Author Archives: Ramon.KGS

Overweight to Obesity

Obesity is one of the most common self-inflicted diseases of the modern world. People figuratively dig their graves with their teeth. “The longer your belt line, the shorter your life line.” This saying has been around for a long time, and it is true.
The relationship between obesity and disease is well established. The weight increase usually comes in the form of excess carbohydrates and fats. Coronary heart disease is far more common in the overweight. Their blood pressure is usually much higher, and they arc more likely to become diabetic. In short, the overweight are more likely to develop the risk factors that will predispose to premature heart disease and a heart attack. The overweight usually have a marked increase of the blood-fat levels, both of cholesterol and triglycerides, when compared to normal. A reduction in weight invariably reduces the blood pressure, and the lipid levels generally fall significantly.
Many sophisticated nations have a high consumption of beer per capita. In Australia this is about 103 litres per person per year. This significantly raises the obesity level. for beer is high in kilojoules.
Doctors and scientific laboratories around the world now universally use Systente International (SI) when recording scientific figures. This replaces the older system, and will be the one used throughout these volumes.
Instead of mg (milligram), the term millimolle (mmol) will be used. Most figures are quoted as so many mmol in every 100 millilitres (ml) of fluid (eg blood). The currently used term is decilitre (dL), which is the same quantity as 100 ml. For example, for cholesterol, the level may have read 200 mg/ 1.00 ml, which in the new terminology would read 5.2 mmol/L. Similarly, with the energy unit, the caloric, this has been altered. and now the kilojoule (kJ) is used. 1 calorie equals 4.2 kJ. Therefore. a 3000-calorie per day diet would now read 12,600 kJ. It is simply a matter of getting used to the new terms and the new sets of figures.

Spina Bifida


Spina Bfida is claimed to occur about once in every 1,000 births. It may even be less. Spina Bifida is a developmental abnormality, the spinal canal failing to completely close over. Various types are possible, but those occurring in the lower part of the back are more common.

Spina Bifida Symptoms

There may be a lump along the course of the spinal column, for example at the lower end. Symptoms may be mild or nonexistent, especially in the form referred to as spina bifida occulta. There may be a weakness of the lower limbs, and later, paralysis may set in; there may be a lack of control over the valves of the bladder and bowels. The parent may be first made aware of it when the child has difficulty in normal toilet training

Spina Bifida Treatment

Many mild cases may live a reasonably normal life. I treated a patient for many years, and he lived until his mid-50s before he died of sudden renal complications. He held down a normal, responsible job, and coped remarkably well. He married, and one lad was born who was perfectly normal.

Often if the disorder is picked up early, say at birth, when obvious cases may be quite apparent, surgery is attempted. A great deal is possible at the time, but unfortunately these children, although saved from death at the time, may endure a very difficult time afterwards and pose a major problem for those undertaking their care from that time on.

All patients will be cared for in accordance with their symptoms and their own level of attainment. Some may require intensive hospital care for a long period of time; other milder ones, such as my patient, may live for many years and engage in useful work.

It is possible to diagnose some of these cases antenatally now? Yes, with the so-called AFP (short for alpha-feto-protein) assessments, cases may be diagnosed before birth. This chemical is produced by the open nerve canal, and may be present in the amniotic fluid of the uterus, or increased amounts may be present in the mother’s blood.

In women who have sustained one case, there appears to be an increased risk of further babies with the same disability, and these women may be screened. It is an indication for a legal termination if the mother so desires it but this of course is an emotive and individual topic.

What Is Asthma?

Asthma is a disorder of the airways of the lungs producing problems in normal may be administered—cromoglycate, or the bronchodilators, or theophyllin. The doctor will work out the best routine for your child. Today, there are various bronchodilators, and they are all good. Aerosol sprays can now rapidly cut short an attack. Salbutamol (“Ventolin”), currently one of the most popular, when inhaled into the airways will hasten relief. Other products are also used.

Asthma Symptoms

1. There will be loud, laboured, wheezy breathing.

2. The sufferer has difficulty in speaking and moving.

3. The sufferer is distressed and anxious.

4. Pallor and sweating are marked features.

5. Sometimes, in a severe attack, lack of oxygen leads to mental confusion.

What to Do in the Case of Asthma Attack

1. Sit the patient upright, with arms resting on a pillow, table or chair for support. Open windows, being careful that the patient is not subjected to draughts or chills.

2. In a severe attack seek medical help promptly, as the patient may have to be given oxygen.

3. If the patient has medication specifically prescribed for asthma, it should be given immediately.

4. Speak confidently and reassuringly to the patient, advising that help is on the way. Perhaps a warm drink may help to relieve the tension and fears.

