Free Medical Advice Online by Vivienne Balonwu

What is Brain Tumor?

Brain Tumor

This is the name given to a number of tumours that can affect the brain, where a group of cells grow out of control too quickly and too irregularly. This is the basis for all cancers, and there are different types affecting the brain. These are named depending on the area and cells affected, and there may be more than one name for one type of tumour, which can be confusing. Tumours that originate solely in the brain are called primary tumours whereas other body tumours that have spread to the brain are called secondary tumours.

What causes Brain Tumour?

The cause of brain tumours remains unclear and although many possible causes have been suggested, there is little good scientific evidence for any of them.

What Are The Signs And Symptoms Of Brain Tumor?

Most brain tumours cause headaches, nausea and vomiting in their early stages due to the increasing pressure developing within the head as the tumour grows. The type of headache is often characteristic in that it is usually worse in the morning (sometimes bad enough to wake you up) and on coughing, sneezing or bending forward – i.e. any activity that increases the pressure in the head temporarily.

Another sign may be an epileptic fit, or seizure that can occur out of the blue and which may be very frightening. Blurred or double vision is relatively common also, as is early morning sickness often linked to the headache.

It is often the case that any other symptoms experienced are linked to where in the brain the tumour is located. Thus, tumours at the front of the brain can cause mood swings, personality disorders and weakness of one side of the body whereas ones at the side of the brain can cause strange smells, blackouts or feelings of deja vu.

Will I Have Any Tests Or Investigations?

Your doctor will refer you to a neurologist or a neurosurgeon – consultants who specialize in diseases of the brain and nervous system. They will do quite a number of tests, starting with a very detailed physical examination. This will include;

• An examination of the back of the eye using a special type of torch (an ophthalmoscope) – this can see whether the optic disc at the back of the eye is swollen, a sign of raised pressure within the brain (raised intracranial pressure).
• Hearing tests.
• Examination of the tongue, facial muscles and reflexes.
• Testing for power and sensation in the arms and legs.

Other investigations are then usually performed to confirm the presence or otherwise of any brain tumours including special brain scans. A CAT (computerised axial tomography) scan is a special X-ray that takes a series of pictures of the head and so builds up a cross-sectional image of the brain. A dye is injected into your arm to help the detail of the pictures here.

A similar scan, but one that uses magnetism instead of X-rays is an MRI (magnetic resonance imaging) scan, and involves slowly passing through a long cylindrical tube whilst lying completely still as the scan is taken. Dye is used as in the CT scan, and both types of scan are painless.

A newer type of scan, and one which is not always readily available, is a PET (positron emission tomography) scan where radioactive sugar solution is injected, and can show whether a tumour is benign or malignant, or whether it is active at present. The dose of radiation is no greater than that used in an ordinary X-ray, and there are no harmful side effects from it.

A chest X-ray is taken as standard, as is a skull X-ray which can occasionally show up tumours on them. An EEG (electrencephalogram) records the electrical activity within the brain, with wires being painlessly attached to the head using a special gel that washes out easily afterwards. This gives a tracing of the brain nerve impulses in the same way that an ECG test records the activity of the heart.

To find out exactly what type of tumour is being dealt with, a biopsy is the only definitive test. Under anaesthetic, a small piece of the tumour is removed and examined under a microscope, allowing exact diagnosis of the tumour to occur.

What Treatment Will I Need?

This depends on whether the tumour is a primary or secondary tumour, and the type of primary tumour involved if it is this type. With primary tumours, the best treatment is to remove them surgically, often followed by radiotherapy (X-ray) treatment to ensure any tumour cells that may have been left behind are killed. If such surgery is not possible, chemotherapy (anti-cancer drugs) are used as the main treatment in courses usually lasting several weeks. Other treatment may also be needed at the same time, such as medication to prevent any fits or to reduce the pressure inside the brain due to swelling.

Secondary tumour treatment depends on where these have arisen from (e.g. breast or bowel cancer). The usual treatment is radiotherapy to shrink down these secondary cancers as well as treating the primary tumour according to its type and location. With secondary tumours, the whole aim of treatment is to reduce any symptoms and improve the quality of life in general.

What Course Will The Illness Follow?

This is individual for each person, and your specialist will be able to give you very good advice as to what symptoms you may expect, and how readily your tumour should respond to treatment. It should be remembered that many people have brain tumours and are treated in many different ways, so the fact you are having a different treatment to another patient does not necessarily mean yours is a more serious type.

Can I Do Anything To Help Myself?

A positive mental attitude is important at this time, and there are many self-help groups that are able to give practical and pragmatic advice to help you through your treatment. If you are unsure about any aspect of your treatment – ask. Your doctor or specialist should be only too happy to try to answer your questions and reduce any unnecessary anxiety.

Tell Your Doctor

1. Have you been woken up at night by a headache?
2. Have you been sick?
3. Do you have any problems with your eyesight?
4. Have you been falling over or more clumsy recently?
5. Do you feel generally unwell?

Ask Your Doctor

1. How risky is brain surgery?
2. Will I lose my hair with treatment, and what are any other side effects?
3. Do I have to stop driving?
4. Will I need to stay on anti-epileptic drugs for life?
5. How soon can I return to work after treatment?

By Dr Roger Henderson, MB BS Lond., LMSSA Lond. Published by Dr Vivienne Balonwu at Free Medical Advice Online.

Useful Contacts:

Cancer Research Campaign
Address: 10 Cambridge Terrace, London, NW1 4JL
Telephone: 0171 224 1333
Website: http://www.crc.org.uk

Free Medical Advice Online by Vivienne Balonwu

What is Influenza Or Flu And What Causes Flu?

Influenza Suffer

Like a cold, influenza or flu means you have picked up a virus, which is passed on by coughing, sneezing or physical contact. In both cases you cannot treat or cure the infection itself, only its symptoms. Antibiotics will make no difference to flu unless you have a ’secondary’ infection of the middle ear or chest.

