Category Archives: Health

Depression

Depression is a very definite emotional overlay to the whole problem. Many women experience depression, bouts of irritability, feelings of anxiety and tension. Emotional conflicts often flare. By this time in life most children have grown up and have left home. The woman’s parents have usually died in recent years, or present a problem in a home or convalescent hospital.

Her husband has either failed in life or has made the grade. If he is a failure, there is not much chance of his extricating himself from it at this age. This fact, along with the economic and social stigma this can present in a vulnerable woman, is an extra burden she feels forced to face each day. Maybe he neglects her, and is more at home with his friends. Perhaps he drinks, gambles or otherwise spends more time following his own social pursuits than in caring for his wife.

On the other hand, if the spouse has made a success of his life, this inevitably means he is away from home for many hours each day, and perhaps is involved in trips on account of the business. He has little time to spend listening to her sad story, and often less patience to help her solve her problems that may seem trivial to him when he spends most of his waking hours involved in major decision- making experiences.

None of this benefits his wife, who often feels more and more alone in the world, deserted by all those who mean the most to her.

Doctors hear these sad but very plausible stories on a never-ending basis each working day:

“Life holds no more meaning for me.”

“Life has come to an end.”

“Nobody cares about me anymore.”

“Life is a bore, a drudge; I often wish I would never wake up in the morning.”

The sad phrases roll out regularly.

Because of the hormonal lack, the sex organs tend to be affected dramatically. With no oestrogen, the lining of the vulva and vagina thin out. They generally tend to shrink in size. However, while some women find that intercourse has lost its desirability and attraction for them, many others discover that their libido is considerably increased.

Suddenly, many realize that their child-bearing days are over. The risk of pregnancy is totally removed, and the need to take precautions for contraceptive reasons vanishes. This can add new dimensions to the thought of sex and intercourse. But when it comes to the physical act of lovemaking, the situations may be annoying and completely frustrating.

Penetration may be painful or difficult. The thin, atrophic, ageing lining tends to stretch less easily, and penile accommodation may be less readily achieved as in former times. Many women have found the demands of a thoughtless husband extremely trying. Considerable matrimonial disharmony can take place over this problem, and marriage disasters are not uncommon during the menopausal years.

Menopausal woman must be treated with love. Conversely, some husbands show a markedly reduced libido and capacity and desire for intercourse. Kinsey showed many years ago that after the age of 40, the sexual desire and capacity of most males tended to reduce gradually. Conversely, that of the female counterpart went in the opposite direction. So, once more, some women tend to accentuate their feelings of neglect. They believe their husbands no longer care, or are probably having an affair (usually imaginary) with some fictitious beauty.

Curvature of the Spine

Torticollis is sometimes referred to as “wry neck.” The child’s head is tilted to one side with the face turned slightly to the other side. When it occurs during infancy, torticollis is usually not visible at birth but appears a week or so later. The cause is not clear but the problem is usually an excessive tightness in one of the neck muscles. The treatment is usually a careful stretching program. In many cases the deformity will correct with this treatment. If the problem is ignored until the child is older than one year, a stretching program is not likely to be effective, and surgery is usually necessary.

A similar condition may develop acutely in an older child, and it will typically disappear over a few days. Rest, local heat, pain relievers, and possibly physical therapy may be helpful once a physician has confirmed the diagnosis. There are a number of possible causes of this condition, including inflammation or infection in the neck and throat, as well as injury. It is important to have the child checked by a physician to make a diagnosis and initiate appropriate treatment.

Scoliosis is an abnormal curvature (usually sideways) of the spine, most commonly seen in adolescent girls but occasionally found in boys. The cause of this curvature is not known, but it seems to be associated with the growth spurt that takes place around puberty. Often the problem is picked up in school screening programs when the child bends forward at the hips while the examiner looks along the spine. If the ribs on one side appear higher than those on the other, scoliosis may be present. An X-ray is the best way to confirm the presence of a spinal curvature, from which the doctors can measure the degree of curvature.

Usually more than one curve is present. One of the curves is considered the main or primary curve, and the other is called the compensatory or secondary curve. If the primary curve is less than 25 degrees, the child is watched carefully, and an X-ray is usually taken every six months during the growth spurt. Curves greater than 25 degrees may require a brace to prevent the curve from worsening. (It is not intended to reduce the size of the curve.) Bracing is not always effective, however, and sometimes the curve continues to worsen. If the curve exceeds 40 to 50 degrees, surgery is usually recommended. The surgery is designed to decrease the size of the curve and fuse the spine to prevent the curve from increasing again. Steel rods are usually inserted along the spine to hold it straighter while the fusion becomes solid. After the fusion is solid (usually twelve months or more after surgery), the child can return to normal activities.