Asthma Treatment

To help the patient easily obtain the full dose of medication, a device called a “spacer” may first receive the dose, which is then inhaled more slowly. These are very effective.

The drugs must not be used haphazardly or too frequently. Despite the fine film of mist the can imparts when the button is pressed, they are very potent drugs. Parental supervision is essential. The doctor’s instructions must be followed implicitly. If relief is not gained within a few minutes, this does not mean fresh sprays are required. Minimum time periods between successive doses are important to avoid overdosing. However, today, the tendency is for patients to under treat rather than over treat asthma.

Cortisone provided a major step forward in the treatment of asthma. With current methods it is being used much less, both in its original form, and its other derivatives, prednisone. prednisolone and beta-methasone. Many adverse side effects occurred with longterm use. But it played its part, and in certain instances is still used. Causing fluid retention, children often develop an odd-shaped appearance called “moon face.” Also, it caused the bones to stop growing, prematurely stunting growth. Many children on long-term steroids have switched to newer methods of therapy.

Other aerosol forms of cortisone-type treatment are now available and they are highly successful in preventing attacks before they occur. Chief of these are beclamethasone (“Becotide” and “Aldecin”). Used regularly, they are highly effective in stopping attacks from occurring. It takes a few weeks for them to become effective. Many children now use this regularly, eliminating the need for oral steroid drugs (the cortisone derivatives).

Other medication that is inhaled is called sodium cromoglycate. It has been around for many years and is also effective in aborting attacks in many instances before they occur. Likewise this must be used regularly. It does not succeed in all cases, but  a certain number find it provides good relief.

What about all the other pills and mixtures that choked the medicine cabinet of many asthmatics?

These are now not nearly so necessary. Tininophylline, adrenaline, theophylline and ephedrine are the basis of many. These are still sometimes used, especially for milder asthmatics.

Sometimes skin tests are carried out by allergy specialist to try to discover the most probable cause of the attacks. When it is found, an extract may be prepared that is injected into the patient in increasing doses over a period of 12-18 months. This is aimed at increasing resistance to product. Also, it is hoped to desensitize the patient, as the doctors say. It is still used, but is not popular. Other methods seem easier and more effective.

Keeping house dust to a minimum is advisable. In fact a special kit to help with is now available and is a worthwhile exercise.

Every effort should be made by the parents to eliminate allergy factors to which the child may be sensitive. Hairy, furred pets may precipitate symptoms. Microscopic house dust mites, present in house dust, and often very prolific in bedding, is notorious for causing attacks. Dry-cleaning bedroom curtains, washing bed clothing, vacuuming the bedroom weekly, probably washing the Nankets monthly, using a damp cloth to wipe away settled dust (rather than a dry duster that simply allows dust to re-enter the bedroom air) often help.

Every asthmatic must have a “crisis plan” worked out in conjunction with the doctor well in advance in the event of a sudden asthmatic emergency occurring.

This is of vital importance. How important is the child’s general health?

Ideally, the fitter the child the better. Keeping free from respiratory infections, and indeed infections of any nature, is worth striving for. Eating sensible, regular meals, getting exercise within the child’s capacity, avoiding cigarette smoke (and educating children on the dangers of smoking before they decide to start).

Many children gradually grow out of their asthma, and develop into strong, fit and healthy adults. The attacks become less frequent, and often finally vanish.

A happy, tension-free home environment can only help. Sensible parents will strive to achieve this. In fact it helps all round—parents included!

Today, asthmatic attacks occur with far less frequency and severity than formerly, because new medications are available that stop the attacks from taking over. (See Section 2: Chapter 5.) In the majority of cases a person who develops a sudden attack of asthma will do best with inhalation of one of the “instant action” aerosol preparations especially designed to cut short such an attack.

Occasionally, however, distressingly severe asthma attacks may prove to be life-endangering, so treat promptly.