A heavy cold can easily be mistaken for influenza, although flu is much less common and often spreads rapidly as an outbreak or, worse, an epidemic. The effects of flu, which infects the body’s breathing passages or respiratory tract, are more severe and can take longer to clear up than cold symptoms.

Flu is not normally dangerous, unless it strikes someone who is already ill or weak, or triggers off acute pneumonia – which is rare. If you are in a high-risk group you can arrange for an annual flu vaccination, which is around 70 per cent effective at preventing infection.

Catching one of the three main types of flu virus (A, B and C) will give you resistance to that particular virus in the future. Unfortunately, type B and (especially) type A produce new strains that your body’s natural defences cannot recognise or fight off – so you may get flu again and again.

How Do I Know If I Have Influenza?

Flu often comes on quite suddenly. The first symptoms are usually a fever, shivering, weakness, a headache, aching muscles and bones, tiredness and loss of appetite. A cough, sore throat and runny nose will normally follow.
After a couple of days your temperature will probably come down and the initial symptoms should be gone within a week. The cough, sore throat and runny nose will take longer, however, and you may feel tired and under the weather for a good two weeks.

What Can I Do Immediately To Make My Influenza better?

• Rest in bed and make sure your room is warm and well-ventilated.

• Soothe your throat and replace lost fluids by having plenty to drink. A hot drink made with honey and lemon or blackcurrant is preferable to tea or coffee.

• Do not smoke as this will make your symptoms worse.

• Try to eat a little, even if you do not feel up to it. If children are reluctant to eat, you could try extra drinks and semi-solid foods such as porridge or yoghurt.

• Treat your symptoms as you would those of a heavy cold – e.g., painkillers for a headache and fever, throat lozenges or gargling salt water for a sore throat, steam inhalations or cough medicines for a cough.

• Bring down a child’s temperature by sponging with lukewarm water.

• Remember to cover your mouth and nose when you sneeze, put your hand over your mouth when you cough and wash your hands regularly. This will help to avoid spreading infection.

• Do not rush back to work as soon as you feel better. Allow time for a full recovery.
What can I do generally to avoid catching flu?

• Steer clear of people who have the virus.

• Avoid places that are crowded or badly ventilated, particularly in winter when flu is more common.

• During the winter months, stay fit and healthy (and keep your body’s natural defences in shape) by eating and sleeping properly. Too much stress or a hectic lifestyle can lower your resistance to infection.

• Ask your doctor about having a flu vaccination if you are elderly and living in a nursing or residential home, over 80 years old, pregnant or have:

¤ a chronic respiratory disorder such as bronchitis, asthma, emphysema or cystic fibrosis
¤ a chronic heart condition
¤ diabetes
¤ kidney disease
¤ liver disease
¤ reduced resistance to infection, e.g., if you are having chemotherapy.

What Treatments Can I Buy Without A Prescription?

Your pharmacist will stock a variety of products for relieving the symptoms of flu, either separately or in combination. Some products, for example, contain a strong dose of painkiller together with ingredients for cough and a blocked or runny nose.
Ask your pharmacist which product is best for you and be careful not to mix products with the same ingredients in them. If your child has flu, get advice from your pharmacist on suitable medicines. Never give aspirin to a child under 12 years old.
For adults, paracetamol is useful for relieving a headache and bringing down a fever, while aching muscles and bones can be eased with soluble aspirin or ibuprofen every four to six hours (do not exceed the recommended doses).

When Do I Need To See A Doctor?

• If you are elderly or frail.
• If your temperature rises above 40°C.
• If your child’s temperature stays above 39°C for more than 24 hours.
• If your baby’s temperature is higher than 38.5°C.
• If you still have a fever after four days.
• If you are in a high-risk category (see above).
• If your symptoms get worse, you develop chest pain or are short of breath.
• If you are coughing up yellow or greenish phlegm.
• If you have severe earache.
• If you were recently in a country where there is a risk of malaria.
• If your baby or child is refusing to drink.
• If your child is sick and starts behaving strangely.

You Should Contact A Doctor Immediately If:

• Your child is weak.
• Your child is having problems breathing.
• Your child seems to find it painful breathing in.
• Your child has diarrhoea and is vomiting or refusing to drink.
• You, your child or baby show any signs of meningitis, e.g.

¤ a high temperature
¤ a persistent headache
¤ a stiff neck
¤ nausea or vomiting
¤ drowsiness or confusion
¤ dislike of bright light
¤ a red/blue skin rash

Babies

¤ a tight or bulging fontanelle (the soft spot on top of a baby’s head)
¤ listlessness
¤ a blank expression
¤ heavy or repeated vomiting
¤ refusal to feed
¤ high-pitched crying
¤ an arched back
¤ pale or blotchy skin with red or blue/black bruises

Note: Babies may display these symptoms without having a fever.

In Summary …

• Rest in bed and stay at home until you have fully recovered.
• Have plenty of fluids, particularly hot drinks to soothe your throat.
• Try to eat
• Treat your symptoms with home remedies or non-prescription medicines such as painkillers.
• Call a doctor if you develop worrying symptoms or are in an at-risk group.

By Peter Mansell, Edited by Dr Peter Stott. Published by Dr Vivienne Balonwu at Free Medical Advice Online.

Free Medical Advice Online by Vivienne Balonwu

What Is Head Lice And What Causes Head Lice Infestation?

Head Lice

Head lice are tiny insects – no bigger than the head of a pin – that live on human hair, and feed by sucking blood from the scalp. Their egg cases are called ‘nits’ and these are always hatched or empty egg shells so their presence does not necessarily indicate active infestation. Once hatched, these shells are harmless. Head lice most commonly affect children, but adults in infected families can also get them. Lice cannot survive out of the hair, and cannot be transferred to animals or pets. They are spread only by relatively prolonged head to head contact, not by brief or fleeting contact, and they walk – not jump – from one person to another.