Kyphosis (or “roundback”) is an accentuation of the normal curvature of pine. Usually this is first noted early during the scene (between ages ten and fifteen) and often simply re-from bad posture. More severe cases are associated with e-shaped vertebrae, a condition known as Scheuermann’s disease. This is treated with an approach similar to that taken with scoliosis. If the deformity is less than 45 degrees the child is taught sitting exercises and watched carefully. If the curve is between 45-70 degrees, bracing is used. Once the curve exceeds 70 degrees, it is usually needed to correct it.

One of the more common causes of back pain in children is spondylolysis defect in a vertebra that may allow it to slide forward onto the one below (condition called spondylolisthesis). Treatment may include rest, and anti-inflammatory medication. If pain persists despite conservative treatment or if the gradual slipping of vertebra onto the other worsens, surgery may be necessary to stabilize that segment of the spine.

Nail Care

Because an infant’s fingernails grow quickly and may accidentally scratch the face, they should be gently trimmed once or twice a week using infant nail clippers. Toenails, (which do not grow as quickly and can’t cause any injury) need only be trimmed once or twice a month.

The hands of a young child are constantly exploring the world around him, and thus both fingers and fingernails are at risk for a variety of injuries. If a child is barefoot much of the time, toenails could occasionally be injured as well. If a nail becomes cracked without roughness, no special care is needed. If a nail is nearly torn however, use clippers or scissors cleansed with rub alcohol to cut off the loose fragment. Each day, soak hand or foot for twenty minutes in a solution of salt water (1 tsp salt in 2 cups water), then apply biotic ointment and a small adhesive bandage and in about a week, the raw nail bed will be covered with new skin, and this routine can be stopped. A new one will eventually grow out.

Occasionally a crush injury (as occurs when a finger is in the path of a in a closing door) will cause bleeding under the nail. This will be manifested by a deep blue discoloration of the nail and a great deal of pain. This in turn should be seen by the child’s physician, who may use a special tool to poke a hole in the nail to release the blood and relieve pain immediately. If the nail bed is cut as the result of a crush injury, it may need to be treated under local anesthesia.

Nail biting is a commonly self-comforting, bad habit among children. Attempts to stop it through ridicule or punishment will cause more harm than good. A child who wants to break the habit can beat it in a variety of ways:

Offer a reward for a certain number of days or weeks of “biteless” nails.

Devise a simple, nonjudgmental signal (such as saying the child’s name in a friendly tone and pointing to your hand) you can use when you see him biting his nails.

Sour-tasting solutions painted on the nails may serve as a reminder to keep fingers out of the mouth.

An infection of the soft tissue at the junction of the fingernail is called a paronychia. This usually involves common staphylococcal or streptococcal bacteria. The infection arises from a break in the skin resulting from thumb-sucking, chewing, or pulling on the cuticle. Occasionally, pus will drain from the breakage which also has a tendency to become red and irritated. If a pus pocket is clearly visible, your child’s doctor might lance it, which will relieve pressure and reduce pain. The doctor might recommend 10 or 15 minute soaks in a solution of a little antibacterial soap in 6 to 8 ounces of warm water, along with the application of an antibiotic ointment. In more severe cases, oral antibiotics might be prescribed.

Ingrown toenails are caused by improper cutting of the toenails and/or wearing tight shoes, and the nail becomes embedded in the flesh. Always cut a toenail straight across rather than curve it down on the sides. If an ingrown nail develops, soak the foot daily in a solution of soap and water as just described. Massage the swollen part of the toe away from the nail. Frequently, ingrown toenails (especially on the big toe) become infected, causing pain, redness, and swelling where the nail joins the infected skin. While gentle cleansing and warm soaks may help to some extent, your child’s doctor might recommend antibiotics and/or removal of the segment of nail that has become embedded in the skin. (A local anesthetic is given to numb the toe before this is done.)

Fetal Alcohol Syndrome

Fetal alcohol syndrome is a specific pattern of abnormalities among infants born to alcoholic mothers. This pattern was first described during the late 1960s and given the name fetal alcohol syndrome in 1973. It is now estimated to occur in one out of every 1,000 births or approximately 5,000 cases per year.

