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Glandular Fever

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What is Glandular Fever?

This is a disorder that commonly attacks adolescents, particularly girls in the 15-25 year age group. It is caused by a virus called the Epstein-Barr virus (EB virus for short), and can produce debilitating symptoms that may persist for weeks or even months. A sore throat and swollen glands under the jaw, and later in almost any part of the body (armpits, groin etc) may occur. These become tender.

There is often a fever, poor appetite, aches and pains all over, frequently depression and disinclination for one’s normal activities and interests. Diagnosis is confirmed when the Paul Bunnell blood test or a serum antibody test yields a positive result, although this does not always occur. The disorder is not highly contagious. It is chiefly of nuisance value, for when the acute symptoms subside, so many feel generally off-color, depressed and unable to get back to normal duties with their usual bright, happy disposition and enthusiasm.

However, the outcome is invariably satisfactory. Unfortunately, treatment is mainly symptomatic, for there is no effective antibiotic against this virus. As glandular fever is essentially a disorder of the body’s lymph gland system, it is considered in detail in that part.

We seem to be hearing more about this strange disease. What is it all about? Glandular fever, or, to use its technical name, infectious mononucleosis, has skyrocketed to prominence over the past few years for various reasons. First, it is more common in adolescents, and is laughingly referred to by many as the kissing disease, or the disease of lovers, and so on.

After many years, it has been found the disease is caused by a special germ called the Epstein-Barr virus. This is often contacted during early childhood, way back in the first two to three years of life. At the time, no symptoms occur, but years later, they can suddenly erupt. During infancy the complaint is rare. The late teens are when it is more likely to cause trouble.

Glandular Fever Symptoms

A gradual onset of fever up to 38.9°C (102°F) is accompanied by a sore throat, swollen glands under the jaw, and elsewhere in the body, feeling distinctly unwell and possibly an enlargement of the liver and spleen, the two large organs located under the lower rib cage.

With obvious symptoms that steadily worsen and fail to respond to simple, do-it-yourself measures already outlined, she should call the doctor.

Glandular Fever Treatment

If there are plenty of similar cases around, diagnosis are often easy for the professional. But certain tests may be carried out that will quickly give the right diagnosis. These are based on testing samples of blood. Certain cells are present in the blood, and also a specific test will tell if the disease is glandular fever.

What kind of treatment is prescribed? As with so many of the viral infections, there is no special antibiotic that will destroy the germ. We hope to have one some day. Usually the patient is put to bed until the fever has subsided and he feels better. Fluids, vitamins, antipyretics (drugs such as paracetamol that will reduce fever and pain) all give some assistance.

The doctor will tailor-make a special routine for each patient. Sometimes severely infected patients may need hospital care, but this is unusual.

Recovery may take anywhere from two four weeks, and in severe cases, several months. Depression and psychological problems occur, often worse in teenagers studying for exams and miss school for prolonged periods of time. But fortunately, recurrences are rare; the on-term outlook is good, and seldom does a patient die from the complaint.

Subdural Hematoma

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This is caused usually by injury to the front or back of the head. It produces a tear of the lining of the brain or of the vessels as they enter the brain substance. Blood accumulates between the brain and the bony cranium. It occurs mainly in older people in the fifty and over age group, but may also occur in younger persons. The blood clots, and later the internal parts liquefy and may absorb additional fluid from the brain fluids. The mechanical pressure of this mass on the brain will ultimately produce symptoms.

Subdural Hematoma Symptoms

There is nearly always a history of injury, but it is emphasized that this is often trivial. Considerable time may elapse, with varying symptoms often difficult to interpret, before the suspicion of a hematoma occurs. It may take days to weeks or months before symptoms occur. The time lapse is shorter in younger people and the symptoms are often more dramatic. Usually there is a definite history of accident often in sports or falls.

Headaches are the most common initial symptom, often severe, on wakening in the morning or after exertion. Other symptoms develop, such as lapsing into stupor or coma, to awaken with almost normal feelings. Mental confusion may occur. Gradually the symptoms increase in intensity.