Any lice which are seen on someone’s clothes or back are incapable of transferring to another person and it is impossible to pick them up from towels, bedding or clothing. It is a fallacy that lice only live in dirty hair – they are found just as frequently in scrupulously clean households. They are seen most frequently in children between the ages of 4 and 11, with girls showing a slightly greater infection rate, possibly due to the length of their hair.

What Are The Signs And Symptoms Of Head Lice?

The main symptom is one of scalp itching, and this can be intense with considerable associated scratching. It can take several weeks for this itching to develop.This scratching can break the scalp skin, and so there may be an associated secondary skin infection which is often painful and may bleed.

Will I Have Any Tests Or Investigations For Head Lice?

Not as such, but it is always best to confirm the presence of active lice by using a special lice detector comb. This is the most effective way to spot them. The hair should be dampened and then combed carefully from the roots to the tips onto a clean sheet of paper. If lice are present they will be seen on the paper or the comb.

What Is The Treatment For Head Lice?

The treatment consists of insecticide lotions or shampoos applied regularly to kill both any live lice and eggs. The current practice in the UK is to use one insecticide for a course of treatment (two applications spaced one week apart) and if this treatment fails, to use another product whose active ingredient is in a different insecticide class. The current insecticides in use in the UK are malathion, the pyrethroids permethrin and phenothrin (all available over the counter from chemists without prescription) and carbaryl (prescription only).

In general, carbaryl is kept in reserve if all else fails. Another method of treating head lice is sometimes followed in the UK called ‘bug busting’. Here, the hair is wet combed intensely, using a special fine toothed comb and conditioner for at least 30 minutes every third day for a week. It remains unclear as to whether this method is any more or less effective than insecticide treatments and is time consuming for parents and children.

What Course Will Infestation With Head Lice Follow?

If treated effectively and correctly, head lice can be readily cleared. If they are left however, they will not disappear by themselves so treatment is the only option.

Can I Do Anything To Help Myself?

It can be impossible to prevent schoolchildren from catching head lice but prompt treatment and regular checking using a lice detector comb will mean their inconvenience is kept to a minimum.

Tell Your Doctor

1. Have you seen any lice or nits on your child or yourself?
2. Have you used a nit detector comb?
3. Do any of your child’s friends have head lice?
4. Has your child been scratching their head?
5. Have you used any treatments yourself?

Ask Your Doctor

1. Will ordinary shampoo remove lice?
2. Is there resistance to any of the treatments?
3. Are there any side effects?
4. Do I need to tell anyone about getting lice?
5. Does my whole family need treatment?

By Dr Roger Henderson, MB BS Lond., LMSSA Lond. Medical advice on head lice is published by Dr Vivienne Balonwu.

Free Medical Advice Online by Vivienne Balonwu

What Is Glaucoma?

Glaucoma

This is a disease of the eye, where the normal fluid pressure inside the eye gradually increases, leading to problems with vision or even blindness on occasions.

What Causes Glaucoma?

The basic problem in glaucoma is in the small space at the front of the eye, called the anterior chamber. There is normally a steady flow of clear eye fluid in and out of this chamber, bathing and nourishing the eye. For reasons which still remain unclear, in glaucoma this fluid begins to drain out too slowly and so the fluid pressure slowly builds up in the eye. This excess pressure causes damage to the optic nerve, which connects the light-sensitive retina at the back of the eye to the brain. It is the health of this optic nerve which is necessary for healthy vision and so progressive damage to it from glaucoma slowly damages the eyesight. Most people suffer from a form of glaucoma called ‘open-angle glaucoma’.

What Are Glaucoma Symptoms And Signs?

Initially there are no symptoms in open – angle glaucoma. There is no pain, and the vision is normal. However, if the glaucoma remains untreated, a person may notice that although they can see things directly in front of them clearly, anything to one side of their vision appears blurred or foggy. They may fail to see objects to one side of them, and feel as if they are ‘looking through a tunnel’. Over time, their vision may gradually disappear to nothing.

Will I Have Any Tests Or Investigations?

Specialized tests are vital for the diagnosis of glaucoma to be accurately made.

There are 4 main tests;

* 1. Visual acuity. This involves using the well-known ‘doctor’s eye chart’ with letters of different sizes on it to measure how well you see at various distances.

* 2. Visual field. This important test measures your side (peripheral) vision, the loss of which is an early sign of glaucoma.

* 3. Pupil dilation. Special drops are put into the eye to dilate the centre of it and allow for the optic nerve to be examined. This means you will have blurred vision for some hours until the drops wear off, and you should not drive in this time.

* 4. Tonometry.There are a number of different types of this test, all of which are designed to measure the fluid pressure inside the eye. A common type is the fair puff’ test which measures the resistance of the eye to a puff of air, and is quick and painless.

What Treatment Might I Need?

Glaucoma is readily treatable, although not curable. The usual treatment is medicines, either in the form of eyedrops or pills. Some of these help to drain excess fluid from inside the eye, and others cause less fluid to be produced in the first place. These have the disadvantage of having to be taken several times each day, and they may also become less effective with time. It is important that your doctor knows any other medicines you may be taking before starting such treatment in order to avoid drug reactions or side effects. Laser surgery is becoming an increasingly popular treatment option. In this case, a strong beam of light (the laser) is focused on the anterior chamber at the front of the eye. This is painless because the eye has been numbed first with anaesthetic eye drops.

