Author Archives: Paula.KGS

Sweating

The skin is liberally supplied with intricate network of sweat glands. They are referred to as the Eccrine Sweat Glands, and there are several million them all over the body. Although all parts of the skin are copiously supplied, they are concentrated mainly on the forehead, in the armpits on the palms of the hands and soles of feet.

The sweat glands are part of system’s heat regulatory mechanism: They react almost immediately to the stimulus of heat, which operates via the brain. It is essential that the body temperature be maintained between certain critical boundaries. Any rise above normal is quickly compensated through the sweating system. When these glands are stimulated fluids pour onto the skin surface where they dry almost instantly. This immediately draws heat from the body, and the temperature falls. A very delicate balance exists to keep body temperatures operatic, within the prescribed limits in this manner.

The fluid excreted is mainly water, however, it contains some salt (sodium chloride) and other chemicals called electrolytes. The volume of fluid that is perspired can reach high levels. On an average two hour period this can reach 10,000 ml. To give an indication of the amount, 5 ml approximately equals one teaspoonful so 500 ml is roughly equal to one glass, and 10,000 ml is about equal to 20 pints! On extremely hot days, or if prolonged hard physical activity is being undertaken, the daily volume can rise still further.

In areas where the humidity is high the sweat does not tend to evaporate from the skin surface. Therefore very uncomfortable feeling occurs. The feeling is sticky as salty water accumulates. Sweat may trickle down the face, under the arms and promote greater discomfort. It is not so common in hot, dry regions such as inland regions where humidity is appreciably lower than most coastal locations. Cramps commonly follow if sweating has been very profuse. This is due to the excessive loss of sodium chloride from the system, and is often relieved by an increased intake of salt in the diet.

A serious Sebaceous (oil-secreting) gland, Dermi Gland cells that secrete sweat cross-sections through the sweat gland known as cystic fibrosis, is often diagnosed by the excessive salt content of the patient’s sweat. There is a defect in sweat-gland function, but this is only an outward sign of an internal disorder. Many people are troubled by excessive sweating. It can be triggered by hot weather or emotional stress. Even in cool weather, many people perspire abnormally. Some find their feet sweat so heavily that new footwear is required every few weeks, because shoes fall apart so quickly with the continuing moisture! For these persons, abnormal sweating becomes a major problem.

Sweating Treatment

When facetious remarks are made about the disability it does little to assist people with this problem, and little help is available. The following ideas may be of some assistance:

Temperature control: working in an area subject to regular air-conditioning may assist, but this is not the answer to the problem on a permanent basis.

Frequent bathing: this gives temporary relief, and helps to avert body odor that may be a common and embarrassing problem. But the sweating usually recommences soon afterwards, and this is a temporary measure only.

Antiperspirants: these are aimed at narrowing the ducts of sweat glands by chemical means. They assist mild cases only. They are of little value for the excessive perspiration.

Vitamin C: some find that large daily doses of vitamin C (ascorbic acid)-1,000 mg once or twice dailysometimes helps.

Further Treatment

Simple remedies rarely (if ever) cure this disorder. Most finally arrive at the doctor’s surgery for advice.

The professional lines available are:

Sympathectomy: this is a form of treatment offering a complete and permanent result. The nerve that supplies the sweat glands is surgically severed. The result is a complete absence of sweating in the offending part(s) supplied from that time forth. Some believe this is a radical measure for a simple symptom, but patients treated often prefer this. Some complain of being “too dry” following the operation. This operation is performed by a surgeon or neurosurgeon. Surgical removal of the skin and sweat glands is also being successfully used in some suitable patients.

Removal of sweat glands: Surgical removal of a triangular area of skin in the armpit is often effective. The application of Aluminium Chloride Hexahydrate (if available) periodically painted on locally is recommended. The daily washing of the armpits with a rough rag for at least five minutes helps.

Other methods

There are IT medicaments of value for this. The anticholinergics and others expected on theoretical grounds to cure must be given as too high for convenience. They produce side reactions that may be unacceptable and they are not generally used for this purpose. Relaxation is often successful in the long-term.

Of course, if you want to learn much more about the skin diseases as well as most other body illnesses, we can only advise you to check with some of the other information we have prepared. Probably the best reference guide of all is Volumes 3-5 of Family Medical Care, which covers the whole spectrum of conditions and medical care of family illnesses. These are available from the same publishers of this book.