Fetal Alcohol Syndrome Symptoms

  1. Poor growth before or after birth, with weight, height, and head circumference smaller than 90 percent of other newborns.
  2. Abnormalities of central-nervous-system function. Of these, mental retardation is the most significant, seen in more than 80 percent of affected children. Fetal alcohol syndrome is one of the leading causes of mental retardation in the United States. Other problems include irritability during infancy, hyperactivity during childhood, and delays in development. In some infants, jitteriness soon after birth is the direct result of alcohol withdrawal. Abnormalities in the central nervous system caused by alcohol may also affect development of bones and joints.
  3. Various defects of the face, eyes, and ears. These are often more apparent during infancy and may become less obvious as the child grows into adult-hood. Symptoms may include incomplete development of the facial bones, upper lip, a short nose, prominence of the vertical skin fold on each side of the nose, and drooping upper eyelids. Various visual disturbances may be present also, including incomplete development of the optic nerve, misalignment of the eyes, nearsightedness, and astigmatism. Varying degrees of hearing loss are common in infants with this syndrome. These abnormalities frequently lead to delays in language development.
  4. Other birth defects occur in infants with this syndrome, including a variety of congenital abnormalities of the heart (affecting approximately 30 percent) and the urinary tract (affecting about 10 percent).

Alcohol Use during Pregnancy

Warnings about the effects of drinking alcohol during pregnancy have been raised for centuries and are now more widely publicized than ever before. Nevertheless, recent estimates suggest that one in three pregnant women use alcohol.

Two basic facts about alcohol and pregnancy are extremely important:

  • There is no safe time to drink during pregnancy. While the first three months of development after conception are usually when the growing baby is most vulnerable to drugs and toxins, alcohol can cause problems throughout the entire pregnancy.
  • The toxic effects of alcohol on the fetus are known to be dose-dependent, that is, potentially more serious with higher levels in the bloodstream. Drinking a lot in a short period of time (as occurs during a binge) may be more hazardous than a steady intake of smaller amounts. Women, who regularly consume more than eight drinks per week, whether all at once or spread evenly over seven days, run a 30 to 40 percent risk of having an infant with fetal alcohol syndrome.

It is impossible to know whether any amount of alcohol in any form can be considered safe for a woman to drink while a baby is growing inside. Therefore, the best option is to abstain entirely from alcohol throughout the entire pregnancy. It is wise for woman to abstain or to consume no more than two alcoholic drinks per week if she is not yet pregnancy but plan to become so in the near future.

While we know of no cure for fetal alcohol syndrome, infants who have it can be helped to reach their full potential. Particular attention should be paid to the child’s vision and hearing to detect and treat problem that could impair normal development. Infants and children with fetal alcohol syndrome are also prone to develop ear infections and persistent fluid behind the eardrums, which should be treated to prevent hear loss. Cavities in the teeth are more common in these children, so conscientious dental care is important. When these children approach school years, educational tests and special programs should be sought for them.

Syringomyelia

This is an uncommon disease of the nervous system occurring in either sex, with symptoms manifesting themselves during the period of most rapid growth. It is rare after the age of thirty. Cavities occur in the spinal cord and produce symptoms. It is believed to be due to an inherited defect in brain development.

Syringomyelia Symptoms

The most common and typical features are a loss of some sensations. This is generally the appreciation of heat and pain, most frequently in the upper limbs. It begins insidiously and without any obvious warning. The patient may discover burns on the fingers from a lighted match without noticing it. As the condition deteriorates, the area covered by this sensory loss gradually increases, until it may equal the area covered by the sleeve of a coat. Generally, the patient is aware of subjective sensations. Dull pains may sometimes occur.

About half of the cases also show wasting of the muscles. This usually affects the muscles of the hands and the inner side of the forearms, and generally takes place on both sides concurrently. It may become very noticeable. Resulting from the muscle wasting, contractures may develop and a claw hand deformity occurs. The legs are usually not affected to such an extent, but a slight stiffness or spasticity might occur. Some might show spinal curvature from effects on the thoracic muscles. The bones may become brittle as the calcium tends to be withdrawn from them.

Provided the condition is diagnosed early, the patient may undergo Gardner’s operation, in which the spinal cord is plugged. Good results are reported when this operation is carried out successfully. Unless this is done, the disease progresses slowly. Life is not shortened, but a considerable degree of disability may take place, and may make the life of the patient difficult.

