|
|
 |
 |
| Sunday, 17 August 2003 |
 |
|
 |
Features |  |
| News Business Features Editorial
|
Compiled by Carol Aloysius The following article taken from the British Heart Foundation discusses a common problem that many people suffer from ... : PALPITATION "I'm very worried doctor, I've got these terrible palpitations". Doctors often see patients who express this anxiety. What are palpitations ? Palpitations are an awareness of the heart beating either rapidly, missing beats or thumping in the chest. We have all experienced palpitations because they occur in everyday life. Emotion, exercise, fever, stomach upsets, alcohol ingestion and anxiety all induce palpitations and in none of these is the heart diseased. Indeed the great majority of palpitations do not have any pathological significance. The distinction between palpitations that occur normally and those that reflect heart disease is not easy to define. Palpitations caused by disease may be particularly disagreeable as the rate of beating may be either very fast, very slow or markedly irregular. Bouts of fast heart rate may be sustained over minutes, or even hours. These sensations which may occur unexpectedly or recur frequently are usually accompanied by other symptoms such as sweating, faintness, chest pain, dizziness or even loss of consciousness. These more disturbing palpitations usually reflect an important upset in heart rhythm. Harmless palpitations Sinus tachycardia Sinus tachycardia is when the heart beats normally but rapidly, e.g. with exercise, emotion, blood loss, anaemia or pregnancy. Ectopics or extra beats The extra beat is the most common abnormality. This is felt as a 'thud' in the chest or a missed beat, although it sometimes may not be noticed at all. Most people have extra beats and they can be made more evident with strong tea, coffee, red wines and some spirits. The electric signal which caused the extra beat arises from an area away from the normal pacemaker, either the atria, AV node or ventricles, and are named accordingly. An electrocardiogram can determine from where they arise. They produce a heart beat which comes earlier than expected - hence the sensation of palpitations. Until recently these beats were thought to be dangerous but now it is known their effect on the heart's performance is minimal. Abnormal Palpitations Tachycardias (rapid beating) If ectopic beats come in runs and occur rapidly they are called tachycardias, taking their name from the site of origin of the ectopic e.g. atria, AV node or ventricular tachycardias. These tachycardias cause symptoms because the heart rate is increased to approximately 200 beats a minute. At this rate the heart doesn't work efficiently and the patient may sweat, feel weak, become short of breath or even collapse. AV nodal and ventricular tachycardias cause more symptoms than atrial tachycardia. Persistence of these rhythms directs the doctor to look for underlying heart disease. Atrial fibrillation (irregular beats lacking any pattern) When the muscle in the atria does not contract together but flutters it is called fibrillation. This often does not cause symptoms as the ventricles still contract at a slow though slightly disorganised rate. If the electrical impulses from the atria enter the AV node, a rapid irregular rhythm causing palpitations can occur. This can be treated with drugs at an early stage. Bradycardias (slow beating) When the pacemaker is diseased the heart rate may fall to very low levels. Sometimes periods of bradycardia occur with tachycardia and this is known as sick sinus syndrome. Slow beating also occurs when there is disease at the AV node (junction box). This is called heart block when all the impulses do not get through to the ventricles. Sometimes the patient is aware of a slow ponderous beating of the heart associated with dizziness. This is treated with an artificial pacemaker. Treatment Palpitations are very frightening and many patients believe that their 'end is nigh' and the condition is potentially fatal. As explained, some arrhythmias are potentially dangerous but most are not and reassurance is the most important form of treatment. It may be helpful to avoid some precipitating factors such as smoking, coffee, tea, alcohol, and some common 'over the counter' cold remedies. Persistently troublesome palpitations may require drug therapy; such drugs are known as anti-arrhythmic drugs. All of these drugs are specific for a particular type of palpitation and therefore are chosen with care as the patient may need to take them for many years. Follow-up visits to your doctor will determine the need to continue treatment or whether it should be changed in view of advances in medical knowledge. Remember most palpitations are harmless ###### A guide to new mothers : Feeding baby from birth to one year For a child to grow, to play and to be happy the child needs food. The most precious food which can be given to a child is breastmilk. Breastmilk provides baby with all the nutrition and water required for optimal growth during the first four months of the baby's life. Therefore, during this period the baby should be given only breastmilk. . Commence breastfeeding within half an hour of birth . Breastfeed the baby as and when demanded by the baby . Do not give the baby powdered milk or any other type of milk at any time. Solid (complementary) food should be introduced to baby's diet when the baby is five months old. From the fifth month What should be given? . The first solid food given to baby should be soft and easy to digest. . Start by giving baby boiled mashed rice . After two days introduce dhal to the rice. How should the food be prepared? . Take two tablespoons of rice, one