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Urticaria


What is Urticaria?

Hives are localized skin reaction indicating that fluid is collecting (edema). They usually appear suddenly and arc whitish-pink in colour. They may he small or large, and single hives may coalesce with neighboring ones to form a large area of inflamed surface. (This is called “giant hives” or angioneurotic edema.)

The itch is often marked and there is a persistent desire to scratch. But this brings little satisfying relief and often produces further infection later. Sometimes itch is minimal.

The lesions vary in the time they persist. This may be from a few hours to days or even weeks.

Urticaria Causes

Generally hives are a manifestation of an allergy. A product called histamine is liberated by the cells, and this produces the swelling, irritation and itch. The factors producing this sensitivity are many.

The possible ones include:

Sensitising drugs. Practically any medication is capable of producing an allergic reaction in a susceptible person. For example pain-reducing preparations (aspirin etc), antibiotics (particularly penicillin, but others as well), sulpha drugs, antihistamines and many others. Sensitizing foods. Many foodstuffs may produce allergic skin eruptions. Some of the common offenders include wheat products, milk, eggs, pork, fish, shellfish and crustaceans, tomatoes, strawberries and chocolates.

Physical factors. Extremes of heat and cold are fairly common in producing urticarial reactions. (For example, after a hot shower, or a swim in a very cold surf or pool, eruptions can suddenly appear.) Other general factors. Chronic infections, foci of infection (such as bad teeth or tonsils), anaemias, and a similar list of “poor health” conditions have also been incriminated. They may play a part in certain people.

Urticaria Treatment

The occurrence of hives is fairly easy to diagnose, and many people have experienced them on many occasions before. Most cases are simple, and home remedies often bring prompt relief.

Local applications

Cool (or sometimes ice-cold) packs often bring soothing relief from the itch, heat and discomfort. Apply often (but discontinue if there is any worsening). Simple lotions and creams containing an antipruritic (anti-itch) product often give relief if the irritation and itch is excessive (for example, calamine liniment containing benzocaine 3 per cent and camphor 1 per cent). Many commercial products are available for this purpose (eg Dermocaine).

Antihistamine creams do not afford much relief (as would he expected). Antihistamines. In simple cases, an antihistamine tablet will often bring quick relief. The non-sedating brands arc best, for this will not cause drowsiness and will enable a good result without the risk of becoming drowsy while driving or working. Terfenadine (“Teldane”) tablets and astemizole (“Hismanal”) tablets do not induce sleepiness and are worthwhile.

However, if sleepiness is not a problem, any of the older antihistamines are suitable. Many brand names are now available over the counter.

Mild laxative

This often assists to eliminate the cause from the system, particularly if the hives appear suddenly and tend to persist. “Coloxyl” or “Colox: with Senna,” or paraffin and its various commercial products are all effective Natural products include psyllium fibre (“Metamucil” powder in water) or taking processed bran with your morning  breakfast cereal. “Durolax” an “Granacol” are also effective. Drinking plenty of fluids (especially water) is quick way of eliminating toxins from the system, or diluting them in the gut.

Diet.

Many people are aware of the foods that produce symptoms. During outbreak it is wise to eliminate the foods  listed above that could cause trouble. Stick to simple foods for a few days.

Medication.

Do not take any medication unless under doctor’s orders. Even if on medication, and relief is not  forth coming, it is wise to have this reevaluated by your physician. You may allergic to some of the items taken.

Further Treatment.

Simple hives often respond quickly and effectively to simple routines. If they persist, or if they become more marked, if they tend to blister or the irritation becomes annoying, further medical advice may be required. Sometimes acute widespread complications take place. Two major complications requiring immediate medical attention a – commencement of hoarseness sudden- or a harsh noise coming from the box, especially if associated with respiratory difficulty and “Anaphylactic. shock,” in which there is uneasiness a feeling of faintness, headache throbbing in the ears. This requires prompt treatment by a doctor.

Adrenaline by injection by the physician may be required and steroid therapy may also be necessary in certain cases. Further investigation is needed if the response persists.

