|
|
 |
 |
| Sunday, 11 May 2003 |
 |
|
 |
Features |  |
| News Business Features Editorial
|
Compiled by Carol Aloysius World Asthma Day was on May 6 : When your child begins to wheeze ... Wheezing refers to noisy breathing due to obstruction to the passage of air into the lungs. Wheezing in childhood is a common illness. In Sri Lanka, around 20 per cent of children under five years of age are affected. What changes in the lungs cause wheezing?
Due to the narrowing of the space inside the bronchi, the smooth passage of air in and out of the lungs is interfered with, more so the expulsion of the air during expiration, because expiration is a passive process and therefore a less powerful process than inspiration. When air is propelled out of the narrowed spaces of the bronchi, an abnormal noise occurs (during expiration). This noise, which is similar to the noise that occurs when air is forced through a narrow tube, such as a flute or whistle, is called a wheeze. There is a belief that childhood wheezing will gradually clear up after the seventh birthday. This belief is true in most cases. As a child grows, the size of the bronchi becomes larger. Thereby the size of the lumen of the bronchi becomes larger, and there is therefore a lesser chance of an obstruction to the pathway of the air, especially in the mild and moderate cases. Causes There are some persons who have an inborn (hereditary) susceptibility to develop asthma. However, susceptibility by itself does not provoke an attack of asthma. Asthma occurs in such a susceptible person only when some other conditions are present. These are referred to as precipitating factors. Allergy is closely linked to bronchial asthma. This is a condition where people react in an over-sensitive (hyper-sensitive) way to certain substances. They are: Certain microscopic (very small) particles that are inhaled during inspiration such as * Dust * House dust mite, which cannot be seen by the naked eye (seen only through a microscope) is one of the commonest precipitating factors. It is often found on carpets, rugs, bed sheets, pillows, etc. * The fur of cats and dogs, or feathers (poultry, birds); also cockroaches * Pollens of flowers of grass * Spores from fungi (moulds). . Rarely, certain foods such as eggs, red fish (blood fish) such as "bala" (skipjak) and "kelawalla", shell fish; fruits such as pineapple and passion fruit. . Certain drugs such as aspirin and certain chemicals that are added to foods, such as sodium monoglutamate (Ajinomoto), or sodium meta-sulphite, a preservative in cordials and aerated waters. It should be noted that all asthmatic patients are not allergic to all the substances mentioned above. They vary from one person to another, and may include one or more of those mentioned above. Other factors in the environment, such as * Smoke, which may come from the kitchen, automobiles, or from tobacco smoking (passive smoking), etc. * Weather changes such as a cold temperature or humidity. * Exercise (exercise - induced asthma) Some patients may get attacks of wheezing and coughing after running, skipping, or sometimes even after laughing or crying a lot. Swimming, however, is less likely to precipitate attacks. Psychological factors, such as jealousy, excitement, worry are relatively common factors, especially when these emotions are bottled up. Asthmatics often become tense; they have also a fear of the attacks of asthma. Symptoms These vary from patient to patient. Asthmatic attacks are usually worse at night or in the early morning. The mildest form usually manifests itself with cough at night or early in the morning. Some children often vomit with the cough, usually the early morning milk. In these children there may be no wheeze or difficulty in breathing. However, if a doctor examines the child at that time, wheezing may be heard with the stethoscope. In others, there may be a cough with an audible (can be heard) wheeze. Those with severe attacks may have all the symptoms referred to: cough, wheeze, difficulty in breathing. In very severe cases the patient may become blue (cyanosed), especially in the lips and fingertips. This is due to an inadequate amount of oxygen getting absorbed into the blood stream from the alveoli. In moderate to severe attacks, the patient may sit up, lean forward and hold the knees or the bed with arms extended. This is done in order to improve the expiration by using the accessory muscles of respiration. Management of wheezing * A clean, unpolluted atmosphere, both within and outside the house, is most desirable as far as is practicable. Houses should be well ventilated, and smoke from the kitchen should not contaminate the living rooms. Smoking (tobacco) inside the house should be avoided at all times, especially in the presence of a patient or a susceptible person. Sweeping the rooms and raising the dust in the presence of a patient or susceptible patient should be avoided. If at all, it should be done with a wet mop or with coconut refuse (pol-kudu), to minimise the dust. Similarly, breaking cob-webs, dusting mattresses, carpets, book shelves, should be avoided. For those who can afford it, a vacuum cleaner is recommended. Dusty playgrounds, or dusty school-rooms should be avoided as far as is practicable. * Avoid