You may see little flashes of red or green light, and the laser makes up to 100 evenly spaced burns around the anterior chamber. These allow fluid to drain more easily out of the chamber and so reduce the eye pressure. This is very effective at treating glaucoma, but pressure may slowly increase again after 1 -2 years in some patients. If medication and laser surgery have no effect, ‘conventional’ surgery is then an option and is performed at hospital. A new channel is created for fluid to drain away from the eye, and drops are needed for several weeks afterwards to prevent any swelling or infection. If the new drain in the eye closes up, a second operation is sometimes needed to re-open it again. This type of surgery works better if you have never had eye surgery before. It is always important to remember that the aim of glaucoma surgery is to save sight, not improve it and some people find that although their sight has been saved it is not quite as good as before they had their operation.

What Course Will The Illness Follow?

If untreated or unrecognised, the usual pattern is that the eyesight gradually deteriorates until vision is very poor or blindness occurs. Once treated, regular checks from eye professionals such as opticians and ophthalmologists are vital to make sure the eye pressure is steady and not increasing once more. If the pressure remains the same, the eyesight tends to stay the same also.

Can I Do Anything To Help Myself?

If you are aged over the age of 60, or have a strong family history of glaucoma, or are Afro-Caribbean in race then you should have annual eye checks, even if you are not aware of any eye problems or symptoms.

Tell Your Doctor

1. Do you think your eyesight is getting worse?
2. Can you see things in front of you better than to the side of you?
3. Do you have a family history of glaucoma or eye problems?
4. Have you ever had problems with eye tests in the past?
5. Have you had your glasses changed recently?

Ask Your Doctor

1. What are the side effects of treatment?
2. Am I allowed to drive with glaucoma?
3. What extra risk do my children have of developing glaucoma?
4. Can I go straight to laser surgery without needing to try medication?
5. Does eyestrain make glaucoma worse?

By Dr Roger Henderson, MB BS Lond., LMSSA Lond. Free medical advice on glaucoma is published by Dr Viv Balonwu.
For further information on glaucoma, visit International Glaucoma Association.

Free Medical Advice Online by Vivienne Balonwu

What is Stroke?

A stroke is when a part of the brain suddenly becomes unable to function. This is due to a lack of oxygen, and so all strokes have the common factor of disease affecting the blood supply to the brain. This usually occurs with little or no warning, and causes weakness and paralysis of any part of the body depending on the part of the brain affected. In the United Kingdom, someone has a stroke every 5 minutes.

What Causes Stroke?

The main cause of a stroke is a blockage to the blood flow, or the bursting of an artery to the brain. When an artery is blocked, this is called a cerebral infarction. When there is bleeding into the brain, it is called a cerebral haemorrhage. There is a third kind of stroke, called an embolic stroke. This is where a blood clot travels through the body and blocks an artery in the brain to form a plug, or embolism.
The diseases which cause strokes to occur are similar to those which cause heart disease. Arteries in the brain may block due to them being furred up by fatty material in the same way that heart arteries become blocked and cause heart attacks. Blood clots can arise from heart diseases where the heart has an irregular rhythm, or where there is damage to the valves of the heart. When a cerebral haemorrhage occurs, the commonest cause is due to a weakness in the wall of an artery – called an aneurysm. These are sometimes present in people from birth as an inherited weakness, but more commonly are the result of high blood pressure.

What Are The Signs And Symptoms Of Stroke?

Any symptoms that occur after a stroke are immediate, and depend both on the area of the brain involved and the degree of damage caused. The commonest symptom is weakness or paralysis of one side of the body. There may be loss of sensation and movement of part of an arm or leg, or complete loss of any function along one side of the body. Speech is often affected, along with facial weakness and tingling or numbness of the face. If the stroke affects the base of the brain, there may be problems with swallowing, breathing and consciousness.
Some patients have a warning attack some time before a major stroke. This is often in the form of a short-lived weakness or numbness down one side, or a temporary problem with speaking. These are called TIAs – transient ischaemic attacks – and are usually completely better within 24 hours.

Will I Have Any Tests Or Investigations For Stroke?

The main test of use if a stroke is suspected is called a CT scan. This will not only rule out any other possible causes for a patients symptoms, but is also able to confirm whether a stroke is due to a clot or bleeding. If it is due to a clot, the heart will be tested for any source of these such as valve problems. It may also be necessary to perform a soundwave test called a carotid ultrasound, which looks at the arteries in the neck to see if there is any kind of blockage to the blood flow there. A neurologist – a doctor specialising in brain disorders – may assist in the diagnosis and management of stroke patients. The main care of patients who have had a stroke however remains good nursing care.

What Treatment Might I Need?

Initially, if the blood pressure is found to be high, this will be lowered by medication. If a clot is the cause, aspirin is started and if it is found there are problems with the heart valves, warfarin – a blood thinning drug – will be used. Any rise in the blood sugar level, which often occurs after a stroke, will be closely controlled, and oxygen may be needed in the early stages to try to minimise the brain damage.

What Course Will The Illness Follow?

This entirely depends on the severity of the stroke and how much damage it has caused. In the early stages there may be problems with swallowing, which in turn can lead to breathing difficulties or chest infections. Once a patient’s condition has settled however, attention is turned to maximising the function that remains. This involves intensive treatment by physiotherapists to improve mobility, occupational therapists (who use a wide variety of activities to help regain dexterity), and speech therapy. The aim is always for the patient to resume as many of their pre-stroke activities as possible, but a total return to their previous condition is the exception rather than the rule. Physical therapy may continue following discharge home, but some stroke patients cannot be cared for adequately at home and so need residential or nursing home care long-term.

Can I Do Anything To Help Myself?

The main factor is to identify and treat high blood pressure – this alone reduces the risk of stroke considerably. Just as important is stopping smoking since the furring up of arteries in the brain and neck is greatly speeded up by smoking. If there is any diabetes, a good control of the body’s sugar level is very important as is controlling the level of cholesterol in the blood, either by diet or tablets. Should the heart be beating irregularly, tablets such as digoxin should control this. This is often used in combination with aspirin or warfarin as blood thinning medicines to reduce the risk of any further strokes.