Health and Education Facts

  • Progress in medical science, better diet and improved hygiene have made the world a healthier place for many.
  • How long people are likely to live is called life expectancy. In 1950, the world average was just 40 years. Now it is over 63 years.
  • Life expectancy is usually high in richer countries. The Andorrans live on average for 83.5 years; the Japanese live for 80.8 years.
  • Life expectancy is much lower in poor countries. People in Zambia live just 37.3 years; people in Mozambique live 36.45 years.
  • Vaccination programs have reduced the effects of some major diseases. The terrible disease smallpox was thought to be wiped out in 1977.
  • Some diseases are on the increase in poorer parts of the world. AIDS (Acquired Immune Deficiency Syndrome) is now killing huge numbers of Africans.
  • In some parts of the world, disease, lack of food and water and poor healthcare mean that one child in every four dies before reaching the age of five in poor countries like Afghanistan and Sierra Leone. World geography
  • In the USA and Europe less than one child in a hundred dies before the age of five.
  • In wealthier countries such as Italy and Switzerland, there is on average one doctor for every 350 people.
  • In most poor African countries, there is just one doctor for every 50,000 people.
  • The first vaccination ever was given in 1796 by Edward Jenner. He used cowpox matter to vaccinate against smallpox.

Uterus


The uterus is a pear-shaped organ, with the narrow cervical part extending from the vaginal roof. It widens out into the vault. A narrow canal penetrates the cervix. This is called the cervical canal, and the external part that joins up with the vagina is called the external os (or hole), and the inner one is termed the internal os.

Inside, the cavity of the uterus widens out, although in normal everyday life its thick walls lie very closely together. The uterus measures about nine centimetres long, six centimetres in width at its widest part and four centimetres in thickness from front to back. It weighs about 40 grams to 60 grams, and its walls (when not pregnant) are one to two centimetres in thickness.

It sits in the pelvis in the midline, and tilts forward. Behind is the bowel, and in front is the bladder.

The uterus is lined with very special tissue called the endometrium. The thickness of this varies from day to day, according to the day of the menstrual cycle. This is under the direct control of

chemicals called hormones, which are produced by the ovaries, as well as by some other parts of the body. Every 28 days (this varies a little with each woman) menstruation takes place. During this time, which extends anywhere from two to nine days, the lining of the uterus is gradually shed. This is recognised by the woman in the form of bright red bleeding occurring on a regular basis. It is termed the menstrual period, but goes by many colloquial names. Whenever a woman uses quaint names for it, it is usually not difficult to understand what she is referring to.

The main part of the uterus is called the body, and the very uppermost part is referred to by doctors as the fundus. This part is often quoted during examinations in the course of a pregnancy, for the height of the fundus gradually rises as the pregnancy advances. It can give a rough estimation of the age of the developing foetus inside.

At the upper corner of the uterus (called the cornu or horn) on each side, a narrow canal leads out and joins with the oviduct. This is a tube, and on each side extends outwards for about 10 centimetres.

The oviduct is also known as the Fallopian tube. At the far end, the oviduct comes into close approximation with the ovary, a whitish-grey organ about the size and shape of an almond. The ovary is packed with microscopic, partially developed eggs, which have been present since birth. By the time puberty is reached (anywhere from nine years onwards), nearly a quarter of a million of these eggs are contained in the ovary. This is an enormous number, and only a fraction of the total will ever be utilised during a woman’s normal reproductive life cycle.

The far end of the oviduct has numerous fingerlike tentacles that largely overhang the ovary. They are present for a very special and important reason. Approximately each 28 days (this varies in different women, but averages this figure), a developing ovum suddenly works its way to the surface of the ovary, and bursts through the surface. It leaves a minute space on the surface of the ovary that quickly fills with blood, and this becomes known as the corpus luteum. Very rapidly this organ commences to produce a special hormone, or chemical, called progesterone, which is pumped into the general bloodstream, and has a profound effect on the uterus.

Conception

Meanwhile, the released egg, or ovum, is suddenly swept up by the fingerlike tentacles of the oviduct. It makes its way rapidly into the free end of the tube. The cells lining the tube have special hair like projections on them called cilia. These move with a sweeping motion in the direction of the uterus.