Pancreatitis

What is Pancreatitis?
This disease, which affects women more commonly, is due to unknown causes. It appears to be associated frequently (in about 30 per cent of cases) with gallstones and liver disease. Some claim that excess bile production tracks back along the tube that conveys pancreatic juices to the bowel (the pancreatic duct) and causes local interference with normal functioning in the pancreas. It occurs in acute alcoholism and after abdominal surgery.
Pancreatitis Symptoms
There is severe abdominal pain, particularly in the epigastric area (just below the breastbone). This may radiate to the back, and may be associated with signs of peripheral circulatory collapse. Paleness, coldness, low blood pressure and a fast-beating heart are the symptoms when this occurs. The abdominal wall becomes rigidly hard and the patient may turn blue (cyanosis). Diagnosis is often difficult, for the condition may mimic other serious abdominal emergencies. However, a blood test that gives a rise in serum amylase is often diagnostic. More recently needle biopsy is being used in the United Kingdom.
Pancreatitis Treatment
This is unsatisfactory, and due to the acute nature will usually be carried out in hospital under specialist guidance. In recent years certain drugs appear to be of value, but none is established as being useful in all cases.
Rest, intravenous fluids and pain-relieving medication are given. There is an appreciable mortality rate (about 10 per cent or more) and recurrences are likely.

Overactive Thyroid Gland

Overactive Thyroid Gland is referred to as an overactive gland or hyperthyroidism. Unlike the underactive state that may set in at birth, this is more common in the 12-14-years age group, and seems to affect girls more commonly than lads.
They may come on quite suddenly, and the symptoms represent a general speeding up of the system and its activity. It’s as though the accelerator has been shoved down to the floor, and everything is racing. So, the patient tends to be nervy and irritable. She fidgets and squirms around and simply cannot sit still for long. The skin tends to feel warm and clammy, and she may perspire more than normal. Occasionally there may be prominence of the eyes, although this is more common in advanced cases in adults.
The heart may race and palpitations may develop, which is a little scary. The child may eat well, but be quite thin, and often feel weak, for the food is being gobbled up at a fast rate. Growth may be above normal. Girls may commence menstruation later than normal, or might not commence at all.
A mother confronted with symptoms in her child along these lines should promptly seek medical attention. Exactly, and that is why I’ve named the most probable kinds of symptoms. The sooner special tests are carried out, the sooner the child will be restored to normal.
Overactive Thyroid Gland Treatment
This will vary with the individual patient. It will depend on the results of tests and assessments. In some cases, medication with tablets may be adequate. In more serious ones, surgery may be necessary. The doctor, usually a specialist, will prescribe a special medication routine for the patient and her particular problem. I might assure mothers that therapy is usually very satisfactory, and in the long run an excellent result will take place in most instances. The main object, however, is action if abnormal symptoms occur.

Rose Center Piece Flower Arrangement

A basket of roses and Peruvian lilies makes a beautiful gift — perhaps for a special birthday, anniversary or Mother’s Day. It would also add a lovely touch of colour and interest to a window sill, a fireplace or an otherwise dull corner that you feel needs cheering up. The basket, painted to tone with the flowers, would be ideal to use afterwards as a container for yarns, sewing materials or bath preparations.

DIRECTIONS:

1. Gather together your materials: a shallow basket with a handle, a waterproof liner such as a plastic box, a block of absorbent stem-holding foam (soaked beforehand),narrow florist’s adhesive tape, scissors, long-lasting foliage such as eucalyptus and flowering shrub, flowers such as roses and Peruvian lilies, florist’s scissors, secateurs(pruning shears), paper ribbon and a stub wire (floral pin). Prepare the basket to co-ordinate with the flowers that you are using, if you wish; the one shown here was painted in stripes of pink gloss paint, to add a touch of sparkle to the arrangement.

2. Put the liner in the basket and place the block of foam in it. Cut 2 strips of adhesive tape and crises-cross them over the foam and down on to the sides of the basket, to hold the foam firmly in place. Arrange the tallest stems of foliage to make a fan shape at the back of the basket. Cut progressively shorter stems for the centre and front, positioning them so that they droop and trail over the rim.

3. Arrange the roses to make a gently rounded shape in the basket, alternating the colours (pink and pale yellow were used here) so that each complements the other to create an attractive effect.

4. Add the Peruvian lilies, cutting some individual flowers on short stems and positioning them close against the foam. Fill in the gaps with short sprays of flowering shrub.

5. Unfurl the twisted paper ribbon by pulling it out gently from one end.

6. Cut the length of ribbon required and tie it into a bow. Gently ease the loop until it looks neat, and trim the ribbon ends by cutting them at a slant. Thread the stub wire through the hack of the loop, and twist and insert the 2 ends into the foam at the front of the basket. Spray the flowers with a fine mist of cool water, and keep the foam moist by adding a little water to it at least once a day.

Otosclerosis

What is Otosclerosis?

This is a progressive disease that often commences in early adult life, particularly in females, producing advancing deafness, accompanied by tinnitus (ringing in the ears) and occasionally giddiness. There is a tendency, apparently, for this problem to run in families, transmitted by the female to her daughters. The condition may proceed to almost total deafness, but often sensori-neural deafness may also supervene.