Adrenal Medulla Secretes

The adrenal medulla (internal part) produces two hormones that are called adrenaline (epinephrine) and noradrenaline (norepinephrine) Noradrenaline controls circulation. If the blood pressure falls, more hormones are excreted. This makes the peripheral blood vessels contract, and this in turn causes the blood pressure to rise. The heart rate slows, but the output remains constant.

Adrenaline also influences the heart and circulation, but it is related more to a response to stress situations. The so-called “fight or flight” mechanism occurs. In moments of sudden danger, this is an inbuilt and automatic response designed to prepare the individual for immediate action.

It is aimed at preserving life. The whole body is geared to cope with an emergency situation, be it attacking an adversary or running for safety. For this reason, adrenaline immediately raises the blood-sugar levels (to provide more food for activity) by converting glycogen stored in the liver to glucose available in the bloodstream. Oxygen consumption increases, making the muscles ready for activity. The air passageways dilate, ready to cope with greater demands and the intake of more oxygen. (This is why it is so effective in asthma where there is a constriction of the air-passages making respiration difficult.

By opening the airways, breathing is immediately made much easier.) There is a marked increase in the heart rate and output, enabling more blood (and oxygen, food and supplies) to be pumped around to the body, supplying all organs with essential requirements. The blood pressure tends to rise.

The body’s reaction by increasing production of this hormone is amazing.

Most are well aware of the symptoms that can occur, for simple events, such as a sudden fright, can produce symptoms. For instance, the “hair stands on end” (you might feel this on the back of the neck or on the legs). Sweating, thumping heart, quicker respiration, muscle tension, general alertness and an improvement in mental acuity all take place. If you do have to run, then the ability to do this is usually accelerated.

Abnormalities can occur in the medulla, and although rare, a significant growth called a phaeochromocytonza can arise. This is usually noncancerous, but it may be malignant. It is said to occur in only one of every 1000 persons with high blood pressure.

Smear Test

Undergoing a smear test is very simple from the patient’s point of view. In fact, it is often carried out in conjunction with a routine pelvic examination, which commonly occurs during an antenatal visit, or a check when a repeat prescription of the pill is being requested, or for any other reason.

It is perfectly painless, and adds only a couple of minutes to the routine pelvic check. Most doctors carry out a breast examination at the same time, as it is convenient to combine the two.

A speculum is inserted into the vaginal canal. This instrument allows a clear view of the cervix, located at the far end of the vaginal canal. A good light is necessary. The doctor then inserts a wooden or plastic device called a spatula. By making a rotational movement of the spatula against the cervix through 360 degrees, a thin smear of superficial cells is secured.

These are then transferred to a glass slide, sprayed with a fixing aerosol or placed in a special solution, then packaged ready for dispatch to the pathology laboratory. Here experts will promptly examine the slide, after it has been stained. under the microscope.

The entire exercise takes a very short time as far as the patient is concerned, although the follow-on work is far more time-consuming. Usually the doctor checks a variety of details from the patient, for this assists the pathologists in making their decisions, and alerts them to possible hazards.

Shortly after, the report from the pathologist will be sent to the doctor. Of course, the majority will be perfectly normal. Sometimes other pathology is discovered, quite apart from any suggestion of cancer. General inflammatory changes in the vagina and cervix may he picked up. Infections due to monilia or trichomonas are also commonly found.

This is a bonus extra, and the doctor can recommend treatment for these if they were not previously known.

Sometimes the smear is unsatisfactory for various technical reasons. and a repeat may be recommended.

But the chief result that spells concern is a “positive smear.” This means the pathologist has discovered cells that are either suspicious of cancer (called “dysplasia”), or are downright positive.

If there is any doubt, a repeat should be carried out soon after, either to confirm or deny the possibility.

But if the result is a definite positive, then immediate action is essential. The patient is alerted, and a cone biopsy is recommended.

This means hospital for a short time. In some centers this is preceded by a colposcopic examination. The doctor examines the cervix under the direct vision of a colonoscope, an instrument that gives a greatly magnified on-site enlargement of the cervix.

By this means, it is often possible to actually delineate the abnormal areas. Some doctors paint a special fluid onto the cervix, and note if there is a color change. Today, the “wart virus” (short for papilloma virus) is believed to be the cause of many (probably most) cases of cervical cancer. Entering the superficial cells, it alters the nucleus, turning the entire cells (and subsequent ones) into cancerous ones. This can quickly spread. The presence of wart virus will often increase the chance of the diagnosis of cancer being made because of the relationship between the two.