So the egg has little choice but to be carried along toward the uterus. Should the egg encounter a male reproductive cell (called a sperm) while in the tube, then fertilisation takes place as the two cells unite. At this instant, conception has occurred, and the woman is then pregnant.

The fertilised egg continues on its way to the uterus, which under the powerful influence of progesterone (from the corpus luteum of the ovary) is rapidly preparing for pregnancy.

The uterine walls thicken, its blood supply is increased, and all is in readiness. The single cell of the egg quickly subdivides, then redivides, and continues to divide, the number of cells doubling on each occasion. By the time it reaches the uterus it has developed into a mass of cells. This then becomes embedded in the thick lining (the endometrium) of the uterine walls, and the pregnancy is under way.

But if the egg fails to contact a male cell, a different situation occurs. It will reach the uterus, and fails to become embedded in the walls, even though they are ready to receive it.

Suddenly the whole process comes to an abrupt halt. The corpus luteum senses that pregnancy has not occurred, so it turns off its progesterone production. Suffering from this lack of chemical, the uterine wall gradually commences to crumble. At first this is represented by a tiny trickle of bright red blood, which escapes to the outside through the vagina.

Over the next several days, this increases, until finally the entire endometrial lining is shed in this manner. A normal menstrual period takes place; the uterine wall is reduced to its. normal state, and once more another cycle commences. Menstrual bleeding starts about 14 days following the release of the egg from the ovary, if pregnancy has not taken place.

Meanwhile, back at the ovary, another follicle gradually makes its way to the surface, and the whole process is repeated. Nature is very persistent. Even though the chances of pregnancy in any one menstrual month are very slim, the process is repeated from the time of the menarche (when menstruation occurs in young females, often around the age of 10 – 16 years) until it ceases, at the so called change of life, or menopause, which is anywhere from the age of 45 – 50 years, or maybe even later.

Ovulation, the moment the egg is released from the ovary, takes place 14 days before the onset of a menstrual period. Pregnancy may take place only in the 24 – 48 hours immediately following this event. This, of course, means that sexual intercourse must occur during that time.

With the enormous number of unplanned, and apparently unwanted babies that are conceived, it is incredible what can take place on a universal basis during that critical 24-48-hours time segment!

Nature’s chief aim is to guarantee reproduction of the species. Therefore, it uses every wile to ensure that this will take place. Just as the system’s hormones help to secure pregnancy internally, so they have profound psychological and emotional effects as well.

Many women have a heightened libido (a desire for lovemaking) at the crucial time when pregnancy is most likely. They are more responsive, more sensuous, more amorous, more “desirable,” as many a faltering male has later on discovered to his dismay (or joy, whatever his attitude to the outcome happens to be).

The act of intercourse means that the male organ of reproduction, the penis, penetrates the vagina. Erection occurs, and this is stimulated by psychological overtones, all inherent in the lovemaking process.

At the point of orgasm (frequently referred to as the climax), millions of male reproductive cells (called spermatozoa, or sperms for short) pour forth from the end of the penis, to be deposited high up in the vaginal tract.

The uterine cervix is bathed temporarily in the seminal fluid, and the cells actively swim up the cervical canal into the uterine cavity. Many are casualties by the way, but a few stalwarts ultimately penetrate into the oviducts (the Fallopian tubes), and work their way along the duct in the quest for an egg.

Should one be encountered, the remaining sperms will actively surround the egg. Finally, one with greater sustaining powers than his fellows will penetrate the outer layers of the egg, enter it, and immediately fuse with it inside to produce a fertilised egg. At this instant, conception has taken place, and the woman is then pregnant. The egg continues on its way down the tube as described previously.

Urinary Tract Infections


What is Urinary Tract Infections?

In fact tests on large numbers of schoolchildren have indicated that many youngsters, especially girls, often harbour germs in the bladder. There are not necessarily any symptoms. –It is frequently called a silent bacteriuria. Apparently germs may lie there quiescent for some time. But if there is a sudden “chill,” or lowering of the body temperature, they multiply and make their unpleasant presence felt.