Otosclerosis Symptoms

Deafness is the main symptom. It progresses until it may be nearly complete. The patient tends to speak in a quiet voice. Many find they can hear better in a noisy environment. The disorder is caused by spongy bone being laid down around the oval window of the middle ear, fixing the stapes, one of the vital bones required for normal movements in hearing. It is uncertain what produces this, but a genetic factor is definitely present.
Some of the points to look for with little ones include whether there is a history of “risk” factors with the child (eg did the mother have rubella during early months of pregnancy?); suspicion by the mother 54 of the child being deaf; and other defects in the child that may have resulted from the risks mentioned.
The child may also not appear to respond to sound in daily activities (eg failure to arouse when noise is present when very young; failure to answer to its own name; failure to vary the tone of speaking as it becomes older; strident sounds for certain, simple vowel sounds; retardation in speech and language development etc).
Some of these factors may be evident as early as three months of age. They will gradually become more apparent. Hearing is as important to speech as sight is to reading. It is imperative that a child suspected of having a hearing disability be referred to a special centre where it can be thoroughly and expertly checked promptly.
In older people, gradual loss of hearing is part of the aging process. Some note it re severely than others. Conversely, many older people have remarkable raring acuity well into old age. Nevertheless, in this electronic era, much can be done for many people with distress of hearing loss.
Sudden reduction of hearing may be caused by blockage of the outer ear canals by and debris, and foreign bodies can produce a sudden mechanical deafness to normal sound. Hearing diminution is sometimes associated with a ringing sensation in one or both ears. This is called “tinnitus.” It can be very disturbing in older people.
This is of particular importance in small children. Children anywhere from age of three months onwards should alert parents to recognize abnormal hearing. Immediately there is any suspicion of this, the child must be on to an appropriate place where diagnosis and therapy may be initiated without further delay.

Otosclerosis Treatment

There was no satisfactory treatment until the advent of the operating microscope and perfection of a microsurgical technique that has revolutionized procedures. This is in the province of the ENT surgeon, who has specialised in this form of surgery. Carried out by a trained surgeon, it is not a serious procedure.
There are several forms of the operation, but removal of the damaged footplate bone and replacing this with a suitable prosthesis is the final outcome. This restores the normal continuity of the growth and can result in a near-normal upbringing, but if it is missed, it can retard them and remain a tremendous drawback that may have a permanent detrimental effect on their physical and mental welfare.
There are many deaf children. Before the advent and widespread use of vaccination for rubella (German measles), many women sustained the disease during pregnancy. They subsequently produced deaf (completely or partially deaf) children. Now vaccination of women is more readily available, this cause of juvenile deafness should commence to reduce in the near future. Past epidemics resulted subsequently in enormous numbers of deaf children.

Infants and children

These should be taken immediately the family doctor who will most probably refer the patient to an Ear, Nose and -oat (ENT) specialist for further pinion and tests on hearing. The vast majority of these children in Australia attend a branch of the Cornnwealth Acoustic Laboratories. Children may be taken there directly, and no formal referrals are required. These clinics are situated in all State capitals and in many larger provincial towns. Tests are carried out, and if the patient requires hearing aids, these are supplied free of charge. They are subsequently maintained and serviced without charge to the child or the parents, and no means test is applied. Almost the entire deaf child population of Australia is catered for by these laboratories.
Approximately two children for every 1,000 born require hearing aids. These are generally fitted around the age of 18 months. But this age is decreasing with an earlier awareness of the child’s defect. Many are now fitted in the 3-6 month age group.

Older persons

As soon as there is an awareness of a hearing loss, medical assistance should be sought. Your own family doctor is usually the best starting point. He can carry out a preliminary assessment and check if there is any local cause. If there is, this will be rectified (eg syringing ears or removing foreign matter or objects). Alternatively, he may refer the patient to an ENT specialist for further investigation. The suitability of a hearing aid can be assessed. This may be carried out in conjunction with the laboratories already mentioned.
An assessment may also be made as to whether other medical disorders are producing some symptoms. Noises in the head, ringing bells, tinnitus etc may have other reasons, and these must be checked out. Suitable measures to correct these should be taken. Often “tinnitus” has no curable cause. The person must learn to “live with it.”

How to Organize Space

Finding suitable storage space around the house for all the personal and household belongings every family accumulates can be quire a challenge. One difficulty is making a sensible compromise between tidiness and accessibility; it is no good having a place for everything if that means spending hours each day laboriously taking things out and putting them back again.