Sunburn

We have already dealt with sunburn, but I think it should have a further brief mention here. Agreed?

Agreed, for it is very important and may be classified as an accident. In Chapter 13, “Strange Conditions of the Skin” we set out the salient items about sunburn and the treatment. I wish to reemphasize that children’s skin is prone to burning, so take adequate precautions against sunburn. Many children brown up quickly also, but when it is soft and tender and lilywhite, it may burn rapidly, often within minutes of exposure to the hot sun. Never leave a baby or child in the sun unattended. Sun kicks are great for babies, but do remember that while they are kicking away probably in a birthday suit, they could be silently and stealthily sustaining sunburn. Also, remember that the ultraviolet rays of the sun bounce back from large masses of light-colored expanses, such as clouds, beaches, open paddocks and fields. Sunburn may occur in any of these situations, often when the child is oblivious to it all.

What’s the best treatment?

Apart from avoidance in the first case, application of cool packs is the best starting point. Repeat these often, using small folded towels placed in icy water wrung out, then placed over the burnt places. Plenty of fluids, ideally fresh fruit juices, will replace fluid loss. Add some vitamins. Paracetamol elixir is best for fevers and pain reduction. The dose will usually be printed on the label. Do not place skin applications on sunburn, for they may sensitize it, and seldom help. Avoid them, despite what your friends may say. Apply ultraviolet screeners to protect against sunburn, but after the event, they are useless.

Sinus Infection

The sinuses are present essentially to give the voice resonance, and in this capacity they do well. However, the problem of infections weighs heavily, and they are commonly caught up in the general infections of the region, particularly the antra and frontal sinuses, with their well-known head and face pains. Toward the back, the nasal canals directly link with the part of the pharynx known as the nasopharynx. In this way, the nasal regions become continuous with the pharynx (throat) and, in turn, with the upper air-passageways of the larynx, trachea, bronchi and lungs. They are also continuous with the middle ear by way of the Eustachian canal.

Sinus Infection Symptoms

Children is likely to be infected if they swim in infected water or pools containing excessive amounts of harsh, irritating chemicals. I might add that many backyard swimming pools are inadequately sterilised and have been found to harbour huge numbers of germs. In turn, these can track into the sinuses and produce infections. On the other hand, if the water is too heavily treated with chemicals, this also may irritate the sinus linings.

The linings of the sinuses may become congested, and the surface will discharge. The chief sinuses, or antrums as they are sometimes called, are located on either side of the nose, below the eye sockets behind the cheekbones. They normally give the voice the deep, pleasant resonance. The cavities are joined to the nasal canals by a tiny opening called an ostium – one is present on each side of the nose. Fluids can normally drain from the sinuses via the ostium into the airways of the nose.

The sinuses are air-containing cavities located in close proximity to the nasal passageways. They gradually develop .:wring childhood to become well established by adulthood. There are four main groups. The maxillary air sinus is the largest and is located on each side of the nasal canals, below the eyes, behind the cheeks. It communicates, via a small opening, with the nasal passageways.

The frontal sinuses are above the orbits of the eyes; the ethmoidal cells consist of many small air cells, irregularly placed in position, located in the upper cart of the outer wall of the nose. The phenoidal sinus is located well back in :ne skull in the sphenoid bone. The sinuses are interconnected, and often when one is affected, almost always this spread to involve the others. Being part of the upper respiratory system, they are very prone to infection, especially the maxillary areas and the frontal sinuses.

This is usually the result of an extended form of a simple nasal infection, very much like a common cold. Excessive blowing wring a simple infection can drive germs into the sinuses. This can cause the drainage apertures to close quickly and a full-scale infection become established, causing a new complaint. Douching of nasal canals has also been incriminated, and so has swimming underwater, swimming in potentially germ- infected water.

Although essentially one sinus will be involved to start with, this may spread to others. Pain, discomfort on pressure over the infected part, elevated temperatures, and general malaise arc the usual symptoms.

Sinus Infection Treatment

This is usually straightforward. It is best done by the doctor or surgeon. Unless the patient can identify the object and it is very close to the surface and he has a pair of suitable forceps available, it is best not to interfere. It is easy to push the foreign item deeper into the nasal cavity, so making its retrieval more difficult.