The child may experience a chill, and possibly shivering. The temperature may rise. There may be the desire to pass the urine often. This may be painful, or it may be worse as the last few drops are being voided. Often, when this has happened, the child may want to run off to the toilet again, frequently within a few minutes. Of course, only half a teaspoonful may be passed and this likewise may feel hot and burning. “Like powdered glass,” is a common way of expressing it. I’m not certain how children know what it is like to void powdered glass, but you get the idea, I’m sure.

Sometimes the urine may be foul smelling. It may be cloudy, or there may blood in it. This is not a very good sign. There may be tenderness over the bladder, or over the lower part of the back. The kidneys are just inside this part and they may be tender in the so-called “renal angle,” as the doctors say. The patient may feel generally unwell, may vomit, have loss of appetite, feel clammy and hot and may be weepy and depressed.

Urinary Tract Infections Treatment

With acute symptoms, it’s wise to have medical attention. The doctor will probably order a urine test. A “midstream” specimen is examined by the pathologist, who will check for abnormal components such as blood or albumen, which indicate that abnormal substances are being filtered by the renal mechanism.

The pathologist will also carry out a culture and sensitivity test. This means the germs responsible for the infection are grown so they may be identified. At the same time, they will be checked against the commonly used antibiotics to determine which is the most suitable one for checking the infection, and preventing a recurrence.

Often the doctor will give immediate treatment. But when the results are to hand, it may be changed. A wide variety of antibiotics is currently available. These are highly satisfactory for renal tract infections. Some doctors give a large single dose. Other doctors prefer to continue therapy for some time in an effort to eradicate all traces of infection, and hoping future ones will not take place.

Often urinary “alkalinising agents” are given. These convert the urine to an alkaline state, and this is believed to help kill off the germs. But some other antibiotics act more successfully in an acid medium. Usually a total package form of treatment is prepared for the individual patient.

Extra fluids are usually prescribed. Plenty of water-based fluids and fruit juices are a good idea. Repeat often. If the is a fever and aches and pains, paracetamol elixir often reduces both. Aspirin products are best not given for these symptoms.

Sucking bits of chipped-up ice s good if there is vomiting. Flavoured ones may be made, such as using lemonade. Often a quick, lukewarm sponge will make the youthful patient feel much better. Sometimes, if hot and miserable, a cold pack to the forehead can help improve feelings.

Infections of the urinary tract are extremely common, particularly in women and children. Prompt diagnosis and treatment are essential. If problems recur, then investigation to find the basic cause is imperative. Infections may be present without any symptoms. Progressive kidney disease may readily occur, and if this becomes well established and chronic, there is no suitable long term cure.

Infections of the Urinary Tract Symptoms suggesting infection of the urinary tract are very common. Surveys show that between 12 and 20 of every 1000 surgery consultations arc for this reason.

“Urinary tract infection is one of the most common disorders encountered by the practising clinician,” a Melbourne kidney specialist says. “At all ages, the female is more prone to develop urinary tract infection and in particular, symptoms of dysuria [difficulty in urinating] and frequency are very common in adult women, most of whom have no associated abnormality in the urinary tract.” Much research has taken place in the past few years, and more accurate ways of determining the cause have been worked out. Tests quite different from those used a few years ago are now being used widely in diagnosis and treatment.

Often urinary tract infections are present, yielding no symptoms. Also, other considerations, such as the so-called “vesico-ureteric reflux,” are being demonstrated by new X-ray methods.

This means that during voiding, in some cases the urine is moved back or refluxes into the urethras, the tubes conveying the urine from the kidneys to the bladder. The significance is that this may produce damage and scarring in the kidneys that may have long-term adverse consequences for the patient.

Symptoms.

Often there are no symptoms, or there may be increased frequency of urination and discomfort. In a typical attack, there may be a feeling of being off-colour or quite ill. There may be a high fever with shivers, vomiting, headache and aches and pains all over, and probably constipation. There may be a dull, aching pain in the loin, and possibly marked tenderness over the lower part of the back. An attack may settle, to recur a little later on. There may or may not be associated elevation of the blood pressure.