By the use of a device called the “cerviscope,” a color photograph is made of the cervix. This is kept for later referral, and rechecking at a later date to compare “then” with “now.” In medicine, this is often vital.

This is followed by a cone biopsy. A cone of tissue is removed surgically. In recent times, the laser scalpel is often used. This is claimed to give a cleaner, more precise incision. and greatly reduce bleeding. The biopsy will include the affected part of the cervix. This tissue is then completely examined by the pathologist to ascertain the extent of the possible early cancer. It also indicates if it has been totally removed.

Although smear tests are most commonly carried out by family doctors and general practitioners, further investigations, biopsies and so on are done by gynecologists.

Snoring

A harsh noise produced by vibration of the soft palate and uvula of a sleeping child who is breathing pre-dominantly through the mouth. Not all noisy breathing is snoring. Nasal congestion and wheezing, for example, also generate sounds during sleep, but these are often heard during waking hours as well.

Snoring occurs for a number of reasons, most of which are not causes for concern. One of the most common causes is relaxation of the muscles and tissues in the back of the mouth, which allows them to vibrate while the child is inhaling or exhaling. Since the position of the head affects the vibration of these structures, simply moving the child can reduce or eliminate the snoring. This type of snoring can occur whether a child is breathing through the mouth or the nose.

Children with nasal congestion, whether caused by upper-respiratory infection or allergy, will breathe through the mouth at night and thus be more likely snore. Over-the-counter decongestants and antihistamines are often not effective in children, but if one an these preparations helps a child breathe more easily through the nose, a bedtime dose could help alleviate the snoring. Unfortunately, decongestants (such as phenylerine or pseudoephedrine) sometimes have a stimuli effect and actually interfere with sleep. While antihistamines (such as diphenhydramine or chlorphern-ramine) usually make children drowsy, occasionally these drugs cause an increase in activity. You may wants give a test dose during the day to see how your child responds.

If a child’s tonsils are unusually large, they may actually touch each other in the back of the mouth. This can cause not only loud snoring during sleep but also short periods of apnea, or cessation of breathing, lasting for several seconds. If the child has a pattern of continuous loud snoring and episodes of apnea, have him checked by your primary, care physician or an ENT (ear, nose, and throat) specialist. Tonsils and/or adenoids large enough to cause snoring and obstruct breathing at night can lead to serious problems involving the heart and lungs. Tonsillectomy and/or adenoidectomy may be necessary to correct this condition,

Hemolytic Anemia

What is Hemolytic Anemia?

This type of anemia is due to a premature destruction of the red cells. Generally speaking it is fairly uncommon, and as care in the use of drugs looking out for situations in which it is likely to occur (such as Rh incompatibilities), and taking the necessary precautions increases, the risks are now far less than they were a few years ago. Apart from some of the usual symptoms of anemia (sometimes a feature. sometimes not, depending on the degree of anemia present), other typical symptoms are associated with it.

Hemolytic Anemia Symptoms

Jaundice (yellowing of the skin and whites of the eyes) can occur. This is due to the excessive breakdown of the red cells, and the production in large amounts of a chemical called bilirubin. The urine and feces may become severely pigmented also, as large amounts of bilirubin are excreted through these systems.

The blood picture (when examined under the microscope) shows typical changes. The bone marrow makes increasing efforts at stepping up red cell production to cope with the rapid rate of cell destruction. For this reason, red cells that have not matured properly are pumped into the general circulation.

These immature cells appear in profusion. The level of actual anemia depends on the body’s ability at balancing the rate of cell destruction with the rate of new cells being made available. In this way, the symptoms of typical red cell anemia will vary from case to case.

Also, abnormal by-products of red cell destruction are usually found in the urine. There is an extensive battery of tests available to help doctors decide which type of anemia is present, and to help pinpoint the probable cause. Most of the others are rarely seen by doctors in the ordinary routine of practice, and the majority is only diagnosed upon investigation in a large hospital equipped to deal with the full range of investigations.

From the practical point of view, it is essential that any of the telltale symptoms mentioned receive prompt medical attention. Your doctor will very quickly have you referred to the appropriate centers for total assessment and treatment. Treatment of these disorders has no place in home medicine, and trying simple home remedies and following the advice of well-meaning relatives and friends is a total waste of time and could be harmful in precluding vital medical attention.

Jaundice, an important symptom in this type of anemia, warrants immediate medical advice from a doctor.