teaspoon of dhal, add one teaspoon of oil and boil well. Once boiled mash all ingredients until it becomes a pasted. Adding oil to baby's diet enhances the taste and increases the nutritional value of the meal. . To help the baby swallow, you could add expressed breastmilk or boiled cooled water to the food. . Do not add salt, sugar or honey to the baby's food. . Commence giving the baby fruits such as papaw and banana. How much should be given? . Initially start with half a teaspoonful and gradually increase the quantity. . By the end of the 5th month baby should be having two complementary meals a day, while continuing to be breastfed. What time should the baby be fed? . Select a time convenient to both the baby and the mother. . It is appropriate to feed the baby at the same time as the main meals are being taken by the rest of the family. . Do not use a feeding bottle to feed the cooked food to the baby. Use a cup and a spoon for this purpose. Sixth to the seventh month . Gradually increase the nutrition level and thickness (density) of the food. The Baby may need an increased quantity by now. . You can now add pumpkin, carrot, ash plantain and sweet potato to the baby's menu mentioned above. After baby gets used to these food you can add green leaves such as thampala, gotukola, mukunuvenna and spinach to the meal. Do not substitute breastmilk with powdered milk. Increase the quantity and density of the food gradually. Add cooked and well mashed soya, fish, chicken or well washed and dried powdered sprats to the baby's meal. Give the baby fruits such as mangoes and avocado pears. Eighth to the ninth month It is important to introduce food with small pieces into the baby's meal at this stage. It is a myth that babies should not be fed after 6 p.m. As in the morning and during the day the baby should be given a prepared meal in the evening too. By the 8th and the 9th month baby should be given at least four meals a day. Initially give the baby only the yolk of a full boiled egg. Start with just half a teaspoonful and gradually increase to the entire yolk. If the baby develops an allergy, delay giving the white of the egg until baby is one year old. Let the baby get used a taking various boiled mashed vegetables for his meal. You could also add grated coconut or coconut milk to the meal. You may see a difference in the food shown above. (e.g. you can prepare a pudding using coconut milk and egg or 'kiri hodi' for baby) Tenth month By this time baby could be given string hoppers or a part of the crust of a white hopper. Baby should be able to sit with the adults for a meal. Give something like a piece of toast to the baby to hold. By this the baby develops the ability to hold something on his own. . Since the fruits and vegetables in the baby's diet provides vitamins to the baby, additional vitamins are not recommended. . Do not add sugar or salt to the baby's meal. At one year You can now give the baby the same food cooked for the rest of the family. However, it is best that hot spices are not added to the baby's food. . Try to give the baby locally available food at all times possible. . Avoid giving the baby chocolates, biscuits and sweet drinks between meals. Continue to breastfeed baby in between. Courtesy: Health Dept. and UNICEF. ####### Head injury The particular structure and function of the head make the symptoms of head injury differ from those of other parts of the body. Bleeding from the scalp The scalp is attached to the underlying inelastic skull with very little tissue between, and because of this a blow on the head, even with a blunt instrument, can cause the scalp to split as though cleanly cut. The edges of the wound tend to be pulled apart by the muscular tension of the scalp. This combined with the excellent blood supply to the scalp makes the bleeding profuse. It also leads to rapid healing and unlikelihood infection occurring in scalp wounds. Apparently severe injuries of the scalp heal surprisingly well. Treatment: Control bleeding by firm bandage until help available, or bleeding stops. In any case keep up pressure for five minutes. Have the patient sitting up, but supported. Depending on severity of bleeding, get patient by emergency ambulance to hospital, or call or visit doctor for examination of wound, stitching if necessary, and assessment of possible deeper injury. Outlook: Very good. Healing likely to be rapid and trouble free. Hair will not grow in the actual scar. Lump on head following a blow Firm, small, tender swelling at site of injury. Skin, if visible, discoloured. This is a simple bruise, but owing to the inelasticity of the tissue the fluid and blood which leak out form this characteristically limited swelling. Treatment: Cool compress may be soothing. Aspirin if headaches. If the blow was hard or there is drowsiness, nausea, or confusion, a doctor's advice is necessary. Outlook: Lump will disappear spontaneously. Large, soft swelling Not necessarily confined to area of injury. This is deeper and maybe more serious, as a fracture of the skull could be present. Treatment: Hospital, or doctor at home in the first instance, because of the possibility of fracture. Outlook: The swelling itself will disappear in a week or two, and leave no after effects. Concussion When a boxer is knocked out, for instance, there is a period when the blood vessels of the brain contract, so that the brain cells receive an inadequate supply of blood, and cannot function properly. Sometimes there is actual bruising of the brain and multiple tiny haemorrhages in its tissue. Identification: Pale clammy skin, shallow breathing, fast weak pulse, may vomit or pass water. Disturbance of consciousness may be so slight as to