy means to the family.


The pregnancy
I became pregnant when I was 27 years old. I had just lost a blighted ovum pregnancy and then conceived naturally in the subsequent cycle. This second pregnancy was a quadruplet implantation, with one embryo lost at 5 weeks' gestation (although this was not accompanied by any bleeding). The ultrasound examination showed tissue in the uterus, although evidence of a fetal heart was not conclusive.

7 weeks
A second ultrasound examination at 7 weeks gestation showed 3 fetal hearts, with two quite close together. Another ultrasound examination at 10 weeks gestation showed three separate sacs, although one was much larger than the other two.

16 weeks
At 16 weeks gestation, biophysical profiles of all the fetuses were made by ultrasound examination and showed that two of the fetuses were developing normally, while the third was smaller.

20 weeks
At 20 weeks gestation, I developed pregnancy induced hypertension and was placed on bed rest. There was an unequal distribution of amniotic fluid in the fetal sacs - one had a very high volume of fluid, while the others had very low volumes. This made it impossible to treat the condition medically, since treatment to increase or decrease the fluid volumes would cause problems for the others.

24 weeks
At 24 weeks gestation, I was spilling protein in my urine, my kidneys weren't functioning properly so I was accumulating fluid, and I had extremely high blood pressure. I was admitted to hospital because the doctors were concerned about premature labour. After a couple of days, my condition had stabilised, but there were still very unequal amounts of amniotic fluid. The only way to even up the amount of fluid was to physically remove some from the large sac. This was done trans-abdominally using an amniocentesis needle attached to a 60 ml syringe. A total of 1.3 litres of fluid was removed, 60 ml at a time (quite a painful procedure because the layers of tissue were moving relative to one another as the amount of fluid decreased, but the needle was left in place all the time to reduce the risk to the baby).

26 weeks
At 26 weeks gestation, another ultrasound biophysical profile of the babies was ordered. The third triplet showed an abnormal blood flow that could have been due to a heart defect and we had to face the possibility that she might not survive. Because of the uncertain outcome, we were asked to decide whether to continue the pregnancy or to deliver at 26 weeks to allow her to be operated on. There was no evidence that we could improve her prognosis by surgery (since nobody knew exactly what, if anything, was wrong), and we felt that the risk to the other babies' health was too great when there was such an uncertain outcome. We decided to continue with the pregnancy.

27 weeks
By 27 weeks gestation, my blood pressure was controlled, my kidneys were working again and I had lost the fluid that had accumulated in my tissues. The fetuses were growing well. I "saw" them most days during the routine ultrasound, and had started referring to them by name. The medical team was pleased with our progress, and foresaw no problems.

28 weeks
At 28 weeks gestation, the Monday morning ultrasound showed that the third triplet's heart had stopped beating. Because of the fused placenta, the babies had to be delivered by emergency Caesarean - since they were now at risk.

The delivery
There were 14 people in the delivery room (hardly an intimate and moving experience!). Baby 1 (Caitlin) weighed 1100g and had to be resuscitated, Baby 2 (Rebecca) was stillborn. She weighed 800g. Baby 3 (Sara) weighed 890g and was doing reasonably well. All of the babies were taken away immediately.

Our first joint parental decision was to allow Sara and Caitlin to be given lung surfactant - fortunately the decision to end the drug trials had been made 2 hours earlier!

Rebecca
The following morning, I had to make my first sole parental decision I had to sign the autopsy release form for Rebecca. The enormity of trying to come to terms with the loss of a child as well as having to understand the challenges faced by the surviving babies, at the same time I was recovering from surgery, is too painful and too hard to describe.

In that first week, we had to arrange for Rebecca's funeral while at the same time I had to start expressing breast milk for Caitlin and Sara. It was a week of sharp contrasts, pain and cofusion, instead of joy and happiness at the birth of three healthy babies.

Caitlin & Sara
During that week, Caitlin had to be given another drug to close the hole in her heart. The surfactant treatment worked very well and both Sara and Caitlin were breathing on their own (ie they didn't need ventilators) within a couple of days, although they still required oxygen treatment. In the following week, Sara was doing very well, and there was talk of moving her out of the intensive care unit. Meanwhile, part of Caitlin's gut had died due to lack of oxygen. This is a life-threatening condition. In other cases it requires surgery to remove the dead portion of the bowel. Rebecca's funeral was held that week. Caitlin recovered and did not require surgery. Her health improved quite quickly, and she was moved into the intermediate part of the intensive care unit.

