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| Sunday, 4 August 2002 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius 'Doctor - made' diseases Are you one of those persons who relies solely on a doctor to cure your illness? and has blind faith in the pharmacist who issues your drugs? If you are, then read on.... Dr. Sampath Nanayakkara discusses the dangers of too much reliance on others for your health. Diseases are caused by different factors. Most commonly:- (1) Those which are present from birth. Apart from these, there is another important factor which is not discussed often and not directly known to the common man. Those abnormal physical and mental conditions induced in the patient by the effects of treatment and, advice given by the doctor or the surgeon. This is called, "Iatrogenic Disorders", simply means ("Iatros" - physician: "Gennan" - to produce) - Doctor made diseases. In today's context, the limitations of this term (Iatrogenic) to be extended further to include - "Pharmacist made" (because, it is not uncommon to see pharmacists or drug sellers are issuing any medicinal drug to a patient on demand) and "Patient himself made" (majority of the patients "Self medicate themselves" before seeking medical advice). In all matters of health ignorance and fear go hand in hand and the illness follows close behind. It is quite reasonable to believe, that a proportion of diseases are caused by the wrong attitudes of the patients as well as doctors. "Doctor patient relationship" is the foundation for the healing process. The patient has all the rights to ask from the doctor "What is wrong with me?" It is also the foremost duty of the doctor to answer that question in a simple language that patient can understand without using medical jargon. Questions unanswered and doubts unresolved may lead to wrong attitudes in the mind of the patient. Therefore it is a very important aspect of the doctor's role to give an explanation about the illness and advice regarding selfcare how to take the prescribed drugs, possible side effects of the drug etc and also REASSURANCE of the patient before he leaves the consultation room. All these factors play an important part in the patient's recovery. Doctors often request laboratory tests on their patients. Any test could yield false positive or false negative result. This means that the doctor may wrongly give a diagnostic label to a patient who actually does not suffer from it, or, the diagnosis may be missed in a patient who truly has the disease. Therefore attitudes of the doctor regarding the validity of the tests is important. Patients always tend to believe that consultations should be followed by prescription of drugs. It is not so. There are self limiting diseases which do not require any drugs, infact, drugs can cause harmful effects in those circumstances. Majority of patients firmly believe that a good doctor is the one who prescribes most number of drugs. This is not so, because each drug has its own side effects. Even a rational therapeutic plan is useless if the patient is unwilling to follow it. It has been found that more than 50% of patients do not follow prescribed drug treatment correctly. As a result drug resistant diseases are gradually emerging in the community. There are dangers too in trying to leave everything to the doctor and playing no part in one's illness at all. Modern medical treatment needs the cooperation of the patient as well as one cannot first lay one's wounded leg down on the doctor's table and say "have that ready tomorrow." One has to carry it about, rest it or exercise it and in fact cooperate with the treatment. Indeed the business of health education of the patient is very much a matter of unearthing and throwing out wrong informations which are deeply rooted in them, before implementing anything new. You and your doctor...: Dementia Q: It is with great interest and hope, I read the article in the Sunday Observer about 'Dementia'. I sincerely thank you for all the information therein. My mother who is 71 years has been suffering from loss of memory (recent) confusion and she is a different person now. I really would like to know if there was a way of curing this or if I can stop further progressing of this illness. The most annoying thing is that she hides things including her vitamins and nothing can be found. This started around Oct '2000 very slightly and got worse by June 2001 when she suffered some trauma due to a surgery (not life threatening) one of her grandchildren had to undergo. After this incident her condition deteriorated rapidly, there are rare moments of normalcy. She looks sad but rarely cries. It gave me some hope to know that there is behaviourial therapy for this. Please let me know at your earliest how I could set about it. I have taken her to a neurologist who ordered a 'dementia' assessment where her score was 16 if it is of any use to you at this moment in time. I would also like to know about the drugs that could 'cause' such a condition as mentioned in the article, as she has been taking medication for every little thing. Mrs. H. Wijayasinghe, Koswatte, Talangama. A: Dementia is a state of disordered brain function. It is normally an irreversible and permanent disease process, as opposed to Delirium which describes temporary disturbances of the brain function. The main features of dementia are irrational behaviour, irritability, restlessness and poor memory. The failure of memory is characteristics, in that the sufferers can recall clearly, the events which happened more than 50-60 years and may think as they occurred recently. However he/she cannot remember things which took place on the present day. The commonest cause is ageing. Due to advancing of age the blood vessels supplying the brain cells become narrower. As a result the brain cells start degenerating gradually. Another cause, which is rare, is deficiency of the vitamin B group specially Nicotinic acid, Thiamin and Riboflavin. It stems from a diet containing largely of polished flour without animal proteins or green leafy vegetables. Other rare cause is syphilis (a sexually transmitted disease). There may be other mental disorders which mimic the symptoms of
dementia, as such a complete assessment of the patient is mandatory. Breast-fed babies and HIV infected mothers formula-fed infants born to HIV-infected women were no more likely than those assigned to be breast-fed to die before their second birthday, even when infection with HIV was taken into account, a recent study in Kenya has announced. HIV-free survival at two years, however, was significantly more frequent among infants in the formula-fed group than among those in the breast-feeding group. Diarrhoea, pneumonia and malnutrition were the most common causes of death, but none occurred more often in one feeding group than in the other. Pneumonia, diarrhoea and malnutrition were the most common contributing