Diagnosis is usually made on clinical grounds, and this may be confirmed by having a bacterial count carried out. The colonies of infecting organisms are actually checked, and it is accepted that a colony count of 100,000 per ml of urine is evidence of infection. Counts of 10,000 or less are usually considered to be due to contamination of the urine sample during collection.

The majority of urinary infections are due to organisms that are sensitive to sulfas, and these are usually given for at least 10 days. Infections resistant to sulfas should be treated with other suitable antibiotics following special sensitivity tests. These are special tests done in the laboratory in which the germ is cultured and subjected to various antibiotics. In this way the most appropriate antibiotic may be found, and used in subsequent treatment.

Often the cephalosporins, ampicillin, co-trimoxazole or tetracyclines are suitable and effective. Other drugs are available also, such as nitrofurantoin and nalidixic acid tablets. Follow-up bacterial tests are carried out to check the efficacy of therapy.

If the infection recurs or fails to be cured with simple therapy, further investigations will be ordered, such as a kidney X-ray. This is called an intravenous pyelogram (or IVP). Alternatively a CT scan or ultrasound investigation may be carried out. The aim is to discover if there is any obvious disorder of the kidneys, or if there are any anatomical structural anomalies present that could be the basic cause of the infection. Congenital defects, if present, may be an important cause for recurring infections, particularly in children. Prolonged courses of antibiotics may be necessary, especially in children, in an effort to prevent progressive renal damage. Some infections and organisms are very difficult to eradicate.

Surgery may be recommended. If investigation indicates that anatomical or structural faults are present, surgical measures may be recommended. When infections are successfully treated, vesico-ureteric reflux may disappear, but if it persists, it may indicate the need for corrective surgery. This may be in the form of a ureteric transplant or the relief of any obstruction to the bladder neck. The patient should also be instructed in sexual hygiene, and told how to reduce the risks of fecal contamination (eg using toilet tissues with a front-to back sweep, rather than vice versa). Suggestions on avoiding infections following intercourse may be offered. Particularly in newlyweds, and those indulging often in sexual intercourse, urinating as soon as possible afterwards is advisable. Treating any urinary infection promptly is essential, and adequate follow- up is wise. Any child with fevers for no obvious reason could he suffering from urinary infections, and the doctor will check this. Efforts should be made at preventive medicine, for the outlook for recurring infections is poor. It may become chronic, and for this there is no simple cure.

Underactive Thyroid Gland


In infants and small children this may be a deficiency of iodine in the diet, producing a visible swelling in the neck called a goitre. be extremely important. It can affect the mental and physical development of the infant, and if undiagnosed and untreated may lead to a serious condition called hypothyroidism. This is also commonly termed cretinism.

Underactive Thyroid Gland Symptoms

Symptoms may set in fairly early in life. The first few weeks may seem fairly normal, but then an observant mother or physician may notice that baby seems sluggish and a bit slow mentally. The skin may appear to be cool and grey; the infant may be constipated, have a large tongue and flabby muscles on the abdomen. In time these become accentuated. The tongue may loll out, a swelling be present at the navel, called an umbilical hernia. There may be a hoarse little cry. Often the symptoms are vague, rather than clear-cut.

This may be at a slower rate than one would normally expect. Mental development especially becomes obviously much slower; the eyes seem to be set widely apart, and an abnormal appearance develops. With further increase in age, the skin becomes dry and coarse, the hair dry, coarse and brittle. There are the obvious signs of thyroxine lack.

Underactive Thyroid Gland Treatment

I’m happy to say treatment is often dramatic. The hormone that is lackingthyroxine – is administered, and can make a world of difference. If given sufficiently early, it can also prevent serious symptoms from developing. But if it’s so difficult to pick, how can the doctors start early therapy? Fortunately, in Australia, obstetrics hospitals now carry out a routine blood test at birth that can detect hypothyroidism. The complaint affects about one baby in 4,000. So in this manner it’s possible to commence treatment virtually from birth. It is done under medical supervision, and may be continued for many years. These services are now available in many countries of the Western world, and have virtually become an automatic procedure for babies.