Sometimes the simple expedient of using a paper clip may be adequate. Often the doctor will use “crocodile forceps,” which are specially designed for this purpose, or fine-pointed forceps to grasp the object and remove it. Deep-seated obstructions may produce more difficulties, and even in skilled hands, it is possible sometimes for the foreign body to be pushed right back into the nasal passageways and into the oropharynx (mouth part of the throat well back). Here there is a risk of it slipping into the upper air passageways of the nose. Sometimes a nasal douche may be ordered, but there is little difficulty or adverse aftermath after the offending object has been removed.

Nosebleed (Epistaxis). This is very common, and in young persons and children generally results from trauma, nasal picking or harsh nasal blowing, particularly in the presence of an upper respiratory infection (such as a cold). The bleeding usually comes from the septum, low down in a part called Little’s area. In older persons, it tends to come from areas higher up, and is more likely to be associated with internal disorders. Blood pressure, cardiovascular disorders, renal and blood diseases are known causes. In an older person, it is essential to exclude a deep-seated cause as well as simply treating the bleed. Many cases of leukemia (cancer of the blood) have presented with nose bleeding being the first symptom. It should never be regarded lightly in older persons.

In Little’s area many blood vessels are close to the surface, and they are very prone to injury. During swelling and congestion of the part during infections, the blood vascularity increases, so increasing the tendency to bleed.

Tumours of the Nasal Cavity.

It is possible for various types of tumours to occur in the nasal cavities. These may be benign (non-cancerous) or malignant (cancerous). Nasal obstruction on one side. and often bleeding or discharge (frequently bloodstained) are typical signs. Any set of symptoms along these lines requires immediate medical attention. Once the disorder has been diagnosed, it will be treated, usually surgically. So-called squamous-celled carcinomas arc the most probable type of cancer, and these usually respond well to treatment. However, other forms of cancers are also possible. Cancer in any part of the body. naturally, requires diagnosis and treatment as soon as possible. Never delay with any of the telltale symptoms.

Polyneuritis

What is Polyneuritis?

This striking and fairly common disorder means the nerve fibres degenerate from the periphery inwards. It may be due to chemical poisons and drugs, to toxins from bacteria in the body, or as a result of disorders of metabolism.

Not nearly so common today, although it still does occur, is alcoholic neuritis. Although this was often associated with a vitamin B deficiency, it probably produced a metabolic disturbance that in turn gave rise to symptoms. Certain industrially used chemicals may cause it, such as arsenic and mercury, often used in agricultural sprays (although the exact relationship is often disputed).

Drugs used in treatment may be a cause. It may occur in diabetics (diabetic neuritis) due to metabolic disturbances that take place with this disease. Unfortunately, even when the diabetes is brought under good control, the neuritis frequently persists. It seems most likely that the ingested toxin is absorbed by the bloodstream and affects the local nerves immediately, rather than producing symptoms from some central (brain) cause.

Polyneuritis Symptoms

Often the first symptom is a “foot-drop” in each lower limb. Muscle weakness, numbness, pain, paraesthesia (altered sensations) or anaesthesia (loss of feeling) may occur. This may also take place in the hands. If left untreated, it may intensify, and spread (“glove and stocking” distribution, suggesting that the skin areas normally covered by such garments are the parts affected with sensory alterations).

There may be alterations in the sweat secretions, ageing alterations in the skin, nails and other tissues. The disorders occur in a symmetrical fashion (eg in both lower, then upper limbs), and they tend to occur at more distant parts then spread toward the body itself. Weakness, muscle wasting, the tendency to muscular contraction, loss of normal reflex function, are all typical. The doctor can usually make a rapid diagnosis, for the picture is generally uniform.

Polyneuritis Treatment

This is purely symptomatic. The doctor will try to find the cause, if one exists, and endeavour to correct this. For example, if it seems to be due to association of a chemical poison, or drug therapy, or alcoholism, then efforts to eliminate these must be made. A search will be made to eliminate diabetes as a cause (often this can be done simply by finding glucose in the urine, now readily indicated by dip sticks in a few seconds).

Vitamin B preparations are often used in abundance. However, although these may improve the general feeling of the patient, unless there is a specific need for them, they are of no proven value. In vitamin B deficiency due to alcoholism (and resulting beri-beri), it can assist considerably. However, psychologically the use of this product can help.

General nutrition must be given attention. Relief of pain by suitable analgesics and physiotherapy in certain cases, especially where there is a risk of muscle contracture, may help considerably. Some forms of relapsing neuritis are assisted by cortisone products. Recovery often takes place, but residual aftermath involving neurotic pain, muscle contractures and wasting may present long term problems.