Meanwhile, Sara had contracted viral pneumonia and her lung had collapsed. She had to be put back on the ventilator. On the same day, I was allowed to hold Caitlin for the first time. She was so small that her head rested in the crook of my elbow and her feet were at the end of my palm. Caitlin continued to do well and was moved to the special care nursery just to grow. She learned to suck and I could breastfeed her. She still had some lung damage and needed extra oxygen.

Sara
Sara was still very ill and her lung damage was worsening. The drugs she was on caused her a lot more damage and in the end, every system was affected. She was being given 100% oxygen but her levels were below 80% (they should be 85-95%). She stayed this way for weeks, until finally she crashed. Her oxygen levels were down to 28% and nothing was helping her. She was still in a humidicrib, and I still hadn't held her. I made a scene in the intensive care unit about how they couldn't let her die because they hadn't let me hold her. I was escorted out of the NICU. The following day, Sara was still alive but her oxygen levels were still extremely low, around 36%. The staff had decided that it couldn't hurt for me to hold her.

Everyone in the NICU knew what was happening and people came running from everywhere with tissues when they put Sara in my arms. As I held Sara, the oxygen saturation monitor alarmed. It was reading 96%. Sara improved slowly, but her oxygen saturation levels stayed relatively low (around 70%) for the next few weeks. The doctors didn't expect her to improve, and couldn't give us a prognosis - although they told us that nobody who had been that sick had ever survived. That week, the nurses put Caitlin and Sara together and took photographs. They thought it might be the only chance we would have to see them together.

Coping with critically ill children
Finally, after 10 weeks, Caitlin was to be released from hospital. The day before Caitlin was to come home, the medical staff called us in for a conference. They told us that Sara was gravely ill, that they had evidence that she had sustained brain damage. They said that she was constantly in pain and that she would never have a good day in her life. They then asked us to support their suggestion that they withdraw care and allow her to die. This was too hard to face, and we asked for their personal rather than professional advice. We decided to put off the decision for another week.

During that week, Sara was treated with high doses of steroids, and she improved dramatically. Caitlin had come home on schedule, and she still needed oxygen. The day that Caitlin came off oxygen supplementation was the same day that Sara came off the ventilator. Sara had to stay in hospital for another 2 months, and she started to grow, although her lung damage was extreme. She was discharged from hospital when she was 5 months old. She was home for 2 days before she had to be rushed back to hospital with breathing difficulties. She ended up staying in hospital for 3 months, and she had surgery (after she got to 5.5 lbs) to stop her from vomiting constantly. A gastrostomy tube was also inserted through her stomach wall so that she could be tube fed when she was too sick to manage eating

When she was discharged from hospital this time, we had to give her nebulised drugs every 3 hours, followed by chest physiotherapy. The treatment that had kept her alive had taken away all the hairs in her lungs, so she couldn't get rid of the mucus on her own. She also had to be fed small amounts of high calorie formula via her g-tube every 3 hours, and she couldn't have been fed less than an hour before chest physio. She also had to be given drugs every three hours around the clock and she was fed via her g-tube overnight while she slept.

We had to be very organised about Sara's care and we devised lots of systems to make sure that she was given the right drugs and treatment at the right time. For example, when Sara was in bed at night she had her oxygen tubing as well as a feed line going into her stomach. This meant that she had two lengths of tubing running through her bed and there was a risk that she could get them tangled around her throat. We ended up putting both tubes inside her sleeper pyjamas and bringing them out at her foot, because then she would have to do somersaults to get the tubes around her neck.

Another problem was that she had to have drugs given to her in her g-tube at 8am, 11am, 2pm, 5pm, 8pm, 11pm, 2am and 5am. Some of these drugs were quite dangerous so we had to make sure that we weren't going to make a mistake in the middle of the night by giving the wrong dose or giving it at the wrong time, since she didn't get the same drugs at each time. Of a night, I'd give Sara her 10:30pm Ventolin etc., then chest physiotherapy, then put her back to bed and hook her up to the overnight feeding bag. There was a peristaltic pump which passed the formula into her stomach at a fixed rate. When the bag was empty, the pump would alarm - we set the flow rate so that the alarm would go off at 5am, so that I could get up, switch it off, give Sara her 5am drugs and then go back to bed. We had to work it so that I did the 11pm and 5am shift and my husband did the 2am shift, so that he could have 2 stretches of good sleep, since he was the one earning the money of a day.