Stomach

The stomach and duodenum are very important parts of the gastrointestinal system. The cardiac valve at the lower end of the oesophagus leads into the stomach, a dilated part of the bowel, which leads into the duodenum via the pyloric valve. The relatively short duodenum in turn proceeds into the start of the very lengthy small bowel.

The stomach is important, for here digestion really commences. Powerful glands in the wall of the stomach pour forth a variety of fluids that act forcibly on the food as soon as it enters. Under the powerful dissecting microscope, the stomach lining has the appearance of a lattice caused by the opening of myriads of gastric glands. Near the cardiac valve, these glands produce chiefly mucus, a thick, heavy fluid, rather jellylike in nature. (This material is often seen in vomitus.)

The greater part of the stomach walls contain glands that actively secrete hydrochloric acid, pepsinogen and other chemicals. These all play a part in food digestion. Toward the far end of the stomach, the glands produce a powerful chemical called gastrin. The presence of food activates the production of gastrin, which in turn causes the other glands to secrete their gastric juices, and so aid digestion. Controlled by Nervous System But apart from this, most of the glands are under the direct action of the nervous system (the computer like mechanism we talked of earlier). This may also regulate gastric-juice production.

Most people are aware of the effect that mental tensions, anxieties and stresses have upon the stomach. Acting through the nervous system, potent gastric juices (containing all the components mentioned) may be liberated in force.

This is probably one reason why such a high incidence of ulcers attaches to occupations in which stress and mental turmoil are an everyday accompaniment. The stomach and duodenum are sites for some very important pathological processes. Peptic ulcers (that means a break in the mucosal lining) are very common, particularly in the duodenum.

Also, the stomach, being the place where all food and fluid intake must go as the first port of call, is subjected to all manner of abuses. Therefore, dietetic indiscretions (foolish food items, excesses of alcohol and other irritants, acid from cigarette smoking) frequently play a major part in producing adverse symptoms. Not only may they help to cause ulcers, but general inflammation of the lining walls (gastritis) can readily take place.

Infections also may gain entry into the intestinal system through this route. One of the system’s most lethal forms of cancer, carcinoma of the stomach, occurs here. Unfortunately, as with oesophageal cancer, symptoms appear usually when it is too late to provide an effective cure.

Urinary Tract Problem


Fortunately, treatment of women suffering from symptoms in this age bracket is very successful. Today, therapy is well advanced, and the majority can benefit. Most women can again discover a full, happy, and well-adjusted life with minimum therapy.

Treatment is based on the artificial use of hormones. These are identical to the ones nature produces normally. The most widely used is called ethinyl oestradiol. This is given in minute amounts, from 10 to 20 mcg daily. Treatment is usually tailor-made to the woman’s apparent needs by the doctor. It is varied in accordance with her response.

Treatment is usually given for short courses. Special caution is needed if there has been any cancer history.

Many doctors prefer to use a variation of this medication called conjugated equine oestrogens, which is widely known by its trade name Premarin. A common satisfactory dose of 0.625 mg a day is prescribed. Many believe this gives a more normal type of reaction, and may be preferable, but it is usually much more expensive.

Today, there are definite guidelines laid down for the use of hormones for menopausal women. This follows some fears encountered in the mid-1970s that continual use might cause adverse repercussions, and there was talk of cancer.

However, this has been refuted, provided the oestrogen is taken for a set number of days per calendar month, and taken in conjunction with the other female hormone, progesterone (or Gestalten), in small doses, for a certain number of days per calendar month. The progestogen pill is usually one of the brands used for contraceptive purposes, being norethisterone 350 mcg (Micronor) or levonorgestrel 30 mcg (Nlicroval).

The method of taking the medication (which will be confirmed by your doctor) is as follows:

Take the oestrogen tablet daily from Day 1 to Day 24 of the calendar month, then discontinue until the first day of the following calendar month. In addition: Take theprogestogen tablet daily from Day 15 to Day 24. then discontinue until the 15th day of the following month. Usually this will cause a slight menstrual bleed about three days after the tablets have been discontinued. But most women will accept this fact of life as small payment for the relief obtaineol from symptoms. Keep in close contact with your doctor, especially regarding this so-called “withdrawal bleeding,” which is not due to cancer despite your age. However, some doctors still believe investigation of the womb (probably before or after medication is started) is advisable as a preliminary safeguard.