Seborrhoeic Dermatitis

What is Seborrhoeic Dermatitis?

Seborrhoeic Dermatitis is a very common skin complaint characterised by the formation of greasy whitish-yellow scales that come away in profusion when the scalp is combed or brushed. These may settle on the clothing giving a mini confetti like appearance. The complaint varies from mild to very severe. It’s generally worse in winter weather, particularly if hats are worn. Dandruff commonly causes itchiness of the scalp.

Seborrhoeic Dermatitis Causes

The underlying cause of dandruff is a condition called seborrhoeic dermatitis, but the reason for it is unknown. Certain areas of the skin have an abundance of sebaceous glands, tiny factories that produce sebum, the waterproofing material covering the skin. The glands gain access to the outside by microscopic canals. If excessive amounts of sebum are produced, above-average layers are laid down on the skin. When this dries out, it tends to flake away in the form of dandruff.

The scalp, eyebrows and mid-portion of the face, nasal folds, the area behind the ears, the breastbone region, the area between the shoulder blades, the armpits, and the parts between the legs (called the ano-genital region) arc most commonly affected.

More advanced cases of the disorder show a reddening of the skin, an excess-ive oiliness. It appears more common in overweight people and those with diabetes. In the overweight, it is common for the area between the fatty folds to be affected, and these crack and become infected with other germs.

Seborrhoeic Dermatitis Treatment

Nothing is curative, but careful regular attention will produce excellent results in most cases.

Regularly cleanse all affected parts. Shampoo the scalp and affected parts with any of the many commercial preparations available for dandruff: Many lines are excellent. Selenium sulphide suspension shampoo and zinc pyrithione 2 per cent preparations are also very effective. Instructions usually accompany the commercial package.

Simple general measures are often helpful. These include eating a sensible balanced diet, avoiding excess sweets and carbohydrates or spicy food, hot drinks and alcoholic beverages. Get adequate rest at night (every night). Follow sensible working hours and avoid foolish excesses. Adequate recreation helps, and the basics of simple hygiene are important. Infections, emotional stresses and upsets, constipation, and dietetic indiscretions should be attended to. Regular scalp massage may help.

If these simple measures do not assist, seek professional help from the family physician. Other treatment could include:

Creams containing corticosteroids (equal to 0.5 to 1.0 per cent hydrocortisone). These often reduce the inflammation and excessive discharges.

Creams containing sulphur (3-5 per cent) and salicylic acid (2-3 per cent) are popular and often satisfactory. They are used as a cream the night before shampooing.

If sores develop, indicating infection from other germs, these must be treated independently.

In overweight people where the condition arises between folds of fat rubbing together, the physician may check for diabetes (a simple blood test will show if this is present). Castellani’s paint (a bright magenta-coloured preparation applied will often cure the irritating,: cracks and fissures that develop in these areas. Pre-cleansing the area with soap and water is essential (but all traces soap must be removed afterwards).