Tell Your Doctor

1. Did your symptoms occur suddenly?
2. Do you smoke?
3. Does anyone else in your family have similar problems?
4. Have you been treated for high blood pressure in the past?
5. Have you ever had what have seemed like stroke symptoms, but which have disappeared after 24 hours?

Ask Your Doctor

1. Am I at risk of a further stroke?
2. How often will I need my blood pressure checked?
3.What help can I get at home to help me with mobility and my daily activities?
4. If I am able to do them, will activity or exercise hurt me?
5. Will I need to stay on Aspirin or other tablets for life?

By Dr Roger Henderson, MB BS Lond., LMSSA Lond. Free Medical Advice Online, Published by Dr Vivienne Balonwu. Get advice, further information and help from The Stroke Association.

Free Medical Advice Online by Vivienne Balonwu

What Is Heart Attack?

A heart attack (sometimes called a coronary, a coronary thrombosis, or a myocardial infarction or ‘MI’) is when part of the heart muscle stops working because not enough oxygen is able to reach it through the heart’s blood supply – the coronary arteries. Any heart tissue that stops working during a heart attack is replaced by scar tissue that is unable to work again and will not heal. Therefore the more heart tissue that is starved of oxygen, the less well the heart can function after a heart attack.

What Are The Causes Of Heart Attack?

The blood supply to the heart is usually stopped by a blood clot in the coronary arteries, causing the heart attack. The arteries are narrowed in places due to ‘plaques’ – a build-up of the fatty substance cholesterol over many years. As this build-up of cholesterol increases, the arteries narrow – a process known as atherosclerosis. This process is speeded up by many other things, including smoking, high blood pressure, too much fat in the diet and diabetes. Being at risk of having a heart attack may also be passed down a family, as having parents or other relatives who have had a heart attack can incease the risk of having a heart attack. Most heart attacks occur in middle-aged men, and are rare under the age of 35. Women tend to have their heart attacks after their menopause.

What Are The Signs And Symptoms Of Heart Attack?

The main symptom is a dull, ‘heavy’ type of chest pain, usually in the centre of the chest. This is often described as a ‘pressure’ or ‘like someone sitting on my chest’ or an indigestion-like symptom. Pain may be felt in the jaw. There is usually some sweating and a feeling of being sick, or actual vomiting. The patient looks unwell, with a greyish colour and may be short of breath. However, up to a quarter of all heart attacks either have no symptoms – a ’silent’ heart attack – or very mild symptoms which may be ignored by the patient. The most common time for heart attacks to occur is in the early morning, from 5 am to 10am.

Will I Have Any Tests Or Investigations?

The medical history and appearance of the patient will suggest to the doctor a diagnosis of a heart attack. This diagnosis is confirmed by an electrocardiogram (ECG) which shows the heart beat and electrical pattern of the heart. This shows up any non-working tissue in the heart as well as any heart muscle which is short of oxygen. A heart attack will produce very characteristic changes on an ECG tracing. If the ECG appears normal, or if the changes are only mild or borderline, then blood tests carried out some hours later can confirm whether there has been damage to the heart muscle or not. These tests pick up proteins which are released into the blood from heart muscle that has stopped working.

What Treatment Might I Need?

The aim of treatment is to restore the blood supply to the heart as quickly as possible this will stop a heart attack. The best way to do this is to dissolve the blood clot in the artery – a process called thrombolysis. The simplest way to do this is to give the person a dissolvable aspirin tablet under their tongue if they are conscious since this will begin thinning the blood immediately. Once in hospital, ‘clot-busting’ drugs can be given to continue this treatment, and these will open the majority of blocked blood vessels within 90 minutes.

These drugs are usually given on a coronary care ward which specialises in dealing with heart attacks. Speed is important here as most of the permanent muscle damage caused by a heart attack has taken place by 6 hours after the start of the attack. In specialised centres, patients may be given an angioplasty which is where a tiny balloon (known as a catheter) is pushed into the artery under X-ray guidance and to the site of the blockage before being inflated. This pushes the clot and plaque out of the way and so restores the circulation in the heart to normal again. Tablets may be given to prevent any complications. These include:

ß-blockers – which reduce the strain on the heart. These drugs may need to be taken for life.

ACE inhibitors – another class of drugs – which improve the heart muscle healing process.

What Course Will The Illness Follow?

Most patients admitted to a coronary care unit will spend several days there being monitored before being transferred to a general ward. They will be encouraged to begin walking around after a few days and will be monitored for any problems with the heart rhythm, shortness of breath or further chest pain. If a patient continues to suffer with any of the above problems, they may need further treatment, such as a change in medication, angioplasty or heart surgery. Provided there are no complications, most patients are allowed home after 5 to 8 days, and recovery is gradual. The time needed to return to normal activities depends on the size of the heart damage, with most patients being able to resume normal daily and sexual activity within 3-4 weeks. During this recovery period, vigorous exertion should be avoided such as heavy lifting or any work which causes sweating or shortness of breath.

Can I Do Anything To Help Myself?

As well as continuing to take regular medicines such as aspirin and ß-blockers, there are a number of ways to prevent the chances of a further heart attack:
1. The most important one is to stop smoking and never start again.
2. Losing weight reduces the strain on the heart, as does controlling any high blood pressure.
3. A low-fat diet will reduce the amount of cholesterol in the blood, and regular steady exercise will strengthen the heart muscle.
4. Try to reduce the amount of stress you may be under, which may mean taking a long look at your job and pace of life in general.

Tell Your Doctor

1. What symptoms do you have?
2. What type of pain is it?
3. When did the symptoms begin?
4. What were you doing at the time?
5. Does anyone in your family have heart problems?
6. Do you smoke?
7. Have you had any similar symptoms before?
8. Are your symptoms getting worse or better?