The guilt and despair involved with having critically ill children is extreme, and certainly outweighs any perceived advantage of just having to have one pregnancy to complete a family.

Meanwhile, Caitlin was doing very well and we had to try to give her as normal a childhood as possible. This level of care continued for 2 years, with Sara in and out of hospital due to lung problems. At 2 years and 3 months, Sara was well enough to be weaned off supplementary oxygen and most of her drugs. She was unable to walk, and had developed an oral aversion, meaning that she didn't like eating. We then had another 2 years of intensive therapy (physiotherapy, occupational therapy, speech therapy) to teach her how to walk, how to move food around in her mouth, and to give her a sense of herself. The breakthrough with her eating was chocolate. She surprised us all by eating an Easter egg. It took her until she was 6 years old before she was confident in chewing and moving food around in her mouth. The girls continued to grow and Sara started to outgrow all of her problems.

Now we have two 10-year olds. They are both generally healthy and intelligent children. However, it took five years of virtually 24 hour nursing and caring to get us here. From my family's experiences, I could not recommend multiple pregnancy to anyone. The guilt and despair involved with having critically ill children is extreme, and certainly outweighs any perceived advantage of just having to have one pregnancy to complete a family. Finally, I would just like to say that we begrudge nothing that we have had to do but please remember my family's trials and hurdles when thinking about the 'rightness' of the "instant family" that multiple pregnancy brings.

| Posted in » Pregnancy  

How Does Human Reproduction Work ?

Humans reproduce when two cells (gametes), an egg (ovum) and a sperm, come together. Each gamete contributes half of the genetic material contained in the foetus. The hormones which control the production of sperm and eggs are called gonadotrophins. There are two types of gonadotrophins: Follicle Stimulating Hormones (FSH) and Luteinizing Hormone (LH). These two hormones are produced in a tiny, pea-size gland at the base of the brain called the pituitary gland. In men, they stimulate the testicles to produce sperm and testosterone. In women they act on the ovaries, where the eggs develop, producing the female sex hormones oestrogen and progesterone.

Sperm
Sperm are produced at the rate of about 300 million per day. They take some 80 days to mature. Each sperm has a head, which contains the genetic material, and a tail, which propels it up through the vagina, uterus, and fallopian tubes, to reach and penetrate the egg.

Eggs
In the woman the production of sex hormones and the release of an egg is known as the menstrual cycle. It is counted from the first day of the period ("Day 1"). In an "average" cycle of 28 days, ovulation the release of an egg from the follicle, happens on about day14. However, cycle length varies between women and it is important to note that ovulation and the fertile time occurs earlier in women with short cycles and later in women with long cycles.

At ovulation the egg is released from the ovary and picked up by the fringed end of the fallopian tube. After ovulation the empty follicle produces the hormone progesterone. This prepares the lining of the uterus (the endometrium) to retain an embryo. If an embryo does not implant, the level of progesterone drops and a period starts again. For more information on ovulation, please click here.

Conception
The mature egg survives only 24-48 hours, while sperm remain viable longer. In natural conception sperm is placed inside the vagina at the time of intercourse. The mucus in the cervix (the neck of the uterus) is slippery around the time of ovulation, which enables the sperm to swim into the uterus. The uterus then contracts in such a way as to help the sperm move up into the fallopian tube to reach the egg.

Once a sperm has penetrated the shell surrounding the egg (zona pellucida) it sets up a barrier stopping other sperm from penetrating. When the head of the sperm has released its contents into the egg, the egg is fertilised. The egg then starts to divide and becomes an embryo. Few days after fertilisation the embryo implants in the endometrium and starts to produce Human Chorionic Gonadotrophins (HCG), the hormone that causes a "Positive" pregnancy test.

 

Fertility Fitness - the impact of increased weight on fertility

Thirty seven percent of Australians are overweight or obese according to recent Australian Bureau of Statistics data and the number is rising. In addition to the association with cardiovascular disease, diabetes and some cancers, increased weight has now been shown to have an adverse effect on fertility and also increases the risk of miscarriage.

