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| Sunday, 21 July 2002 |
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Features |  |
| News Business Features Editorial
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Cardiac neurosis is a common symptom among the young in Sri Lanka: mind over heart by Dr. D. P. Atukorale The reaction of the heart to emotional disturbances is obvious to everyone of us. You are aware of the strong beating of your heart during moments of fear. This is due to the stimulation of part of the nervous system called sympathetic nerves which secrete a chemical called catacholamines which in turn cause palpitations by accelerating the heart rate and raising blood pressure.
When these healthy young men and women are examined however one is unable to find evidence of heart disease. Electrocardiograms, X-rays and other cardiac investigations are normal. Recently we came across a young athlete who had all the above features of cardiac neurosis. Extensive investigations showed no evidence of any heart disease. Recently he was seen by an eminent cardiologist in UK who confirmed the diagnosis of cardiac neurosis. Another psychiatric condition which stimulates heart disease is the hyperventilation syndrome which is quite common among young girls. This is characterised by shallow, rapid, irregular respiration sometimes leading to lightheadedness and muscular twitching. The patient may complain of not getting enough air to breath. The heart is quite normal in this condition. Treatment is to give reassurance and psychotherapy. On the other hand there are a number of psychiatric conditions which occur in patients with organic heart disease. These ailments are common among coronary patients. Excessive anxiety may complicate any kind of heart disease and patient may fear that he is about to die or that he will become a helpless cripple in spite of the doctors re-assurance to the contrary. As a result of anxiety these patients have insomnia at night and restlessness by day. Emotional depression may complicate any type of heart disease. Mild depression is a normal reaction to any disease. In coronary thrombosis patients, in whom the awareness of the heart attack comes on relatively suddenly, acute severe depression is not uncommon and skilful psychotherapy often hastens recovery. Personality disorders are not uncommon after heart ailments. In one of these personality disorders the patient seems to lose capacity for doing things for himself and requires help from others even in ordinary matters. Others use the heart ailment as an emotional device for the domination of others. This type of aggressive behaviour is often a nuisance to patient's relations. There is another category of heart patients who refuse to believe that they have heart disease. They neglect to observe the precautions and often neglect treatment. They come physically overactive. These patients if not given correct treatment may get a relapse and often end in premature death. These patients are the chronically elated type or hypomanic type as opposed to depressed type. In other cases, the cardiac neurosis is due to over-protection of the child who has been found to have a "heart murmur" by the family doctor. We sometimes come across teenagers with cardiac neurosis who have not been sent to school because they have been found to have a heart murmur by the family doctor. When these children with heart murmurs are investigated we find that some of them have normal hearts. In Sri Lanka, cardiac neurosis is quite common coronary thrombosis patients and rheumatic heart patients. About two decades ago coronary thrombosis patients were given three months bed rest and a good number of them were cardiac invalids at the time of their discharge from hospital. Now it is known that prolonged bed rest is harmful to "heart attack" patients. With early mobilisation, less anxious attendants and better communication nowadays we rarely see cardiac invalidism. Majority of coronary patients who are admitted to Cardiology Unit leave hospital at the end of one week and majority resume their previous jobs in about twelve weeks. Over the years doctors have been guilty of great sins in creating cardiac neurotics. Till the days of Mackenzie who was a famous physician many a boy was kept in bed for months on account of sinus arrythmia (normal variation in pulse with respiration) and on account of innocent heart murmurs. Today the brunt of cardiac neurosis fall on sufferers of high blood pressure and coronary thrombosis. Unless properly investigated by a cardiac physician any pain in the chest, palpitations and cardiac murmur etc, should be disregarded as unimportant and the patient should lead a normal life. Otherwise the patient may suffer from cardiac neurosis and may become a nervous wreck for life. Such a patient is called a hypochondriac. Phonetic problems in cleft lip and palate patients by Lasni de Alwis (Speech Pathologist and Audiologist) Cleft lip and palate is a congenital disorder most commonly seen in Sri Lanka. It directly affects the communication of the child. The palate separates the oral and nasal cavity. When the two sides of the roof of the mouth do not fuse properly during the developmental period it leaves a cleft in the palate. Sometimes cleft can be seen only in palate. Sometimes it can be seen both in palate and lip or can be seen only in lips. Sometimes it can be extended till the uvula. When the cleft lies under the skin of the palate (called submucous cleft), it cannot be seen at all. Cleft can be bilateral (both the sides) or unilateral (only in one side). Children born with these conditions have problems with feeding, speaking, hearing, psychological and language development, intelligent and educational problems. They require corrective surgery. Most surgeons repair cleft lip when the baby is six to ten weeks old and cleft palate at 6-12 months of age. The exact age for repair will depend on the size and health of the child. A completely formed lip is important not only for a normal facial appearance but also for sucking and to form certain sounds made during speech. In the child with a cleft lip these functions are affected. In some cases clefts of lip, dental arch may both be involved. This may lead to phonetic difficulties (pronunciation problem) in speech. In post surgery there may be poor sensory feed back in the region of the cleft, particularly in the alveolar ridge, which may result in imprecise articulatory placement. Second