Ask Your Doctor

1. Is my heart beating regularly?
2. Will I recover normally?
3. Do I need to stay on treatment for life?
4. Are any of my family at increased risk of heart problems?
5. Will I be able to return to my usual work?

By Roger Henderson, MB BS, LMSSA

Free Online Medical Advice published by Viv Balonwu.

Free Medical Advice Online by Vivienne Balonwu

Uterine Fibroids, What are they?

Uterine Fibroids

Uterine fibroids are ‘knots’ or hard ‘balls’ of muscle fibres that grow in the muscular part of the wall of a woman’s uterus, or womb.

They are very common, occurring in about 10% of women in the UK, and can be single or multiple.

Their size varies from miniscule to large, and they can occur in any part of the womb including the cervix.

They always develop during a woman’s fertile years, and tend to shrink in size after the menopause, suggesting they grow as a result of exposure to the hormone oestrogen.

What causes Uterine Fibroids?

This is unknown. They are more common in black women, and less common in thin women who have never been pregnant, or who have been on the Pill for at least 10 years continuously.

What Are The Signs And Symptoms Of Fibroid Tumors?

Most women are unaware they have fibroids. They are often discovered by doctors at well-women clinics or during examinations for other conditions. Any symptoms reported are usually of very heavy, painful periods with ‘flooding’ and the passage of blood clots. There may be abdominal pain or pain on intercourse, and very occasionally there may be fertility problems such as recurrent miscarriages.

Will I Have Any Tests Or Investigations?

Most fibroids can be felt by a vaginal examination, and present as firm lumps inside the womb. This is usually followed up by an ultrasound scan – such as pregnant women have – which clearly show them up.

What Fibroid Treatment Might I Need?

This depends entirely on the symptoms they cause since many women with fibroids have no problems whatsoever and so need no treatment. Some specialists may recommend tablet treatment called ‘GnRH analogues’ which can cause fibroids to shrink, but the most effective treatment remains surgery. This always used to involve a hysterectomy – where the whole womb was removed, but many women are now favouring two newer techniques;

1. Myomectomy – the fibroids alone are removed, leaving the rest of the womb intact. This is a much more difficult operation to perform, and is not undertaken by all consultant gynaecologists as it can sometimes cause heavy bleeding and may not cure the problem of flooding / heavy periods.

2. Endometrial resection – here a special wire fshaves away’ the lining of the womb under general anaesthetic. This is often better at stopping the problem of heavy periods but does not remove all of the fibroid.

What course will the illness follow?

If there are no symptoms, many ladies never need treatment. Fibroids often gradually enlarge until the menopause, when they begin to shrink back down again. Symptoms may therefore increase and decrease with age.

Can I Do Anything To Help Myself?

Although fibroids cannot be prevented, some women with small fibroids find that alternative treatments such as acupuncture, homeopathy or reflexology help their symptoms. If your periods are heavy, ask your doctor if you need to be tested for anaemia.

Tell Your Doctor

1. Have your periods become heavier or more painful?
2. Do you pass clots during a period?
3. Do you have any unusual abdominal pain or pain on intercourse?
4. Do you want any more children in the future?
5. Have you had recurrent miscarriages in the past?

Ask Your Doctor

1. If I get pregnant, can fibroids be a problem?
2. Can fibroids become cancerous?
3. What side effects do any drug treatments have?
4. Am I still able to have hormone replacement therapy?
5. What do I do if my local specialists are not keen on doing endometrial resections but I would like this as a form of treatment?

By Roger Henderson

Free medical advice online published by Vivienne Balonwu.

Free Medical Advice Online by Vivienne Balonwu

Sickle Cell Anemia, Disease and Treatment

Sickled Red Blood Cells

This is an inherited blood disease, mainly affecting Afro-Caribbean’s and black Americans/Africans but is not an exclusively ‘black’ disease – it simply affects a disproportionately higher number of people than a Caucasian population. It affects the haemoglobin in the blood, which is the oxygen-carrying part, and is one of the commonest inherited blood diseases.

The abnormality means that the distorted or ’sickled’ red blood cells are much more fragile than normal red cells and so are more likely to burst or rupture. This causes the symptoms, and also can cause anaemia – known as sickle cell anaemia. People with sickle cell disease who are especially prone to problems include pregnant women, dehydrated people or those undergoing an anaesthetic, or if body injuries occur.

What Causes Sickle Cell Anaemia

This is a genetic condition, passed on by parents to their children. For it to occur, a sickle cell gene must be inherited from both the father and mother, so that an affected child has two sickle genes. If just one is present, this is known as a sickle cell trait rather than sickle cell disease, and sickle cell trait does not cause sickle anaemia. If two parents with sickle trait have a child, this child has a one in four chance of having sickle cell anaemia. Sickle cell trait has a greatly lowered incidence of symptoms, with a normal life expectancy.

Signs And Symptoms Of Sickle Cell Anaemia

These are due to problems of the circulation, caused by the abnormal ’sickle’ shaped red blood cells blocking the normal flow of blood through the body, and so reducing the oxygen supply to organs. Such an episode is known as a sickle ‘crisis’, and causes varying symptom severity depending on the organ involved and the degree of sickling. Such symptoms include;
 
¤ Fatigue and other symptoms of anaemia.

¤ Severe pain.

¤ Swelling of the joints.

¤ Leg ulcers.

¤ Repeated bacterial infections, with lung and heart involvement.

¤ Eye and visual disturbances.

The treatment of these symptoms and of sickle cell disease in general is aimed at whatever individual features are present, and so is a highly individual treatment, with no single treatment available to reverse any long-term damage from repeat crises.

Will I Have Any Tests Or Investigations?