This association was first noted in studies in the 1950's but received little attention until the last decade. Most of the work to date has concentrated on fertility issues in women. As a woman's weight increases she requires higher levels of insulin to maintain a normal blood glucose level. These increased levels impact on the ovary, stopping ovulation and leading to increased male hormone levels. The result is irregular menstrual cycles and fertility problems. Women who have been diagnosed as having polycystic ovaries (PCO) are particularly at risk. Some studies have shown that even women at the higher end of the normal weight range can have their fertility affected.

Increased weight can also impact on the effectiveness of fertility treatments. As a woman's weight increases, she will require more drugs to get the desired response, and in up to 30% of cases, will still not respond well enough for treatment to occur. In addition, despite the increased stimulation, her chance of pregnancy is significantly reduced as a consequence of the effects of the increased weight.

If a pregnancy does occur the risk of miscarriage is increased, with once again women with PCO being particularly at risk.

The good news is that a small amount of weight loss can reverse these problems. An Australian study, which was a world first, has shown that a group programme of exercise and dietary advice, without an emphasis on low calories, can restore menstrual regularity and therefore ovulation and pregnancy for up to 90% of the women involved. Even women with causes of infertility unrelated to producing an egg each month (anovulation), such as tubal blockage or male sperm problems, showed a dramatic improvement in their chance of pregnancy on treatment. In addition, the risk of miscarriage was significantly improved. The women lost a maximum of seven to ten kilograms over six months so it was not necessary to get back to the normal weight range to get the beneficial effects. Even a 2-5% weight change was effective in restoring ovulation.

The study found that lifestyle changes are much easier for women to achieve if they were part of a group of women with the same fertility aims as themselves. Conversely, individual dietary advice and lifestyle management has not been shown to be particularly effective. The advantage of the group programme is that it appears that the weight loss is sustained and therefore it is likely that long-term health benefits will also result.

The programme is currently available to women who live in Sydney, Melbourne or Adelaide. Contact details can be obtained through ACCESS. (link to about Access)

Very little is known as yet about the effects of increased weight on male fertility. We do know that as a man's weight increases his testosterone levels can drop and in extreme situations there is an alteration in the semen profile. A study is now underway to explore this issue further. It is being run in association with the Gutbusters programme. Any overweight men interested in seeing the effects of weight loss on their sperm and hormonal profile can contact Wendy on (02) 9586 3214.

In summary, for women in particular, weight loss should be considered as part of the initial treatment of any woman above her 'weight for height' average, who requires fertility management, irrespective of whether it is as simple as ovulation induction or as complicated as IVF. As anyone who has tried to lose weight knows, getting the bit of your brain that wants to lose weight to connect to the bit that has to do it, is very difficult. However, making use of group dynamics, either with a specific programme associated with a fertility clinic or some other means, has been shown to be most effective in achieving the aims of weight loss, pregnancy and a healthy outcome.

| Posted in » Infertility  

Trying to Conceive: Infertility

A couple is regarded as infertile when they have not conceived after 12 months of regular, unprotected intercourse. About 15% of couples of reproductive age have a fertility problem. Find that hard to believe? That's because most don't talk about it. Three out of five couples conceive within six months of trying, one in four takes between six months and one year. For the rest, conception takes more than a year, which means that there may be a problem of infertility.

The causes of infertility are many and varied and can be related to male or female issues. They include problems with production of sperm or eggs, problems of the fallopian tubes or uterus; endometriosis, frequent miscarriage; and hormonal and autoimmune (antibody) disorders in both men and women.

In about 40% of infertile couples, the problem is a male factor and in about 40% it is due to a female factor. For the remaining 20%, both partners have an infertility problem, or the cause is unknown ("idiopathic").

There is no evidence that stress causes infertility. There is plenty of evidence, however, that infertility causes stress.

Treatments for infertility include surgery to fix blockages of the fallopian tubes, hormone treatments for either partner, insemination of the woman with the sperm of her partner or a donor, IVF (In Vitro Fertilisation) and related treatments such as GIFT (Gamete Intra Fallopian Transfer). Some people try natural treatments, such as herbs, acupuncture and meditation.

If you are trying to get pregnant , and have not succeeded after a year of trying, you may have a fertility problem, and it is worth seeking medical help.

If you are over 35, and have been trying to fall pregnant without success, it may be a good idea to start checking things out even earlier. Infertility investigations can sometimes take a long time, and if you put off seeking help, you could be leaving it too late.

| Posted in » Infertility  

Down Syndrome Characteristics

Other names :
Mongolism, trisomy 21.