How to Dress a Bed

If your budget were unlimited, you could change your bed linen to suit your mood, the way we change our clothes. What a luxury to slide between luxurious silk sheets one night and crisp white cotton the next, followed by country florals, fleecy tartans, faded stripes and fresh, bright ginghams on each succeeding day. However, practicality rules, and generally we dress our beds to match the room decor and can sometimes end up with the same designs for years on end.
Layering many different prints and textures is a style of bed dressing that is popular and it is both sophisticated and relaxed. The different fabrics can be combined successfully despite, or perhaps because of, their diversity. Frilled prairie prints can be teamed with cotton lace. Cosy tartans and faded patchworks create an attractive and comfortable style.
Use bed linen to set a mood or create an atmosphere. If you want the room to look light and airy, go for white cotton sheets, pillow cases and duvet covers. Dress up the look with hand-crocheted lace borders and cushion covers, mixing old and new together. Or, for a touch of country freshness, add a gingham or floral bedcover or a patchwork quilt, or for something more Victorian, use a satin eiderdown. A mixture of plain sheets, duvet cover and pillow cases in different colours creates a modernist style that looks stunning with a black-framed bed.
You can also choose from the huge array of imported textiles now on the market. Layer and drape hot-coloured silks, batiks, ikats and hand-blocked prints to re-create the atmosphere of another continent. Cover pillows with silk scarves and drape saris from a four-poster, then dye your sheets strong earthy yellows, red and browns for a rich layered look.
It is important to consider the feel of fabrics as well as the look. There is nothing to compare with the luxury of Egyptian cotton sheeting, especially after years of laundering, so never say no to hand-me-down pure cottons —even though they need ironing, unlike mixed poly-cotton sheets.
Woollen blankets are wonderfully warm, but very itchy against the skin, so turn back a wide border of top sheet to cover the blanket.
Velvet bed throws feel very luxurious and can be made from old velvet curtains. Edge and join panels with a rich-coloured velvet braid for a medieval look.
If you have a four-poster bed, drape it with anything from chintz curtains to strings of heads, or perhaps floaty layers of net and muslin. But, you don’t need a four-poster to have drapes, and there are all sorts of ways in which fabric can be gathered or hung to give a variety of different effects.
This stylish Japanese-inspired bed uses wooden pallets for the bed base and a cream decorator’s dustsheet for the cotton bedcover wooden box that is wall-mounted the bed, with the fabric hung from the inside in two sections, to drape on either side of the bed. The effect can be solid and grand, or light and romantic, depending on the fabrics used. Alternatively, fit a simple semi-circular shelf to the wall the bed from which to drape a length of muslin. A staple gun is the ideal tool for this type of draping because it allows you to pleat the fabric as you attach it to the shelf. Another advantage is that it is very quick — you can drape a bed in this way in just an hour or two.
A mosquito net is a ready-made bed drape that simply needs a ceiling hook for installation. For a fun look, evoke the African savannah by adding a few potted palms and fake animal-print rugs, or create an air of mystery with a deep colour on the walls to highlight the light drifts of net.
The most important thing to remember when draping a bed is that you will always need more fabric than you imagine. The success of the draped effect relies upon a generous amount of fabric to spill out on to the floor around the bed to add to the sense of luxurious splendour.

Basic tools

The three most invaluable tools for dressing beds are a cordless (hand-held) electric drill; a glue gun and a staple gun. Staples are used for most upholstery work these days and a medium-sized staple gun is ideal for drapes, pleats and upholstery. A cordless drill allows you the freedom of dashing up and down ladders and drilling in awkward places where there is no plug socket available. If you have never used a glue gun before, you will be delighted — they can be used for gluing almost any two surfaces together and provide an instant bond that makes life a lot easier.

BEDHEADS

Beds without headboards create a very utilitarian and temporary impression. A headboard can make the simplest of beds into an item of furniture with definite style, and the possibilities really are endless.
Revamp existing headboards to give a totally different character using paint, rope, upholstery, drapes or fabric wraps. An old padded headboard, for instance, may be very comfortable but quite unpleasant to look at. All you need is a length of fabric and a staple gun to give it a completely new appearance, such as the padded headboard made from chintz curtains; leopard-skin-printed velvet; a rich chocolate-brocaded stain; a woven Mexican striped blanket or a black and white hounds-tooth check all have strong designs to give instant attitude to a padded headboard.
You may prefer something a little more subtle. Rub down a new turned-pine bedhead with sandpaper, and then paint it with two coats of matt paint. The first should be a bright colour and the second a lot darker. When the paint has dried, rub it back with fine-grade sandpaper or wire (steel) wool to reveal flashes of the brighter colour beneath. Paint initials or a marriage date along the top rail to transform a mass-produced bed into a family heirloom.

Cross Eyes

What is Cross Eye?

The term cross eyes refers to a visual defect or condition in which a person’s eyes cannot be align simultaneously, giving the eyes a crossed appearance. At it simplest level, the human visual system consists of the eyes and the brain. The eyes are responsible for sensing light reflected by the things around us. It is the brain’s act of interpreting this light that allows us to reconstruct the thing perceived in order for us to see it.

Cause of Cross Eye

Under normal circumstances, light bounces off the objects we ‘look’ at, then passes through the lens (a biconvex structure in that eye that is transparent and responsible for perceiving distances by changing shape). The light then travels to the fovea which is a small area found at the centre of the region in the retina called the macula. It governs central vision also referred to as foveal vision hence is responsible for visual sensibility.

When no defects exist, the light transmitted reaches both foveas and a three dimensional image is formed once the process reaches the brain which must interpret what was picked up by the fovea. When only one fovea receives the signal from the retina due to squinting or any other deviations, cross eyes occur.