New diagnostic techniques may quickly identify the trouble. Brain scans, ultra sonograms and the CT scan or MRI can quickly and accurately give a diagnosis and localize the lesion. Unless diagnosis is made and treatment undertaken, the outcome is often fatal. Newer techniques, if available, may assist in the diagnosis. Treatment (and perhaps diagnosis) involves repeated tapping of the cranium with trephine holes through which the blood clot may be sucked out. Sometimes a flap of bone is lifted from the cranium and the clot removed in this manner. Recognition and treatment of a subdural hematoma is usually dramatic and curative.

A variety of other conditions may occur in this category, but in principle they are covered, and for practical purposes the chief ones have been described. Hypertensive cephalopathy may take place. This happens when the blood pressure in a patient already suffering from high blood pressure rises still further. A stroke does not result, but headache, sickness, drowsiness and maybe coma could follow. A crisis lasting from hours to days may occur, and then the patient may recover again. This is an emergency measure that must be treated in hospital.

Cholesterol

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What is Cholesterol?

Cholesterol is a white, fatty substance manufactured mainly by the liver.

It is involved in a number of important bodily functions, including the formation of vitamin D and some hormones.

Particles known as lipoproteins circulate cholesterol to all parts of your body via your blood. At this stage it is called blood cholesterol. Scientific evidence shows that above-normal amounts of cholesterol in the blood increases the risk of atherosclerosis – the condition that can lead to heart attack or stroke.

There are a number of factors that influence the level of cholesterol in your blood. For most people the cause is diet-related. A high-fat diet is the main reason why high blood-cholesterol levels are so common. Rarely is it a hereditary condition.

Your doctor will tell you if the level is too high and if dietary changes are necessary. The National Heart Foundation’s publication Healthy Eating for the Heart will give you more details.

High blood cholesterol can be prevented. Most people can avoid ever having high blood cholesterol if they follow the right diet and start young enough. Most people who do have a high blood-cholesterol level can lower the level by dietary means.

Follow these guidelines:

  • Maintain a healthy weight. If you are overweight now set about losing approximately 1 kg a week by changing your eating habits and increasing your physical activity (see the National Heart Foundation booklet The Weight Loss Guide).
  • Limit your total intake of fat. You may need to reduce the amount of fat and fatty foods you eat, or substitute with polyunsaturated fats and oils or cut back on certain foods high in cholesterol. More foods rich in dietary fiber and starch may need to be included. (Remember that cholesterol present in foods and ingredients of animal origin is only one influencing factor on blood-cholesterol levels; the main dietary factor is fat.)
  • Take a good long look at what you eat now. There is probably room for some improvement.

Often the following changes are all that are necessary:

  • Always trim fat off meat.
  • Browse through the butchers or supermarket for the meat with the least fat marbling.
  • Always discard fat and skin on chicken.
  • Experiment with low-fat dairy foods.
  • Include at least one vegetarian meal per week based on dried beans, peas or lentils such as soya bean casserole, lentil patties.
  • Avoid deep-fried and fatty takeaway foods.
  • Try low-fat salad dressings and sauces.
  • Switch to whole meal bread.
  • Try brown rice and pasta instead of white.
  • Limit high-cholesterol foods such as egg yolks, offal products, prawns, fish roe and squid.
  • Avoid packet snacks and biscuits between meals.
  • Ensure vegetables and fruit feature on your daily menu.
  • Drink more water.
  • Increase physical activity (get off the bus one stop early, swim three times a week, walk to the local shops instead of driving).
  • When you buy supermarket foods, always check the label – if fat, shortening or oil is high on the list of ingredients, look around for an alternative.
  • Use the Heart Foundation cookbook Guide to Healthy Eating.

Meal Suggestions

Breakfast

  • Have wholegrain breakfast cereal such as rolled oats, untoasted muesli, commercial whole-wheat cereal and switch to skim milk. Include fruit or juice.
  • If you like something hot, how about mushrooms on toast or grilled tomato or asparagus or baked beans?
  • Try tasty whole meal bread or enjoy the texture of wholegrain types. Switch to easily spreadable polyunsaturated margarines and use just a little.