Introduction :
Genetic condition characterised by poor muscle tone, abnormal joint movement, mongoloid shaped face, mental retardation, small nose and other characteristics.


Discovery :
Down was a London physician, who in 1866 first described the condition.


Types :
There are as many different types as there are patients, as all vary to some degree in the severity and characteristics of the syndrome.


Cause :
Down Syndrome is a congenital disease that occurs at the moment of conception, due to the presence of three copies of chromosome 21 instead of two (one from each parent). Thus one of the alternate names for this syndrome is trisomy 21. The other name for the syndrome, Mongolism, comes from the patient’s characteristic facial appearance, which is more like that of the Mongol (Chinese) than European. Contrary to some uninformed opinion, Down syndrome can occur in the Chinese, and is easily identifiable.


Incidence :
Down syndrome occurs at a rate of one in every six hundred births overall, but rises to a rate of two in every hundred for mothers over forty years of age.


Prevention :
There is no method of prevention other than women having their children well before turning forty.


Investigations :
Cells from the child can be examined for characteristic genetic changes to confirm the diagnosis.


Screening :
Diagnosis of the condition in older pregnant women before the birth of the child is possible from the 15th. week of pregnancy by two processes - amniocentesis and chorionic biopsy. In these, samples of cells from the fluid around the baby, or the placenta, are examined under a microscope for the characteristic triple chromosome 21. If this is present, the foetus has Down syndrome.


Course :
The condition can be very easily recognised and diagnosed at birth by observing some of the many characteristics of the syndrome. Infants have poor muscle tone, joints that move further than normal, slanted eyes, a flattened facial appearance, small stature, mental retardation, small nose and a short broad hand. Other characteristics that may be present include a fissured protruding tongue, short neck, widely spaced first and second toes, dry skin, sparse hair, small genitals, small ears, poorly formed teeth, and a squint. Close examination of the hands of these people reveals characteristic finger prints that have a whorl with the loop on the thumb side of the finger tip, only one crease on the palmar surface of the little finger instead of two, a smooth pad at the base of the thumb and a prominent crease across the hand from the web between the thumb and index finger to the other side of the palm.


Treatment :
There is no cure possible, as the abnormal chromosome pattern is present in every cell in the entire body. Treatment involves special education, occupational therapy and physiotherapy. They are otherwise treated medically as normal patients.


Diet :
Some patients have difficulty in eating because of their protruding tongue and require food to be mashed or blended before than can cope with it.


Complications :
Down syndrome patients have a higher incidence of abnormal heart formation, a clouded lens in the eye (cataract), infertility, and leukaemia.


Outcome :
Provided there are no serious heart abnormalities or other complications, the life expectancy of these people is relatively normal. Their intelligence is about 40% that of normal (an IQ of 40), and although there is significant individual variation, almost all require lifelong care from devoted parents, carers or an institution.


Further information :
The Down Syndrome Association has branches in every state offering information and support for the families and carers of people with Down Syndrome.

| Posted in » baby  

Nice Guidelines for Diabetes

Other names :
Diabetes mellitus, sugar diabetes.


Introduction :
An inability of the body to process sugar effectively.


Discovery :
The effects of insulin were discovered in 1921 by Canadian Dr. Frederick Banting and his medical student assistant Charles Best, after experimenting on dogs.


Types :
There are two totally different types of sugar diabetes - juvenile (type one) and mature (type two). Most people who develop juvenile diabetes which requires daily insulin injections, do so as a child or in early adult life. They must use the injections for the rest of their lives, as we do not have a cure for diabetes, only an effective form of control. Older people who develop maturity onset diabetes can often have the disease controlled by diet and tablets (see Medication Table). This is because there is not a lack of insulin, but a lack of response by the cells to the insulin. The tablets make the cell membrane respond to insulin again.