Also referred to a “wall eyes”, the medical term for cross eyes is Strabismus. As mentioned before, the condition occurs when both eyes cannot be focused on the same object at the same time. One or both eyes may have the tendency to point up or down as well as in or out. The affected eye or eyes may be turned in a particular direction at all times as in the case of constant Strabismus or the eyes may look averted occasionally. The occasional turning of eyes; referred to as intermittent Strabismus, can occur when eyes are affected by pressure or when the affected person is ill.

Regardless of the type of the condition being experience, proper evaluation and treatment must be sought to control or correct it. Approximately 3 to 5 percentage of children suffer from cross eyes to some degree and the idea that children eventually grow out of the condition is now a debunked myth.

Cross Eyes Treatment

In children, if only one eye is affected, among the first steps taken is covering the unaffected eye with a patch to prevent the child from relying on the properly developed eye. This can prohibit the visual development of the crossed eye, rendering the situation permanent especially in the absence of treatment. Starting treatment as early as 6 months often guarantees quick recovery with the average one year old needing one week to recover. Once children reach age six or beyond a full year may be necessary. Surgery is also an option. If chosen, the earlier it is carried out, the better however, the condition and patient are factors in deciding when the best time is.

Upon restoration of normal vision or after successful surgery, patients may be required to use ‘eye exercises to complete full visual correction

Thyroid Gland

The thyroid is an important endocrine gland located in the neck. Two lobes on either side are connected across the midline by a narrow segment of tissue called the isthmus. The function of the thyroid is to manufacture, store and secrete two thyroid hormones, named thyroxine and tri-iodothyronine.
Iodine is an essential ingredient for this production, and without it, problems rapidly occur and increase. Each day the body needs between 100 and 200 mcg of iodine. This usually comes from marine fish, and from vegetables grown in soil containing iodine. When this is digested, it is trapped by the thyroid gland, under stimulation from the thyroid-stimulating hormone (TSH) of the pituitary gland.
Normally the thyroid gland produces a hormone called thyroxine. In turn, this can exert a powerful effect over other endocrine glands lower down. It may also affect the heart and the brain and other body organs. The thyroid is tied up with iodine and is required for the production of thyroxine. Normally this comes from the food we eat. Fortunately, in Australia in most places there is little shortage of this in our normal everyday diet. In some countries it is lacking, and when this happens the thyroid gland swells up as if in an effort to squeeze out more iodine from somewhere.
Two important medicaments called thiouracil and carbimazole have the opposite effect, preventing it from being trapped and utilised by the thyroid gland. This is important, for they are often used in treating overactive thyroid glands. Under the influence of TSH, the two thyroid hormones, thyroxine and tri-iodothyronine, are released into the bloodstream.
Production of these hormones is largely influenced by a naturally occurring “feedback” system. The higher the level of the hormones in the blood, the less TSH is produced, and vice versa. In this way, relatively stable levels are maintained. It is a very ingenious and workable system.
The functions of the thyroid hormones in the body are very widespread. They affect the rate at which all body cells work. All normal development is dependent on them. Muscle growth, sexual development, the rate at which calories are burnt up, the rate and output of the heart are all related. The breakdown and utilisation of protein is greatly influenced by it. This is clearly shown by the weakness that develops in a patient with an overactive thyroid (hyperthyroidism) and the symptoms that occur.
Many tests have been devised to measure the activity and presence of the thyroid hormones. These tests are aimed at helping to diagnose accurately the various disorders that can occur with this gland. Anyone who has been investigated for thyroid problems will be well acquainted with names such as BMR (basal metabolic rate), once popular but now rarely, if ever used, protein-bound iodine test, tri-iodothyronine (T3) resin uptake test, serum total thyroxine and thyroxine (T4) resin uptake test, free thyroxine index, radioactive iodine uptake, TSH stimulation test, tri-iodothyronine suppression test and thyroid scan.
In recent years it has been found that thyroid antibodies occur, and a search may be made for these. These are the so called thyroidal antibodies. More recently an antibody referred to as LATS (short for long-acting thyroid stimulator) has been found in some patients with Graves’ disease.
The general principles of thyroid disorders will be discussed. First there is the simple nontoxic goitre (enlargement of the thyroid) occurring just because the diet is deficient in iodine. It represents the body’s efforts to make amends for this. The gland may be overactive or underactive.
Overactivity gives rise to the condition known as hyperthyroidism, commonly called Graves’ disease. A similar condition tending to occur in older persons is called nodular toxic goitre. If the thyroid gland is underactive, the resultant condition is referred to as hypothyroidism. In infants this is called cretinism, and in older patients it is called tnyxoedema.
Cancer of the thyroid is relatively rare, but is important, and it will be discussed briefly. Also, mention will be made of another condition called thyroiditis.