sudden exposure to the cold. Bathing - daily baths - should be encouraged, but if this takes place in the cool of the evening, the child should put on something warm, at least for the next hour, and not be exposed to the cold. * If any food, or other substance, has been identified as producing an allergy in that person, it should be avoided. * The psychological management is important. If, at the first sign of a cough or wheeze, the family members become anxious and tense, expecting the condition to get much worse, these fears and anxieties are transmitted (passed on) to the patient who gets alarmed and agitated. On the other hand, if the family members act discreetly, the child gets confidence and courage, and half the battle is won. Treatment Treatment is directed at relieving the obstruction in the bronchi by * relaxing the constricted (tight) muscles around the bronchi * decreasing the swelling of the inner lining of the bronchi, and * by reducing the secretions. There are two groups of drugs that are commonly used to relieve the spasm (construction) of the bronchi. The first group includes * salbutamol - referred to as albuterol in USA - (brand names - Ventamol, Ventolin, Salmol); two recent additions which act like salbutamol and have a longer duration of action are salmeterol and formoterol * terbutaline, (brand names - Butylin, Betalene Bricanyl), * orciprenaline (brand name - Alupent). These drugs, especially salbutamol, tend to cause fine tremors (shivering) of the hands, more so in adults than in children; however this side effect is not a contraindication to the use of these drugs. The second group includes aminophylline and its derivative, theophylline. (brand names: Choledyl, Quibron, Euphyllin, Deriphylline, Nuelin and New Tedral). These drugs are given by mouth; aminophyline can also be given into a vein for rapid action. These drugs are called bronchodilators - they dilate (enlarge) the cavities (lumen) of the bronchi. One of the drugs of the first group can be given in combination with one of the drugs in the second group, if necessary. However, 2 drugs of the same group i.e. drugs that act in the same way as theophylline, or 2 drugs that act in the same way as salbutamol eg. salbutamol and terbutaline, should not be used together. Most of these drugs are available as tablets, syrups, inhalations or injections. (Inhalations are preferable for long term use. The dose inhaled is very much less than the drug given by mouth or injections, as the inhaled drug acts on the lungs only; whereas a drug given by mouth or injection acts all over the body. The predisposition to asthma cannot be cured. However it is possible to minimise or prevent the frequency of attacks (i.e. control the disease) by taking medications, exercises as mentioned above, and preventing the precipitating factors. (From your child your family by Dr. Herbert Aponso et al) *** Common triggers * Infections of the airways - viral infections such as the common cold and bacterial infections of the respiratory tract such as sinusitis, pharyngitis and bronchitis * allergic rhinitis (catarrh) * changes in weather-sudden change in temperature or humidity * cigarette smoke * environmental pollution * industrial chemicals and sensitisers e.g. tea dust, wood dust, flour dust, isocyanates, allergens such as pollens and spores, house dust mites, house-hold pets (allergens in the saliva, urine and dander), * certain food items, food additives * emotional factors * non-specific factors: such as laughing and coughing. *** Are you a victim of...Lung Cancer Smoking is the number one cause of lung cancer. Lung cancer may also be the most tragic cancer because in most cases, it might have been prevented -87% of lung cancer cases are caused by smoking. Cigarette smoke contains more than 4,000 different chemicals, many of which are proven cancer-causing substances, or carcinogens. Smoking cigars or pipes also increases the risk of lung cancer. Lung cancer is the leading cancer killer in both men and women. There are two major types of lung cancer: non small cell lung cancer and small cell lung cancer. Non small cell cancer is much more uncommon while small cell cancer is more common. The former usually spreads to different parts of the body more slowly than small cell lung cancer. Squamoers cell carcinoma, ademocarcinoma and large cell carcinoma are three types of non small cell lung cancer. Small cell lung cancer, also called oat cell cancer accounts for about 20 per cent of the lung cancers. Smoking is the leading cause of lung cancer. The more you smoke and the longer you smoke, the greater your risk of lung cancer. But if you stop smoking, the risk of lung cancer decreases each year as abnormal cells are replaced by normal cells. After ten years, the risk drops to a level that is one-third to one-half of the risk for people who continue to smoke. In addition, quitting smoking greatly reduces the risk of developing other smoking-related diseases, such as heart disease, stroke, emphysema and chronic bronchitis. Many of the chemicals in tobacco smoke also affect the non-smoker inhaling the smoke, making "secondhand smoking" another important cause of lung cancer. It is responsible for approximately 3,000 lung cancer deaths and as