By the use of these hormones, a general feeling of wellbeing often occurs. Depression and anxiety may vanish. the world smiles again, hot flushes disappear as if by magic, the old irritability wanes, nerves settle, sleep improves, and the outlook brightens.

In some women, the skin becomes less wrinkled, the fingernails and toenails grow more rapidly, and break and crack less easily.

Many cases have been reported where the hair becomes more attractive, wavy and shinier.

These hormones have often been called the youth pill. Women taking them and gaining these results are often apt to agree, but it is not the universal panacea for greater beauty, and it is not the eternal fountain of youth. But it certainly may help.

The bladder is located in very close proximity to the vagina and uterus. The urethral outlet, the tiny external opening through which urine escapes from the body is located just above the vaginal entry This short canal, about three centimetres in length, is closely related to the front wall of the vagina, and it runs into the bladder, also closely related to the front vaginal wall.

With a weakening of the overdistended vaginal walls during the passage of time. a cystocele can readily occur. As the vaginal walls weaken, the bladder presses into the vagina and tends to prolapse down its length. In this way, residual urine can collect in the bladder, and this often becomes a source of chronic infection.

Cystitis persists unless action to clear it up is taken. This can be by the use of the appropriate antibiotic, or more sensibly by surgical repair.

However, another situation can occur concurrently with this, giving rise to a condition called stress incontinence. The valve of the urethra becomes weakened, and any sudden forceful stress on the bladder can cause the sudden release of a small amount of urine, over which the person has little (if any) control. This may be difficult to differentiate from a bladder infection.

It is most important that bladder infections be treated promptly. If they are not, the infection may spread up the canals that lead to the kidneys (called the left and right ureter), and produce kidney disease that may become serious. It can produce its own set of symptoms, such as loin pain, an elevated temperature, nausea. vomiting and rigors.

Enormous numbers of women suffer from urinary-tract disorders, particularly infection. In recent years much work and research has been devoted in major centres to this problem. It seems that many women suffer from urinary-tract infections (UTI) without knowing, and without symptoms being produced. If major infections occur, then the typical burning. scalding, frequency, malaise and urgency occur. But with minor infections which are serious, just the same, due to their implications), symptoms are often entirely absent.

It is well-known that urinary infections can readily be cleared up with the use of suitable antibiotics. But there is a tendency for recurrences. These days, long-term treatment with antibiotics and certain sulfa compounds is widely used. The lower part of the urethra (the canal leading from the bladder to the exterior) normally has bacteria in its lower third. It is well-known that these can be pushed into the bladder following sexual intercourse. Many women complain of cystitis the following day.

A simple and effective way to overcome this is to get out of bed and pass the urine as soon as possible after intercourse. on every occasion. This may present a nuisance problem, but those taking the trouble to do it regularly find the beneficial results well worth the small amount of effort and inconvenience involved. This immediately gets rid of the urinary reservoir and sweeps out the germs that may have recently penetrated there. and so denies them the opportunity for multiplying, which they will surely do otherwise.

Vitamin Needs

Vitamins are certainly an important factor in life. Fortunately, the average  diet, both for baby and adult, is adequate in most cases to meet daily vitamin needs.

However, some babies do have vitamin deficiencies. The most likely to be encountered are those due to a lack of vitamin C (ascorbic acid) or vitamin D.

Vitamin C is present in breast milk. If baby is breastfed, and is taking a reasonable daily intake, vitamin C needs will be adequately catered for.

Cow’s milk is devoid of this vitamin. A supplement is essential.

Correct. This is most simply given in the form of orange juice, which is very rich in vitamin C. One orange contains about 60 mg. It is essential that the juice, when squeezed, be not boiled, for this could destroy the entire vitamin C component. Give it to baby freshly squeezed. This can be done between feeds. It can serve a twofold purpose – adding to the fluid intake, and providing the essential vitamin.