Subacute Combined Degeneration of the Spinal Cord

In this serious disease of the spinal cord, the so-called white matter gradually degenerates and produces symptoms due to this fact. It is caused by a deficiency of vitamin B12 (Cyanocobalamin), and is frequently associated with Pernicious Anemia. It is now seen much less often, probably due to the widespread use of the vitamin B complex in today’s modern society.

Vitamin B12 is essential for the normal production of the blood, and its deficiency also leads to a fatal form of anemia if left untreated. However, as symptoms invariably lead to prompt diagnosis (on a blood count and examination of a “blood film” by the pathologist) treatment is always commenced early, so that advanced cases of the disease are now rarely encountered.

Subacute Combined Degeneration of the Spinal Cord Symptoms

These usually commence gradually, with numbness and tingling in the feet being a common set of initial symptoms. To a lesser extent this sensation may lingers. Sometimes the patient may complain of coldness or swelling in the feet, or feeling similar to stepping on cotton wool. Usually the sensory loss gradually extends to cover the “sock” area, and later on to the “stocking” area. Gradually the patient becomes insensitive to temperature and pain, and the sense of position. Unsteadiness in walking follows.

As the condition progresses, there is wasting of the muscles, usually those below the knee being affected first. These paralyzed muscles may become very painful and tender, and movement may be difficult and cause pain. Sometimes there is visual impairment, and mental changes may take place. Apathy, memory loss and confusion are common. Often routine blood tests will detect the anemia.

Subacute Combined Degeneration of the Spinal Cord Treatment

Treatment is usually successful and often spectacular, particularly in early cases, by the injection of vitamin B12 regularly. It is less successful in advanced cases, but any patient with this disorder should be treated vigorously with vitamin B12 therapy.

POST VIRAL SYNDROME Dealt with more fully under Upper Respiratory Tract Infections, post viral syndrome deserves mention here. It has been around for centuries, being well-known in the 1800s and early 1900s as “neurasthenia”. Feeling tired and incapable of performing a normal day’s work are the key symptoms. A check indicates this is followed by a simple bout of the flu. It may take days or weeks to become noticeable. Often swollen glands in the neck, armpits, groin and elsewhere occur. Before diagnosed, all other possible causes must be excluded by tests. It is a diagnosis of elimination and history. Fortunately, many patients gradually improve over a period of months or even years.

Occasionally it may persist and worsen, causing partial paralysis, a condition known as ME (Myalgic Encephalomyalgia). This is rare, with the patient in severe cases being confined to a wheelchair. Much research attention by major universities and teaching hospitals around the world is focused on the disease, its cause and treatment. Australia is in the forefront of research. At present, encouragement, adequate rest, exercise within a person’s tolerance, sensible nutrition, probably vitamins are the mainstay of treatment. There is no specific drug or routine that is curative. Several self help organizations provide information, counseling and support for the various nerve-related disorders. Persons wishing to contact any of these self help organizations should check their local telephone directory for locations

Insect Bites

Insect bites (and stings) are very common occurrences. Swelling and redness around the site of the bite (or sting) are the most common symptoms. Depending on the person or insect, other symptoms like itching, stinging or pain may occur as well. Some persons may be allergic to the sting or bite of an insect which can result in mild to life-threatening reactions.

Bites and stings contain proteins along with other substances which the body may identify as harmful; this is the reason for allergic reactions. Fire ants, hornets, wasps, yellow jackets, ticks and bees are some of the most common insects that can cause severe allergic reactions. In fact, deaths occurring from bee stings are 3 to 4 times higher than fatalities from snake bites.

Many insect bites can cause diseases. It is important to note that most bites are harmless hence diseases caused by insect bites do not result from the actual bites but from other organisms transferred when bitten. Micro-organisms like protozoans, bacteria and viruses (referred to as pathogen) are spread by insects (referred to as vectors).