The solution is to tailor make storage to suit its purpose. Some things need a temporary resting place where they remain readily accessible. Others need long-term storage, perhaps being retrieved and used only occasionally. And there is the third storage category, that of display, simply to show things off.

In a typical home, possessions are stored in one of three main ways: on shelves, in cupboards (closets) or in drawers. These may be combined in a variety of storage or display units, and the amount of each type of space that is required will vary from house to house. For example, the avid book worm will have miles of shelves lining the walls, while the clothes horse will need more wardrobe space.

The storage that is needed can be provided in one of two ways. One is to buy or make pieces of free-standing furniture that match the required storage function. The other is to use raw materials such as wood and manufactured boards plus the appropriate hardware to create built in storage space, arrays of shelving, cupboards in alcoves and so on. The former is the best solution for those who value furniture more than function, since the pieces can be moved from one house to another. However, built-in storage is generally more effective for providing the most space for the least money, since the house walls can often be used as part of the structure.

Water Accidents

In my opinion it should never occur, but unfortunately, each year, a significant number of drownings are reported. They are more common among younger children, more common during holidays, and more likely toward sunset. They may occur at beaches, but with the proliferation of backyard swimming pools in recent years, lots of backyard drownings are occurring. They are more common in private pools than better supervised public ones – this is worth bearing in mind.

Also, it is possible for a child to drown in a few centimetres of water. A fall, leading to temporary stunning with the face. nose and mouth submerged, has led to quite a few fatalities in recent times. Parents should be alerted to these possibilities.

Drowning is more common when the children at play are unsupervised. Stupidity and skylarking with older children has also led to unfortunate accidents. Ideally, an adult should be present when children are using pools, or at the surf. A major no-no are dams in rural places. Even in hot weather, while the upper few centimetres of water may be warm, underneath it is likely to be extremely cold, and this seems to increase the risk of cramps and drowning. Never swim in unknown waterways or where there are chances of hidden debris being just under the surface.

It’s possible for children to become good swimmers in the first year of life. Training must continue, for they often forget after a break. The sooner children learn how to swim and save themselves from a potentially dangerous situation, the better.

Ideally older children and parents should know the basics of artificial resuscitation. Knowing how to initiate breathing, and also how to start a heart beating once more after it has ceased is imperative if you wish to be of maximum help to a person who has suddenly “died” for any reason. Drownings probably head the list with children, but electrocution and other situations may also require this as an emergency measure.

White Blood Cells

Apart from red cells, there are the white cells or leucocytes. Some are produced by the bone marrow and are called granulocytes, because they have varying coloured granules dotted throughout them when stained ready for examination under the microscope.

There are three kinds of granulocytes. One form, called the neutrophil, has the capacity of engulfing and devouring foreign particles in the blood. They are termed phagocytes, and this capacity is necessary to combat infections. The germs are simply gobbled up by the cell, digested and destroyed. Incidentally, the white cell dies also – a case of giving its life to help keep the owner alive. This is seen in the formation of pus.

There are two other types of granulocytes: the eosinophils (that stain a bright red) and the basophils (that turn blue on staining). The eosinophils are associated with allergic reactions, being present in higher numbers in patients with allergies (such as asthma and hay fever) and parasitic infections. Basophils are involved in inflammatory and allergic reactions.

So much for the red cells. They seem very important. Now what about the white cells you spoke of? These are also extremely important. They are really the fighting force of the body. Their task is essentially one of protection. In time of need they are mobilised, and they vigorously attack any unwanted foreign invaders that may harm the system. There are many different kinds, but they are essentially there for the same purpose.

If infection occurs at any part of the system, the white cells congregate, and actively attack the germs. They actually approach them, roll over them and totally encompass them in a weird process called phagocytosis. When this has happened, the cell usually dies, with the germ inside it. This is how pus forms – it’s really a collection of millions of dead white cells and dead germs.

In times of infection, huge numbers of white cells are manufactured rapidly by the system, and thus the “white cell count” of the blood increases, as the doctors say. This condition is called leucocytosis – the leucocyte being the official name of the white cells. Sometimes there is a swing in the opposite direction, and there are insufficient white cells. This is called leucopenia, and may be dangerous if an infection strikes.

Where do the cells come from?

There are many different places around the body where they are manufactured. The softish material in the centre of the large bones of the limbs called marrow is an important one. Others are made in the lymph glands, and two large organs located in the upper part of the abdomen called the liver and spleen are also associated with the cells. A gland in the upper part of the chest of children, called the thymus, also produces certain types of white cells. Another solid part of blood are the platelets, microscopic particles that play an important part in blood clotting