Cause :
Glucose, a type of sugar, is essential for the efficient working of every cell in the body. It is burned chemically to produce the energy for the cell to operate, and is found in most fruit and vegetables. When glucose is eaten, it is absorbed into the bloodstream from the small intestine. It then travels to all the body's microscopic cells through the arteries and capillaries. Once glucose reaches a cell, it must enter across the fine membrane that forms its outer skin. This skin is normally impermeable to all substances, but insulin has the ability to combine with glucose and transport it from the bloodstream, through the cell membrane and into the interior of the cell where it can be used as an energy source for that cell. Insulin is a chemical of very great complexity. It is made in the pancreas, which sits in the abdomen below the stomach. The insulin it produces enters the bloodstream, and is attracted to those cells that are running short of energy and require more glucose. If there is no glucose available because you have not been eating, or because the glucose cannot enter the cell, the cell weakens and eventually stops working altogether. People who lack the insulin necessary to take the glucose into the cells have type one (juvenile) diabetes, and if the insulin is not supplied, they become steadily weaker because their muscles and other organs cannot work properly. There may be very high levels of glucose in their blood stream, but because it cannot enter the cells, it cannot help them. These diabetics therefore require regular supplements of insulin to keep them well. Insulin from pigs and cattle has been available for many decades, and in the last few years, human insulin has been produced by genetic engineering techniques to enable diabetics to lead relatively normal lives. The only problem with insulin is that it cannot be taken by mouth as it is destroyed by acid in the stomach. It must be given by injection two or more times a day. This way insulin enters the blood stream directly and can start transporting the necessary glucose into the cells immediately.


Incidence :
90% of diabetics have the maturity onset (type two) form of the disease. There is an hereditary tendency to developing this type of diabetes, but there is no inheritance in type one diabetes.


Preventio Guideline :
If there is a family history of type two diabetes, patients should ensure that they remain within normal weight limits, and so delay or prevent the onset of the disease.


Investigations :
If you suspect that you may have diabetes, your doctor can perform a simple test on your blood or urine to determine the diagnosis within minutes. More sophisticated blood tests can be undertaken to measure the severity of diabetes, its type and even give a three month average for the blood sugar levels.


Screening :
Urine tests can be simply and cheaply undertaken to detect most cases of diabetes, but wide scale screening is not routine in the community.


Course :
The early symptoms of diabetes are excessive tiredness, thirst, excess passing of urine, weight loss, itchy rashes, pins and needles and blurred vision.


Treatment :
Juvenile diabetes is controlled by regular injections of insulin. Different types of insulin with varying periods of effect are available. Maturity onset diabetics must follow a strict diet and sometimes take medication (see Medication Table) on regular basis every day to control their blood sugar levels. The earlier diabetes is controlled, the better the outcome for the patient, as side effects and body damage are less likely.


Diet :
Diet is essential for all diabetics, because the amount of glucose you eat is not normally constant, and diabetics lack the means of adjusting the amount of glucose in their blood with insulin. As the insulin injections remain at a constant strength, the glucose intake must also remain constant. A diabetic diet has minimal sugar, and is low in fat and cholesterol. Regular, equal sized meals are better than occasional meals off varying size. Fat cells can react abnormally to insulin very easily, and so overweight diabetics must lose weight and remain within certain strict limits. Dietitians can assist diabetics with guidelines on an appropriate diet.


Complications :
Poorly controlled diabetes can cause eye cataracts and visual damage, glaucoma, kidney disease and failure, poor circulation to the feet with ulceration and gangrene, damage to nerves, impotence and an increased risk of all types of infection.


Outcome :
Prior to the isolation of insulin, diabetics died within a few months or years of diagnosis, but today, provided a diabetic is careful in managing their disease, patients can lead a normal length and healthy life.


Further information:
Diabetes Australia is a major charity that is represented in all major towns and cities. It offers education, supplies, support and services for diabetics.


Medical curiosity :
Diabetes has been recognised as a disease for over three thousand years. In ancient Egypt, and up to relatively recent times, diabetes was diagnosed by the physician sipping the patient’s urine and noting its sweet taste. Fortunately for doctors as well as patients, more sophisticated diagnostic tests are now available

| Posted in » Diabetes  

Heartburn: Upset Stomach

Other names :
Reflux oesophagitis.


Introduction :
Burning pain behind the breast bone caused by reflux of acid from the stomach into the oesophagus.


Types :
May be caused by over indulgence, weakness of the diaphragmatic sphincter of the stomach, a hiatus hernia or other causes of excess acid production.