Lunch

  • Whole meal sandwiches or rolls made with lean meat, salmon or cottage cheese and lots of salad makes a convenient lunch. If buying at the sandwich shop, ask for no butter or salt.
  • Fill up with nonfat yoghurt and fresh fruit.
  • On a cold winter’s day, warm up with a mug of hot homemade soup.

Dinner

  • Enjoy fish more often or experiment with an occasional vegetarian meal. Eat only lean meat and lean poultry and have plenty of vegetables – hot or cold. Use recipes from the Heart Foundation cookbooks Guide to Healthy Eating or Harvest Cookbook.
  • For dessert try your own combinations of fruit – fresh or cooked – with ricotta topping.

Snacks

  • Try not to snack but if you must make your own and keep it small. Convenience and fast foods are often high in fat. Have a crusty bread roll stuffed with bean sprouts and mushrooms.
  • Munch a crunchy apple or enjoy a few dried fruits, nuts and seeds. If overweight is not a problem, make your own cakes and loaves using skim milk, a little polyunsaturated margarine and egg whites instead of full-cream milk, butter and whole eggs. Carrot, pineapple, apple or zucchini are useful additions in cakes.

Triglycerides

Triglycerides are also an important type of fat. They are found in food and in most of the body’s fat tissue. The level in the bloodstream rises with overweight and dietary factors. As with blood cholesterol, a high level can increase the risk of heart disease, although a high triglyceride level is not considered as important a risk factor as high blood cholesterol.

Laxatives

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If constipation is present, and there is difficulty in passing hard, dry stools, laxatives may be used as a temporary measure to restore the normal bowel function.

However, the number of bowel actions a day (or week) can vary enormously. Bottle-fed babies will often go many days before having a bowel action. If these actions are soft and normal in consistency, baby is not necessarily constipated and does not need laxatives.

In hot weather, baby may lose an enormous amount of fluid. If this is not made up, either in the form of boiled water or milk, or other fluid-containing products, a child will soon become partially dehydrated, and constipation can ensue. The best way to get back to normal is to increase the fluid intake.

Therefore, water may be the best laxative or cure for apparent constipation. That’s right. Also it’s necessary to try to find out why bowel actions arc hard and dry and infrequent before resorting to laxatives. For example, if baby has a tear at the back entrance, there’s a tendency to “hold back” (because a bowel action hurts). The baby becomes constipated, not through any real fault of the bowel system, but merely because it’s more comfortable. Treating the tear is more important than rushing to the laxative bottle.

The doctor may prescribe a local anesthetic ointment to be applied.

Sometimes it is desirable to help nature along. The simple method of inserting a glycerin suppository into the back passage will often produce an effective bowel action from 15 to 45 minutes later. The suppository should be well covered with lanoline or petroleum jelly (and some added locally) to facilitate easy entry. Push gently, and avoid undue pressure that may produce discomfort. It is often necessary to hold the folds of the buttocks together for several minutes to check the suppository slipping out. The suppository dissolves, mixes with the hardened fecal mass, and this is all expelled in the form of a fairly normal bowel action.

The suppository, of course, is used once and once only. (Some mothers believe a suppository is pushed in and out a few times, wiped, and then returned to the bottle for future use! This sounds incredible, but it happens.)

In acute constipation, a simple enema may sometimes be needed. Experience is usually necessary for this, and a trained sister may have to do it. Very simple forms of enemas, commercially prepared, are available today that make this much easier to perform.

Often, adding products to the dietary intake will correct constipation problems. Adequate fluids between feeds can be curative. Increasing the sugar content of the milk may assist.

Prune juice and molasses are also advocated by some, and can be effective as baby gets older. Adding pureed fruits to the diet of older children may be effective (such as pureed prunes and plums). Commercial oral preparations are often used. Medical advice should be sought before any long-term use of these laxatives is started.


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