The way of diagnosing the disease is to take a simple blood test and look at the abnormally shaped sickle cells under a microscope – a procedure sometimes called a ’sickle preparation’. A further special blood test called a haemoglobin electrophoresis test accurately identifies blood haemoglobins and sickle blood has a characteristic pattern.

It is now possible to do tests for sickle disease on an unborn baby by using an amniocentesis or chorionic villous sampling method. This is performed by an obstetric specialist and the sample of blood or amniotic fluid is DNA analysed for the presence of sickle cell disease. The lung damage in sickle disease – where small areas of lung tissue die due to a lack of oxygen – can be very difficult to distinguish from pneumonia on ordinary chest X-rays and so a special test called an angiogram is sometimes used to try to differentiate between the two, where dye is injected into the affected area of the lung.

What Treatment Will I Need?

The current treatment is primarily aimed at managing the individual features of the disease as they occur. The anaemia usually settles without specific treatment but occasionally the low level can be such that blood transfusion is required in hospital. A sickle crisis is often extremely painful and requires strong analgesics, oxygen and high fluid input – intravenously if necessary. The drug hydroxyurea is sometimes used in a sickle crisis to help relieve the pain but must be closely monitored for side effects as it may be toxic to bone marrow.

In children with sickle disease, pneumonia is one of the commonest reasons for hospital admission and this is usually due to a bacterium called Pneumococcus. Prompt treatment with antibiotics is needed to reduce any complications or life-threatening infection overwhelming the body.

What Course Will The Illness Follow?

The great majority of people suffering from sickle cell disease suffer repeated attacks of infection, pain crises, anaemia and repeated, progressive damage to internal organs. Most have a reduced life expectancy of the fourth or fifth decade, with bacterial infection being the commonest cause of death at any age. There may be progressive damage to the kidneys, heart, lungs liver and brain, although it is possible for some patients to have virtually no symptoms for months or years at a time – this however tends to be the exception rather than the rule.

Can I Do Anything To Help Myself?

It is important to recognise the early signs of sickle disease and report these promptly to your doctor. Genetic counselling is also playing an increasingly important role in helping to reduce the incidence of the disease since if each parent is a carrier of the illness any offspring has a 50 per cent chance of being a carrier and a 25 per cent chance of inheriting both genes being affected with sickle cell disease.

Tell Your Doctor

1. How recently did your symptoms start?
2. Have you had similar symptoms before?
3. Do both your parents have sickle disease?
4. Have you had a blood test for anaemia recently?
5. Do you have bad pain?
Ask Your Doctor

1. Will I need to go to hospital?
2. Can my spouse and I have genetic tests before we have any children?
3. How long is it usual to stay in hospital?
4. What are any treatment side effects?
5. Should I keep antibiotics at home in case of infection?

By Dr Roger Henderson, MB BS, LMSSA

Free Medical Advice on Sickle Cell Anemia by Vivienne Balonwu.

Free Medical Advice Online by Vivienne Balonwu

Hypothyroidism

The thyroid gland lies in the neck, just below the Adam’s apple. It is responsible for how fast or slow the metabolism of the body runs, and thyroid hormones are essential for the normal and smooth running of the body.

An underactive or hypothyroid gland is the commonest thyroid illness, being more common in women than men and increasing with age. The two important thyroid hormones are thyroxine (T4) and tri-iodothyronine (T3).

The production of these hormones is stimulated by another hormone called thyroid stimulating hormone, or TSH. If levels of thyroid hormones drop, the amount of TSH increases to try to manufacture more – the lower the level of thyroid hormone, the higher the TSH level.

What causes Hypothyroidism?

Possible Causes Of Hypothyroidism Are;

¤ A lack of iodine in the diet (rare in the Western world because iodine is added to table salt).

¤ The thyroid gland is itself attacked by the body – a condition usually called Hashimoto’s thyroiditis.

¤ After thyroid surgery e.g. for thyroid cancer.

¤ After a viral illness or pregnancy – this is usually temporary, and may last 3 to 6 months before a full recovery is made.

¤ Certain medications such as Amiodarone or Lithium.

¤ Primary hypothyroidism – the cause in most people. Here, there is no obvious reason for the thyroid hormones being low and the TSH being high.

What Are Signs And Symptoms Hypothyroidism?

If hypothyroidism is mild there may be no symptoms at all, and any symptoms which occur are sometimes ignored by the patient or put down to ‘age’. They are all caused by the slowed metabolism of the body, so symptoms usually include some or all of the following;

¤ tiredness

¤ weakness

¤ an intolerance or dislike of the cold

¤ constipation

¤ dry skin and dry, coarse hair

¤ a hoarse or ‘croaky’ voice

¤ weight gain

¤ depression

¤ irregular periods

If left untreated, severe hypothyroidism can cause enlargement of the heart, fluid on the lungs and severe drowsiness. In extreme cases, death may ensue.
Will I have any tests or investigations?
Some cases will be obvious from the history and examination of the patient, but blood tests will be needed to confirm the diagnosis. The raised TSH test result is probably the most reliable indicator here, with T3 and T4 levels usually being low.

Treatment Of Hypothyroidism?

This is a simple replacement of thyroid hormone – thyroxine – in tablet form. Most people will need between 100 and 150 micrograms each day, and young patients are usually able to start on the full dose straight away. In the elderly however, starting with smaller doses is sensible to prevent any heart problems.

What Course Will The Illness Follow?

Most people begin to notice their symptoms fading within a few weeks of starting treatment although some may feel radically improved within a few days. Blood tests will be taken every few weeks while the body is reverting to normal, with the aim being to keep the TSH level at between 0.5 and 5 IU/ml. Once this is achieved, tests can be don every six months to a year.

Can I Do Anything To Help Myself?

If you are taking thyroxine, it is important not to stop taking this because you are feeling better. This treatment is for life.