Cause :
Heartburn is caused by the reflux of hydrochloric acid from the stomach into the lower part of the gullet (oesophagus). If the patient has a hiatus hernia, where part of the stomach slips through into the chest cavity, acid can more easily escape up into the gullet to cause heartburn. A hiatus hernia and heartburn may occur during pregnancy because of the pressure of the enlarging womb and the hormonal effect on muscle tissue in the oesophagus and stomach. The oesophagus (gullet) runs from the throat to the stomach through the back of the chest. At its lower end, it passes through the diaphragm, which is a sheet of muscle that separates the chest from the belly. At the point where it passes through the diaphragm, there is a muscle ring (sphincter), which opens when you swallow food, but remains closed at other times to prevent the concentrated hydrochloric acid in the stomach from coming back up (refluxing) (Upset Stomach ?) into the oesophagus when lying down or bending over. The cells lining the inside of the stomach are made acid resistant by a thick layer of mucus, but those lining the oesophagus lack the protective mucus. If acid (along with food) is able to flow back up into the oesophagus, the acid will attack the unprotected cells, to cause inflammation, ulceration, pain and scarring. This is heartburn or reflux oesophagitis. There are two types of hiatus hernia. In some patients the hernia remains fixed in the one position, but in others, the hernia may slide up and down, depending on the patients position or activity. A large meal may be sufficient to push the overloaded stomach up into the chest. Some babies are unlucky enough to have a defect or temporary weakness in the muscle ring at the bottom of the oesophagus. The reflux of acid into the oesophagus causes considerable pain to the infant. Most children will grow out of the problem, but medication must be given in the meantime to prevent the burning and pain. In adults, factors such as obesity, smoking, over eating, rapid eating, alcohol, stress and anxiety, and poor posture may cause the excessive production of acid in the stomach or slackness in the muscle ring.


Incidence :
Probably five percent of adults suffer from heartburn at least once a week, often following dietary indiscretions. Babies and overweight elderly men are the two groups who are most likely to suffer from reflux oesophagitis.


Prevention :
Lying down, stooping and heavy lifting should be avoided after heavy meals. Meals should be kept small and frequent, rather than the traditional three large meals a day. Smoking will lower the tone of the muscles at the lower end of the gullet, and aggravate heartburn. Overweight patients should shed those extra kilograms to prevent the fat pressing on the stomach. If a hiatus hernia is present, raising the head of the bed is also useful.


Investigations :
When reflux oesophagitis and/or hiatus hernia is suspected, it will be proved by either gastroscopy, in which a flexible tube is passed down into the stomach, and through which a doctor can see exactly what is happening; or by a barium meal, in which a special fluid is swallowed, and its passage into the stomach (and sometimes its reflux back up into the oesophagus) can be followed by a series of x-rays.


Course :
Heartburn has absolutely nothing to do with the heart. The name derives from the sensation of burning pain or warmth behind the lower end of the breast bone. The pain may spread all the way from the top of the stomach to the back of the mouth. The patient may also experience a bitter taste on the back of the tongue, a feeling of fullness, burping as gas escapes easily from the stomach, difficulty in swallowing, bleeding from the damaged part of the stomach, pain from ulceration or pinching of a hiatus hernia, and palpitations if a large hiatus hernia pushes onto the heart. Heartburn is often worse at night, after a large meal and when the patient is lying down, as it is easier in these situations for the acid to flow up out of the stomach. If the attacks of acid reflux are intermittent and mild, the lower end of the oesophagus can recover between each episode, but if the attacks are regular or constant, the pain will become more severe, and significant damage may occur to the area. A hiatus hernia may may be present but cause no symptoms.


Treatment :
Treatment of reflux involves the appropriate advice with regard to losing weight, propping up the head of the bed, having the main meal in the middle of the day, avoiding bending and heavy lifting, stopping smoking and reducing alcohol (nicotine and alcohol relax the diaphragm muscle ring). Medication can be given to reduce the acid concentration in the stomach (antacids) and to act as a foam that floats on the stomach acid to protect the lower end of the oesophagus. Further treatment will involve the use of medication to drain acid out of the stomach, and reduce acid production (cisapride and other ulcer treatments - see Medication Table) Only in severe, resistant cases is it necessary to resort to quite major surgery to treat the problem. Gravity is the most important factor in keeping the stomach in the abdomen rather than the chest, and the acid in the stomach rather than the oesophagus. Bending over to garden or lift, and any heavy lifting are banned. The head of the bed should be elevated, and three or more pillows used to raise the chest higher than the abdomen. Lying on the right side rather than the left, to enhance the drainage of the stomach, can also be tried. In only a very small percentage of patients, who do not respond adequately to the above regimes, should surgery be contemplated. A number of different procedures can be performed. These are major operations, that require a significant time in hospital, but more than 80% of patients obtain a satisfactory result. Babies with reflux are treated with a mixture (eg: Gaviscon) which is given after every feed. More sophisticated treatments (eg: cisapride - see Medication Table) are available for the intractable cases.