causes of death, although none of the three was significantly associated
with either feeding method. Contraceptive services help prevent abortions A study has revealed that unintended pregnancy is significantly less common in as a result, the proportion of all pregnancies that end in abortion is significantly lower there. Short-term health benefits for underweight infants from rapid growth Rapid catch-up growth in the first 20 months of life appears to confer short-term health benefits on babies who are born small for their gestational age. According to data from a cohort of babies born in Brazil in 1982, those who were born small but gained weight rapidly had a significantly lower rate of hospitalisation in 1985 than did similar infants who did not gain weight as quickly (6% vs. 15%). These fast growing small babies had nearly the same rate of hospitalisation as fast-growing infants whose birth weight was appropriate for their gestational age. The data come from a population-based co-hort study of babies born in 1982 in the southern Brazilian city of Pelotas. These infants were followed up twice - at age 20 months and at age 42
months. Compete records were available for 3,582 infants; these records
included information on the infant's birth characteristics (length of
gestation, weight, and size of gestational age) and on maternal
characteristics (age, education and family income), 20-month follow-up
data on infant hospital admissions and 42-month follow-up data on
mortality. Causes and prevention of suicide It is reported, that more than 20 persons commit suicide daily in Sri Lanka. This is a social and human problem which requires constant and concerted attention of the government, non government sector and the community as a whole. According to psychological analysis the main reason for people to commit suicide are depression, alcohol and drugs, and inability to cope with overwhelming emotional stress. Moral and spiritual poverty is also an important cause in most suicidal cases. All these factors lie in the alienation of people (specially youths) from simple lifestyles and the absence of healthy powerful life patterns and spiritual atmosphere at home. There are however a number of steps you can take to help someone who may be in danger of taking his or her own life. Take all suicide threats seriously. Approximately 70% of all suicides communicate their intentions to others in various manner within a few weeks or months of the deaths. But unfortunately people do not take these statements seriously as there is a common myth that people who threaten to kill themselves really don't do so, and that only those who do not confide their plans in anyone will actually commit this act. This is untrue. Approximately 70% of all suicide communicate their friends, relatives or someone else. Therefore if anybody talks about suicide you should take seriously. If someone mentions suicide, don't be afraid to discuss it. Yet another myth about suicide is that one should never discuss suicide with another person this will only add to the person's suicidal tendencies. This belief is beyond the truth. Encouraging people who have suicidal ideas to talk about such thoughts may get them out in to the open and can be helpful to have a realistic approach on life events. If not when you understand their intentions you can pass them on to a counsellor or psychologist. So don't be afraid to discuss this matter with potential suicides if it arises. Recognize the danger signs. This is a very important fact with regard to preventing suicide because if you are keen on your fellow you can recognize number of warning sings that suicidal individual says or does before committing the act. Among them, the most obvious clue is a previous attempt. Other indications of danger include following signs. - Increased moodiness and mood swings. If you recognise these changes in others along with other indications it may mean that they are contemplating suicide. If a friend or a family member shows the danger sings don't leave him or her alone. Most probably suicide is a solitary act. So if you are concerned about someone who is seriously contemplating such an action, it is advisable not to leave him or her alone until he or she is sent to a counsellor. The most important of all; get help. Perhaps the most important point to keep in mind is this K. W. S. C. Kumarasingha, Psychologist and Counsellor Counselling
Centre Youth Services Council Sciatica Question: I am a 64 year old retired school teacher. About three years back I was suffering from severe pain on my lower back, specially over the right buttock which sometimes travelled along my back of the thigh, towards the ankle. I am severely incapacitated at times due to this illness. I sought Ayurvedic treatment. But it did not work. Please help me! A: Most probably you are suffering from Sciatica. But sciatica is not a disease. It is a symptom of some other conditions which irritate the sciatic nerve by pressing on it in the distribution of the nerve from the back to the foot. Usually sciatic pain is felt in the buttock and radiates down the back of the thigh and calf to the outer side of the foot. It gets worse when coughing, sneezing or straining. Some patients may develop numbness on the same sites. In severe cases muscle weakness in the calf area and 'foot drop' may occur. The most common cause is bulging of the 'Disc structure' in between the vertebral bodies of the spine due to sudden twistz of the spine, by lifting heavy weight while the spine is being bent forward or sometimes during child birth. Bulging of the disc (this is called intervertebral disc) may press on the nerve roots giving rise to sciatic pain. In older age groups degenerative changes in the disc itself may produce sciatic pain. Rare causes like tumours of the spinal cord and surrounding structures have also been identified. The initial treatment is bed rest on a firm mattress supported by a board. Sitting positions or even leaving for toilet purposes is not permitted if one expects a full recovery. Bed rest is advocated for about 2 weeks followed by gradual mobilisation with back-muscle strengthening exercises. In elderly patients with continuous pain, a spinal support is valuable. If the conservative treatment fails or the condition is progressive surgical treatment is considered. Dr. Sampath R. Nanayakkara (Family Physician) |
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