Tell Your Doctor

1. Do you feel the cold more than you used to?
2. Have you put on any weight?
3. Are you falling asleep in the day?
4. Has your hair become thicker or coarser?
5. Have your bowels been a problem lately?

Ask Your Doctor

1. Am I entitled to free prescriptions?
2. Are there any foods I should not eat?
3. Should I stop taking any herbal or mineral supplements?
4. How long should it be before I am feeling better?
5. How underactive is my thyroid gland?

By Dr Roger Henderson, MB BS Lond., LMSSA Lond.

Free Medical Advice on hypothyroidism is provided by Vivienne Balonwu.

Useful Contact:

1. The American Thyroid Association
Address: Townhouse Office Park, 55 Old Nyack Turnpike – Suite 611, Nanuet, New York 10954
Fax: 914 623-3736
Email: admin [at] thyroid.org
Website URL: http://www.thyroid.org/

Free Medical Advice Online by Vivienne Balonwu

Tonsilitis

Tonsillitis is an infection of the tonsils, caused by either bacteria or viruses. Tonsils are groups of tissue, similar to the lymph nodes or ‘glands’ that circle the throat. This circle of tissue is part of a ring of glandular tissue around the throat called Waldeyer’s ring, and the tonsils are found on either side of the back of the throat.

Their purpose is not clear-cut, but their function is probably at its peak in the first few years of life when they may assist the body to make antibodies as part of its defence against infection. Tonsillitis may be acute or chronic.

What Causes Tonsilitis?

Acute tonsillitis is caused by a number of possible bacteria or viruses, with the commonest being the streptococcus bacteria, sometimes being called ’strep throat’. Viral tonsillitis is more common in the winter months, and glandular fever – which can mimic tonsillitis – is caused by the Epstein-Barr virus.

Tonsillitis is more common below the age of six, and then again in adolescence.

Symptoms Of Tonsilitis And Signs

In an acute attack of tonsillitis there is a gradual or sudden onset of a sore throat, sometimes severe, which is often accompanied by a high temperature. It is often difficult to swallow and so the sufferer may drool saliva as a result, and there may be bad breath and earache as well. The tonsils either look bright red and angry or have grey-white spots of pus sitting on their surface. The neck may appear swollen and in children there may be a slight rash over the body as a fine red rash due to the streptococcus bacterium.

In chronic tonsillitis, there is repeated infection of the tonsils and these form pockets of bacteria and infection in unhealthy tonsils. This leads not only to all the symptoms of acute tonsillitis, but small stones (tonsilloliths) are often found in these pockets. These smell offensively of rotten eggs, and give the characteristic bad breath so commonly found in chronic tonsillitis. In some cases the infection is so severe that an abscess forms around the tonsils called a quinsy, usually only affecting one tonsil. This may swell to the extent that swallowing is impossible, and either high-dose antibiotics or draining of the quinsy surgically is needed to reduce the symptoms.

Will I Have Any Tests Or Investigations?

Most doctors will treat tonsillitis depending on whether they believe it is viral or bacterial without any special tests. Some will take a simple throat swab to be examined in a laboratory for any bacteria, and only treat the patient if this proves to be positive for bacteria such as streptococci.

Tonsilitis Medication – What Treatment Might I Need?

Viral tonsillitis is treated conservatively with fluids, rest, paracetamol for temperature control and gargles. Antibiotics have no place in treating viral tonsillitis.

For bacterial tonsillitis, antibiotics are added to this regime, which clear the infection within a few days. It is vital to finish any course of antibiotics once they have been started. Removing the tonsils surgically – tonsillectomy – is considered only in people with repeated infections, especially if they interfere with normal activities such as work or school. As a general guide, six or more attacks each year in children is the yardstick for surgical referral, and in adults it tends to be the effect on lifestyle rather than numbers of attacks that is important. In chronic tonsillitis, bad breath and tonsilloliths are reasons for surgery.

What Course Will Tonsilitis Follow?

Viral tonsillitis will need only simple treatment as described above, and the vast majority of cases of bacterial tonsillitis get better within a few days only. In the rare cases of an abscess forming around the tonsils, this is treated by draining it either by a needle and syringe or by incision – cutting it with a scalpel and allowing the pus to drain. Long courses of antibiotics, sometimes with a brief course of steroids as well, are occasionally used to treat massively enlarged tonsils before removing them.

Tonsillectomy is performed under a general anaesthetic and the tonsils are removed from the wall of the throat, and the blood vessels attached to them are tied off. On average, around 100mls of blood is lost during this operation which is why most children are over the age of 4 before it is performed – below this, such an amount of blood lost may be considered significant. It is a safe procedure, with the usual (but uncommon) complication being bleeding from the operation site either just after the operation or 7 to 10 days later. Children recover very quickly from tonsillectomy, usually returning home within 24 to 48 hours, but adults may need 3 to 4 days in hospital to recover as well as a week or two off work when they have gone home.

Can I Do Anything To Help Myself?

Once tonsils have become chronically unhealthy there is little which can reverse them naturally, but before this point has been reached it is sensible to have a diet rich in vitamins and minerals to try to boost the body’s defences against infection. It is best to seek a medical opinion about bacterial tonsillitis sooner rather than later in order to try to prevent the formation of tonsilloliths in the future.

Tell Your Doctor

1. Have you had similar symptoms before?
2. Do your symptoms prevent you from opening your mouth properly?
3. Are you able to swallow normally?
4. Are you losing time off school or work because of your symptoms?
5. Do you have more than 5 attacks like this every year?

Ask Your Doctor

1. Do I need my tonsils removing?
2. Are there any problems in having repeated courses of antibiotics?
3. Do I need to see a specialist at any time?
4. Can enlarged tonsils ever be very dangerous?
5. Are there any natural alternatives to antibiotics?

By Dr Roger Henderson, MB BS, LMSSA

Free medical advice Online published by Vivienne Balonwu.