be a momentary dizziness, or so severe that unconsciousness continues for weeks. Treatment: Quiet, dark room, head low until consciousness returns, then raised on two pillows. No stimulants. Bed for two weeks at least. Avoidance of brain strain, particularly in those who usually do brain work. After effects: Usually none, except that memory of the injury is absent, and sometimes greater memory loss. Headache may persist and cause lack of concentration for some weeks. Courtesy: Dictionary of medical symptoms ###### Guilt management Guilt is a different from self blame because it carries the strong implication of 'sin' - sin at having a sexual relationship, especially outside marriage, or sin at considering an abortion. Looking at guilt is part of taking seriously what a woman is doing in having an abortion, whether she sees it as essentially ending a life, or as simply as cleaning away a mass of cells. Self blame and guilt are both negative and positive in their effects. A woman might turn to an abortion to relieve this guilty feeling. If she is left feeling worthless and bad inside, she can become seriously depressed after the termination. A woman's feelings could change during the time between knowing that she is pregnant and having an abortion, depending on whom she has spoken to, time, and her day-to-day situation. She may feel angry with her partner on one day and blame herself on the next, but all these feelings could contribute in deciding on an abortion. This process can be greatly changed by people who are prepared to listen constructively to what the woman says, without judging her behaviour. Counsellors are very helpful in these situations. A woman might have an overwhelming feeling that she wants to be rid of the pregnancy and yet she may be aware of how callous such a reaction must be to an outsider. Such feelings can be a way of distancing herself from the pregnancy and not facing up to conflicting feelings; but it can also be a simple indicator of her fear of having that child. It might seem to be a trap keeping her in a relationship that she does not want to be in, or it may prevent her from doing what seems to be more important to her. Sometimes it is very hard to come to a decision. Blame Abortion, adoption, or bringing up the child can be equally hard options. The woman will have to make the best out of a bad job, which may seem very unsatisfactory. Sometimes it is question of finding out what she definitely does not want, and taking her decision from there. It seems a basic human reaction to try and apportion blame and there is a limited choice when it comes to pregnancy. Often the woman will swing from blaming herself to blaming her partner, before recognizing the reality of the situation. When the woman blames herself and says 'I should have said 'no' to him' she is correct that if she said 'no' she would not have become pregnant. Taking all the blame for the pregnancy means that the woman also takes control, and ensures that the decision is hers. But the woman may carry all the negative feelings alone by taking the blame alone. She may think that she should be punished for her 'sins'. The sin might be having had a sexual relationship, or it might be considering abortion. This could be another way of punishing the partner, by destroying 'his' child. Anger A woman is likely to be angry when her partner has clearly 'used' her. Sometimes she will want to blame her partner rather than face up to her part in what happened. if the woman is a victim of rape or incest she may feel so violated and invaded that she may carry the burden of guilt and distress, for the attack and the pregnancy. This could be another psychological factor in considering an abortion. This may work for a time but eventually something will trigger off a reaction of some kind. Sometimes this happens when the child would have been born, on the anniversary of the abortion, or later at the birth of the child. She may realize that she has 'left-over' feelings from an abortion when she notices other things going wrong in her life; for instance, finding that relationships with men become difficult, or her enjoyment of sex is affected. It is that this point that she may have to face up to the emotions endangered by the abortion. Women who are likely to be affected after an abortion A woman who has serious difficulties such as depression, anxiety, or general feelings of worry and stress and these were present before the pregnancy. A woman who feels that the decision has not really been hers, but forced on her by family, friends or partner. A woman who has been so uncertain that she has found it hard to come to decision. A woman who always believed that abortion is wrong. A woman who has dealt with abortion alone and has not been able to talk openly about her decision with anyone. A woman who was in very difficult circumstances, but has been very cool and controlled before the decision. A woman who has had a strong negative reaction from professionals. A woman who has had an abortion late in pregnancy, i.e. after twelve weeks. (this category is not included in my study) A woman who has had an abortion because she was carrying a handicapped child. Women who are less likely to be distressed A woman who had looked clearly at all the options facing her, before the abortion. A woman who is certain of her decision (although allowing for a small measure of doubt). A woman who has been able to talk over her decision with her partner, friends or family and they have supported her in this. A woman who has believed in the past that abortion is an appropriate decision. - Dr. R. A. R. Perera |
|
News | Business | Features
| Editorial | Security Produced by Lake House |