The main vectors and diseases are

Mosquitoes: malaria, dengue fever, West Nile virus, Japanese b encephalitis, yellow fever and filariasis
Ticks: lyme disease, tick borne encephalitis and typhus fever
Lice: Typhus Fever
Flies: Blackflies- filariasis, sandflies-leishmaniasis, Tsetse flies- sleeping sickness
Assassin Bugs: Chagas disease
Fleas: Plague or Black Death

Avoiding Insect Bites

The easiest way to deal with insect bites is to prevent them. The above diseases may be worldwide or occur in specific regions on the globe. For this reason, research the areas to which you are travelling to know what you will be exposed to. Prohibit skin contact by wearing suitably thick clothing that covers the entire body since short or thin clothing can facilitate bites. In the absence of proper clothing, insect repellants must be used on skin. Insecticides (spray or heated tablets) and pyrethroid coils can be used inside rooms while mosquito nests treated with insecticide can be used outdoors or for unscreened rooms.

Treatment for Insect Bites

Where bites occur, for allergic reactions or serious symptoms (including high fevers, dizziness and nausea) see a doctor. Most bites however, can be treated at home. More times than not, a simple local application is all that is needed since the insect remains on the skin’s surface. These are ointments, creams and antiseptics that can be used at the site of the bite. Antiseptics are important especially for bites that cover extensive areas and may already be resulting in swelling, redness or any kind of irritation.

Ticks on the other hand tend to burrow beneath the skin so removing the insect carefully to avoid further infection is needed. Using turps or kerosene to kill the tick is recommended then, using a fine tipped splinter forcep (instrument that looks like a tweezer but narrows to toothpick looking tips), firmly grip the neck of the tick and pull the head from under the skin (avoid leaving the head below the skins surface or squishing the tick on the site of the bite since both can lead to further infection). The necessary topical treatments can be used or in serious cases consult a doctor.

Peritonsillar Abscess

What is Periltonsillar Abscess?

This is often a prolongation of tonsillitis. This means that a marked degree of infection occurs, so that an abscess develops between the tonsil itself and the side wall of the pharynx. Because most sore throats are promptly treated these days periltonsillar abscesses are now rarely seen.

Peritonsillar Abscess Symptoms

It is usually on one side only, but the tonsil area will suddenly swell more severely on the affected side. That part becomes exquisitely tender and the temperature may suddenly increase further, the glands swell further, and the feeling of malaise and discomfort increases, particularly on the affected side.

Often inspection will indicate that the affected side is far more infected than the opposite side. Sometimes the abscess will suddenly burst of its own accord and foul smelling pus will discharge. Immediately after this happens relief is gained. The temperature soon falls and the patient feels much better, often within hours.

Peritonsillar Abscess Treatment

The doctor will give antibiotics, and prescribe therapy much the same as indicated for tonsillitis, but the abscess may have to be incised, artificially making an escape route for the pus. The same rapid relief is obtained. Antibiotic therapy and general measures are continued for some days until a complete cure has been achieved.

Parents often inquire about the need for tonsillectomy with tonsillar infections. This is not carried out nearly as often as in previous years, and doctors now have clear-cut reasons for the operation. Here are the main ones why your child might need this operation:

  1. If the tonsils are very large and make normal breathing difficult, especially if they are infected, then they may have to be removed.
  2. Recurring bouts of acute tonsillitis that require antibiotics may need surgery. This may happen if the child has three attacks for two successive years.
  3. Some children are allergic to the antibiotics best suited to them when they are ill. In this case, surgery may be recommended. However, today there are usually several antibiotics the doctor may use with equal success in treatment.
  4. Some children run high fevers with tonsillitis, even to the point of having convulsions each time the temperature rises. Doctors may advise the operation in these cases to avoid the risk of brain damage.
  5. Sometimes the tonsils produce speech difficulties, and in these cases they may be better removed.
  6. Persisting sore throats that, despite treatment, still remain sore, sometimes benefit from tonsillectomy. However, in the total picture, the number of cases requiring surgery is quite small in comparison to days gone by. The vast majority of children have fewer attacks as they become older, and surgery is seldom needed.

If the infection is severe and definitely recurring and is obviously having an adverse effect on the child, then the ear, nose and throat surgeon may remove them, but only after careful appraisal of all the evidence. The tonsils exert a protective function on the system, for they are part of the body’s immune system, and produce special cells. There is some evidence to suggest that the raw surface left after their removal may allow other less attractive germs and viruses into the system. So, if for no other reason, as a cover, they may play a beneficial role. It is recommended that you do not consistently harass your doctor to have your child’s tonsils removed merely because you had yours out after one or two sore throats twenty or thirty years ago. Times have changed.