many as 62,000 deaths from heart disease annually. Another leading cause of lung cancer is on-the-job exposure to cancer-causing substances or carcinogens. Asbestos is a well-known, work-related substance that can cause lung cancer. Lung cancer takes many years to develop. But changes in the lung can begin almost as soon as a person is exposed to cancer-causing substances. Soon after exposure begins, a few abnormal cells may appear in the lining of the bronchi (the main breathing tubes). If a person continues to be exposed to the cancer-causing substance, more abnormal cells will appear. These cells may be on their way to becoming cancerous and forming a tumour. Symptoms In its early stages, lung cancer usually does not cause symptoms. When symptoms occur, the cancer is often advanced. Symptoms of lung cancer include: . Chronic cough, . Hoarseness, . Coughing up blood, . Weight loss and loss of appetite, . Shortness of breath, . Fever without a known reason, . Wheezing, . Repeated bouts of bronchitis or pneumonia, . Chest pain. These conditions are also symptomatic of many other lung problems, so a person who has any of these symptoms should see a doctor to find out the cause. A growing number of doctors are using a form of CT scan in smokers to spot small lung cancers, which are more likely than large tumours to be cured. The technique, called helical low-dose CT scan, is much more sensitive than a regular X-ray and can detect tumours when they are small. If you are diagnosed with cancer, the doctor will do testing to find out whether the cancer has spread, and, if so, to which parts of the body. This information will help the doctor plan the most effective treatment. Tests to find out whether the cancer has spread can include a CT scan, an MRI, or a bone scan. Treatment The doctor will decide which treatment you will receive based on factors such as the type of lung cancer, the size, location and extent of the tumour (whether or not it has spread), and your general health. There are many treatments, which may be used alone or in combination. These include: Surgery may cure lung cancer. It is used in limited stages of the disease. The type of surgery depends on where the tumour is located in the lung. Some tumours cannot be removed because of their size or location. Radiation therapy is a form of high energy X-ray that kills cancer cells. It is used: . In combination with chemotherapy and sometimes with surgery. . To offer relief from pain or blockage of the airways. Chemotherapy: is the use of drugs that are effective against cancer cells. Chemotherapy may be injected directly into a vein or given through a catheter, which is a thin tube that is placed into a large vein and kept there until it is no longer needed. Some chemotherapy drugs are taken by pill. Chemotherapy may be used: .In conjunction with surgery, . In more advanced stages of the disease to relieve symptoms. . In all stages of small cell cancer. Prevention
####### Psychological management of attempted suicide Attempted suicide is primarily a behaviour of the young adult, and is particularly common in under 35-year-olds, but seldom occurs in children under 12 years of age. Throughout adolescence, the incidence increases markedly among girls, reaching a peak in the 15-24 year old age group. The incidence is highest among individuals of lower socio-economic status, and in people in urban areas characterized by social deprivation and over crowding. Single and divorced individuals are more at risk than those in other marital categories. Many patients who attempt suicide have a background of disrupted family relationships, often because of early parental death or separation. Approximately 75 per cent of adults who make attempts are facing problems in their relationship with their partner. A major quarrel or separation is the most common event preceding the act. Parents who attempt suicide often have difficulties with their children and there is evidence for an association between attempted suicide and child abuse. A marked association exists between unemployment and attempted suicide. Rates of attempted suicide in both men and women are 10-15 times higher among the unemployed than the employed, and the risk of attempted suicide increases substantially the longer a person is unemployed. A greater than expected number of patients who attempt suicide have physical health problems, and there is an increased risk among people with epilepsy especially men. Teenagers who attempt suicide have similar difficulties to their adult counterparts, but in many cases they also face problems in their relationships with their parents. Although psychological difficulties are found in most patients who attempt suicide, only a third are found to have a definite psychological disorder and in many cases this is transient, being largely secondary to social difficulties. About 5-8 per cent of patients suffer from serious psychological illnesses, which require treatment in a hospital. The most common disorder is depression, with anxiety and schizophrenia occurring in few cases. Personality disorders and problems related to the use of alcohol are also common, especially among men. Approximately 90 per cent of cases of attempted suicide involve deliberate