dentition may be absent or displaced in the cleft. That may create a space for the tongue find difficulty to produce s, z, t, d sounds, occasionally after the lip has been surgically repaired, scar tightness of the upper lip and consequent lack of mobility in speech. The palate has an extremely important role during speech. Because when you speak, it prevents air from blowing out of your nose, instead of your mouth (thus preventing the voice from being hypernasalised). The palate is also very important when eating. It prevents food and liquids from going into the nose. When swallowing, the tongue presses up against the palate and pushes the chewed food to the back of the throat where it then goes down in to the stomach. Therefore it is very difficult to feed the child with cleft lip and palate. There are special ways and special equipment like spoons that have been specially made for such children. Parents should be very careful when feeding a child with cleft lip palate. Palatal sounds of the speech, eg. ja, ch, ya, can be affected in these children, affecting their speech in the process. Other than speech problems the child with cleft lip and palate may have language problems. He may be subject to language delay. There are a number of reasons why these children may be especially prone to language deficit. The early mother baby bonding in which early interaction takes place, is under stress and may therefore provide a poor start. There could also be a number of other factors that could be detrimental to language development eg. hearing loss. Furthermore if a child's speech efforts are not easily understood it will be difficult for parents to reinforce communication efforts. Cleft lip and palate require surgical correction. Long-term communication disorders are likely to result from long periods of hospitalisation. Delayed intervention affects the development of adequate and acceptable speech. Parents of children with cleft lip and palate must consult their family physician and speech pathologist and follow their advice. A number of professionals may be involved in the management of speech therapy for such children. All of them, play a very important role. Even with expert surgical repair, speech training is necessary. Some common fungal infections (a) Ringworm of the scalp: (tinea tonsurans) Symptoms: Presents as multiple, scaly, circular or oval patches of hair loss, either grey coloured ('grey patch' variety) or dotted with stumps of broken hair ('black dot' variety). 'Kerion' (painful, nodular swelling) covered with pustules and 'favus' are the inflammatory variants. Treatment: Use topical and systematic anti-fungal agents for 4-6 weeks, shampooing with selenium sulphide suspension. (b) Tinea Manuum (Ringworm of the hand) This is frequently characterised by diffuse, fine scales on the palm especially noticeable in the palm creases. Treatment: Topical and systematic anti-fungal agents for 8-12 weeks. (c) Tinea pedis ( ringworm of the foot) Commonest type is the intertrigenous type characterised by peeling, maceration and fissuring in the toe web spaces, accompanied by pruritus and malodour. Treatment: Topical and systematic anti-fungal agents for 8-12 weeks. Also try to reduce perspiration (avoid wearing closed footwear and use anti-fungal powders). (d) Oral candidiasis (Thrush) Commonly seen in the very young, very old, or very ill. Diabetes and systematic use of antibiotics, corticosteroids, drugs could be a cause. Symptoms: Appears as creamy white patches, loosely attached to and overflying a bright and oral nucosa. Treatment: Topical application of anti-fungal solutions. Aesthetic Dentistry This year's Annual Scientific Sessions of the Sri Lanka Dental Association centred around developments in the field of "Aesthetic Dentistry". At these recently concluded sessions, Dr. Madhava Murthy from Bangalore spoke on "advanced restoratives and beauty with functionality". This is a form of treatment which is more cosmetic than for the treatment of dental ailment. Through it those with broken or chipped teeth can have their teeth restored through use of a special technique which is fast replacing the conventional tooth capping" method."Today, no one need hide their smile because of a chipped tooth or wide gaps," said Dr. Murthy. Composite resin has a range of white to ensure the right match for a natural look. To the question "is it costly?" Dr. Murthy's answer was "what is the price of looking and feeling good - especially when your tooth will last longer than a dress or a suit that may cost the same amount?" Health update... Soy-beef burgers! Meet a new cholesterol fighter: beef. Unlikely as that sounds, researchers found in a study released last week that adding soy to lean ground beef turned it into a cholesterol-reducing substance. Cancer link in cod liver oil Dangerous levels of chemicals linked to cancer have been found in cod liver oil sold by two British retailers, the Food Standards Agency said. Two types of fish oil supplements sold by Superdrug and Holland & Barrett were found to have at least twice the daily tolerance level of dioxin and dioxin-like PCBs if the products were consumed at the dosage suggested on the packaging. The FSA has called for the fish oils to be withdrawn from sale. Dioxins and PCBs are potentially cancer-causing chemicals produced by industrial activity, which are present in the environment and food. Potential risks to health come from long-term exposure to high levels. Courtesy: The Hindu News Flash Hotline for STDs/AIDS The Health Dept. has introduced a hotline to provide the public with correct information on Sexually Transmitted Diseases (STDs). It will operate on all working days from 9 a.m. to 3 p.m. and on Saturday from 9 a.m. to 12 noon. The Hotline number is 667162. |
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News | Business | Features
| Editorial | Security Produced by Lake House |
In view of the key position the heart occupies in our body the heart
may be profoundly influenced by psychological and psychiatric states.
There is one disorder that is apparently psychogenic in its origin which
continues to disable many young men and women called "irritable
heart" (also called neurocirculatory asthenia). In this discorder,
the people who are affected are very young males and females usually
between the ages of 16 and 25. These patients complain of palpitations,
difficulty in breathing fatigue sharp left sided chest pain, sweating of
palms, headache dizziness and fainting attacks.