Diet :
The pain can be brought on if certain foods are eaten to excess. Common offenders are salad dressings, peppermints, fatty or fried foods, pineapple, citrus fruits, coffee, alcohol and highly spiced foods. Medications such as aspirin and some arthritis treating drugs can also cause heartburn.


Complications :
If ulcers form in the oesophagus because of acid reflux, they may erode down to a vein or artery, and severe bleeding may occur, that in extreme cases may be life threatening. The other main complication is scarring and narrowing of the lower end of the oesophagus, to the point where it may be difficult, or even impossible, to swallow food. Rarely, if left untreated this process may continue to develop into cancer. Long before these advance stages, most patients have sought medical assistance for the problem. The symptoms of a heart attack may be neglected because the patient thinks it is heartburn. This may have fatal consequences.


Outcome :
The majority of patients can have their heartburn controlled if they follow a doctor's advice, and use the appropriate medication.


Medical curiosity :
In the past, patients with heartburn often got worse with treatment rather better because milk and cream soothed the burning, but increased the patient's weight, thus aggravating the heartburn.

 

Stress Cause Infertility

Stress and infertility are intricately linked. There is little evidence that stress causes infertility but it is well known that infertility causes stress.

Stress is a normal part of life - but many would argue that dealing with infertility isn't normal. Finding ways of dealing with the stresses of infertility help a person cope both with the physical treatments and outcomes that occur.

Many see that management of stress is one of the major roles of infertility counsellors. Counselling is not only for those who aren't coping but talking with the unit counsellor can be a positive way of taking back control of the emotional side of infertility.

Counselling is important when someone is in crisis and maybe needs more therapeutic options. It is also useful and sensible to discuss options, outcomes and ways of managing stress as a way of avoiding situations getting too difficult or out of control.

Obtaining information is also a way of taking control. It is easier to cope if you have as much clear accurate information as you feel you need to make your own decisions. The counsellor isn't a clairvoyant who can predict what is going to happen, but by looking at options and thinking about possible outcomes it will be easier to manage feelings at that time. Thus seeking counselling can be proactive.

All Australian infertility clinics provide access to trained counsellors (social workers or psychologists). Some clinics see counselling as more integral to their service than others. In some states counselling is mandatory and in others it is variable. But however it is offered, counselling is of most benefit when it is client motivated ... when people are doing something for themselves and getting what they want from that service.

As everyone who has been there knows, infertility is more than a medical diagnosis. A diagnosis of infertility brings a range of emotions which can be hard to handle at times happens in the midst of and often linked to a lot of other social pressures such as tense work environment, elderly relatives or pregnant friends.

Most people cope with infertility most of the time, but reactions can be surprisingly strong and unexpected when they do hit. Many a person has seen a counsellor to find out if their emotional responses are normal, to get reassurance that others have similar reactions, and to work on coping techniques. This can also be part of the information gathering - finding out how others have coped and what has helped them.

It can be particularly difficult for people who are used to being able to organise their lives to suddenly come to this big problem - infertility. The usual methods of setting goals and steps to achieve them don't work and even more frustration occurs.

Frustration is one of the most common words used to describe infertility. People get annoyed at not being able to achieve what they want and the usual coping mechanisms aren't being effective. However the very nature of infertility often means that all the annoyances, disappointments and fears are bottled up and it helps to let them out by being able to talk.

The private and sensitive nature of infertility means that a person's usual sources of support may be inappropriate or hard to use at this time. Partners who are usually very supportive may be having their own responses to this crisis and aren't able to help each other. Or it maybe too hard to talk because both are too close to the situation.

Likewise it may be difficult to talk with friends and relatives because they don't really understand or their social circumstances are very different. Sometimes because of their very concern and closeness it may be hard to talk for fear of upsetting them as well.

It may be better to talk with someone who is not personally involved, who understands both the technology and the range of emotions, and who has professional training and experience in this area. This may be useful in untangling confused fears and looking realistically at the situation.

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