self-poisoning. Most of the remainder are self-injuries, heavy drinking immediately precedes and attempt, and alcohol may also be used as part of an overdose and add to its danger. The substance used in overdoses tends to reflect availability and most often used are aspirin and paracetamol such overdoses being particularly common in young people. Self-injury is usually self-cutting, especially wrist or forearm. Violent forms of self-injury (gunshot wounds, hanging and jumping in front of trains) are less common among those who survive attempts, and suggest serious suicidal intent. Attempted suicide may involve little premeditation - the act often being considered for less than an hour, and sometimes only for a few minutes. The motivation often appears to be complex. Indeed, it may be difficult to establish what a patient hoped would result from overdose or self-injury. Psychologists often explain the behaviour in terms of communicating anger, eliciting guilt and trying to influence others, as well as signalling distress. Attempted suicide usually evokes helpful responses from those close to the individual, leading to an improvement in social circumstances and psychological well-being. However, attempts are often repeated, and are then sometimes fatal. The risk of repetition is highest during the first six months after an attempt. Many chronic repeater suffer from severe personality disorders, abuse of alcohol or drugs, and have a history of violence and police convictions. The risk of suicide following an attempted suicide is considerable. Approximately 1 per cent of patients end their lives by suicide during the year following an attempt, which represents a risk approximately 100 times that of the general population. Primary prevention of attempted suicide appears to be difficult. Some patients who are in a state of extreme crisis may benefit from a brief period in hospital. About 30 per cent of patients appear to be suitable for brief problem-solving counselling sessions on an outpatient basis. Counselling should be directed towards both the patient and the partner, or other family members where appropriate. Cognitive therapy approaches may be helpful. Occasionally medications might be required, and when the risk of a further attempt seems high, should be supervised by a relative. When a person has attempted suicide, prevention depends on the occurrence of widespread social changes. Repetition could be reduced by special services that produce positive changes in psychological and social functioning. - Dr. R. A. R. Perera ####### Lactose intolerance Lactose intolerance is the inability to digest lactose (milk sugar). It is caused by a lack or deficiency of lactase, an enzyme manufactured in the small intestine that splits lactose into glucose and galactose. When a person with lactose intolerance consumes milk or other dairy products, some or all of the lactose they contain remains undigested, retains fluid, and ferments in the colon, resulting in abdominal cramps, bloating, diarrhoea, and gas. Symptoms usually begin between thirty minutes and two hours after consumption of dairy foods. The degree of lactose intolerance varies from individual to individual. For most adults, lactose intolerance is actually a normal condition. Lactase deficiency can also occur as a result of a gastrointestinal disorder that damages the digestive tract, such as celiac disease, irritable bowel syndrome, regional enteritis, or ulcerative colitis. It can also develop on its own. There is no known way to prevent it. Although far less common, lactose intolerance can occur in children as well as adults. In infants, lactose intolerance can occur after a severe bout of gastroenteritis, which damages the intestinal lining. Symptoms of lactose intolerance in an infant can include foamy diarrhoea with diaper rash, slow weight gain and development and vomiting. Lactose intolerance can cause discomfort and digestive disruption, but it is not a serious threat to health and it can easily be managed through dietary modification. Prevention /Treatment
####### The answer to an appeal from a reader Dear Mr. Nalliah Nagendran of Batticaloa. I am Ravi Jayewardene, a Trustee of the Poorna Health Care Trust under which the Chelation Clinic at Ratnam's Hospital is run. The information that you supply in your letter is misleading in many ways and mostly erroneous. The frequency and the number of treatments prescribed at our clinic are assessed by our doctors only after a consultation with the patient and never before, therefore if you have not yet consulted any of our doctors and they have not had the opportunity of going through your medical records and examining you, they certainly would not have prescribed any medication for you. The cost of a single treatment at our clinic is SL Rs. 1,800 and not Rs. 3,000. In our seven years of operation I know of no patient that has taken a hundred treatments in our clinic. Lastly Dr. Athukorale is a highly respected and eminent Cardiologist who is very professional in his outlook, as such I seriously doubt that he would have prescribed chelation or any other form of medication without seeing or examining you. - Ravi Jayewardene |
|
News | Business | Features
| Editorial | Security Produced by Lake House |