Some of the more probable types of hemolytic anemia include:

Hemolytic Disease of the Newborn

The most likely situation in which this may occur is when an Rh-negative mother produces an Rh-positive infant, and the cells from the baby stimulate the mother to form anti-Rh (usually anti-D) antibodies.

These antibodies can then cross via the placenta and become attached to the baby’s red cells, causing their destruction (hemolysis).

Generally there is a history of a previous pregnancy or miscarriage in the mother, and during the birth of the first baby (who usually comes through unscathed) the release of fetal cells into the mother’s circulation takes place, and sets up the antibody production that will affect later babies.

Each subsequent baby will tend to be affected more severely It may be lethal to the baby, and a condition called hydrops foctolis can develop unless immediate steps are taken soon after birth. Formerly the only method of treatment was to give a prompt exchange transfusion to the baby. In this way, the diseased blood was removed, new blood replacing it completely.

It was a time-consuming and arduous undertaking and a marathon event for a newborn infant. However many lives were saved in this manner. In the late 1960s it was found that if the mother were given a special single injection of anti-D antibody within 7 2 hours of the birth of her Rh-positive infant, this effectively stopped production of the antibodies, and the risk to subsequent babies was greatly reduced.

As a new generation of mothers is growing up, and with routine blood tests being carried out before and at the time of birth (on the mother and infant), treatment is now effectively cutting back on this form of anemia. In time it will most likely disappear altogether.

However, a miscarriage, abortion or blood transfusion (with Rh-positive blood in an Rh-negative woman) may lead to similar complications later on in pregnancy.

Incompatible Blood Transfusion

The most obvious example of hemolytic anemia occurs when a patient is given the wrong blood during a transfusion. This is termed “incompatible” blood. In 1900 Karl Landsteiner showed that there were four main blood groups that could destroy incompatible red cells. For example, if a patient of group B is given group A blood, the group A cells will be destroyed by the anti-A in the recipient’s plasma. That is why great care is taken to type and cross-match blood before every blood transfusion. Only group 0 blood may be given in a dire emergency without cross-matching with relative safety, for it contains no antigens.

Symptoms that may occur when the wrong blood is given include acute hemolysis, the appearance of hemoglobin in the urine, fever and severe back pain, and frequently renal disorders. Most of the mistakes that occur causing this reaction have been found due to administrative errors at the hospital (wrong labels on bottles, failure to check labels correctly etc).

Hemolytic Anemia Due to Drugs and Chemicals

Certain drugs are well-known for their ability at reacting on the red cells and causing their premature destruction. This may occur almost at once, or in others it may occur about 10 days after administration of the drug, the first dose apparently sensitizing the system and later doses having an immune type reaction. But the result is the same, irrespective of the cause—red cells disintegrating and possibly causing a medical emergency.

Other Causes

A variety of other causes have been incriminated. Certain bacterial infections appear capable of producing bone-marrow depression and red-cell destruction.

Mechanical trauma of the red cells can cause their premature breakdown in others. Apparently healthy young men doing a lot of marching or running particularly on hard surfaces for prolonged periods of time, may damage the red cells in the blood circulating in their feet.

Hemoglobin is later passed in the urine a frightening experience. It is harmless and wearing rubber insoles in the boots should correct the problem.

Burns may have a similar effect, the red cells becoming directly damaged or else suffering damage as they flow through injured vessels. They subsequently tend to fragment and hemolyse. In these modern times, when Teflon is being used in cardiac surgery unless the prosthesis is completely covered with normal cells, red cell damage can occur similarly leading to cell destruction.

Other prosthetics can cause similar cell damage, a problem of modern surgery limited to the second half of the 20th century. It will probably increase as does the rate of surgery of this nature.

Enlarged Spleen

The spleen is an integral part of the reticulo-endothelial system of the body apparatus that deals with red cells once their useful life has come to an end. They are disposed of quietly, and their place taken over by the ever-proliferating number of new red cells produced in bone marrow.

However, if there is splenic enlargement from any reason, the organ may overreact and increase in its rate of destroying the red cells.

Many disorders can lead to splenic enlargement, even simple viral infections such as a glandular fever or viral hepatitis or any other mild viral infection. But some of the infections and conditions producing an enlarged spleen are rarer and more bizarre.

If it can be shown that normal red-cell production is taking place in the marrow and that destruction in the spleen is excessive, its removal could be the choice of treatment.

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.