Scurvy is the disease produced by a lack of vitamin C.

Rickets, due to a lack of vitamin D, is uncommon these days. Sunshine assists the vitamin to be produced in the body. However, occasionally cases of premature babies with rickets have been reported. Giving babies a vitamin supplement is practically standard practice in many developed countries. Doses are usually marked on the label.

Volvulus

When this occurs. part of the bowel twists on itself. The result is that the blood supply is suddenly cut off. This gains access to the bowel via the mesentery, a sheet of thin tissue that provides the bowel with its nutritional requirements. When this occurs, a closed-loop type of obstruction takes place. The immediate risk is that if complete, the bowel, devoid of its blood supply, may quickly die and become gangrenous and perforate. Peritonitis may quickly follow. Often the volvulus is not complete, and cases occur where it tends to come and go.

Sometimes symptoms come on rapidly, or they may be much slower. Symptoms simulate a bowel obstruction.

Volvulus Treatment

Acute cases must be surgically treated as an emergency. For chronic forms, more probable with older adults, decompression by a rectal tube may be possible. However, this again is in the province of the doctor, and any symptoms that indicate abdominal problems must receive prompt, expert medical attention. Delay may prove fatal.

One of the major changes in surgical care in recent years is the day-care centres. Here, the patient is admitted for one day (or part of a day) only. Many one-time major surgical operations have contracted to fairly “minor” procedures that can be completed in a short time.

With quick-acting general anaesthetics (or the use of local anaesthesia), a large amount of investigation and treatment can be quickly and expertly carried out. Theatres are often attached to the centres, with certain theatres being geared for a small, specific range of operations (eg endoscopic or colonoscopic surgery, eye surgery, various gynaecological or abdominal laparoscopic techniques). This not only reduces overall costs, but enables more patients to be treated in a shorter time. It appears to be the way of the future.

Vitamins

Vitamins are chemicals that are important in maintaining good health therefore, deficiencies can lead to serious diseases or illnesses. Despite an increase in “megavitamin therapy” or “orthomolecular medicine” (practice of using large amounts of vitamins and mineral including supplements and IVs to treat varying conditions), many of the vitamins we need are found in nature with fruits and vegetables being the main source. For this reason, having a diet that is well-balanced guarantees an adequate daily intake of the chemicals needed because; as essential as they are, they are needed in minute doses. In fact, the measuring units used are micrograms and milligrams.

Referred to as “organic catalysts”; vitamins help to initiate numerous chemical reactions in the body and are unique in that they remain in the body even after being used. They also help with the body’s development with each having its own (sometimes multiple) function(s) and established daily allowances. The absence of even those needed in trace amounts can easily or quickly be felt by the body since they are important for bone formation, hair and nail growth, good sight, healthy teeth and gums as well as the overall growth and maintenance of the body. Energy and even emotional stability have both been linked to adequate intakes of these essential chemicals.

Vitamins were initially named using the alphabet, reflecting the order in which they were found. Overtime names were added or substituted as the numbers increased and more discoveries about the variations were made (the B complex for example).

The list of commonly know vitamins and their deficiency diseases include:

  1. Vitamin A (related to the chemical Carotene): Night-blindness and Keratomalacia
  2. Vitamin B Complex:
    • Vitamin B1 (Thiamine): Beriberi and Wernicke-Korsakoff syndrome
    • Vitamin B2 (Riboflavin): Ariboflavinosis
    • Vitamin B3 (niacin): Pellagra
    • Vitamin B5 (Pantothenic acid): Paresthesia
    • Vitamin B6 (Pyridoxine): Anemia and Peripheral Neuropathy.
    • Vitamin B7 (Biotin or Vitamin H): Dermatitis and Enteritis
    • Vitamin B9 (Folic Acid): Asneural Tube and other defects if deficiency occurs during pregnancy
    • Vitamin B12 (Cyanocobalamin): Megaloblastic Anemia
  3. Vitamin C (Ascorbic Acid): Scurvy
  4. Vitamin D (Calciferol): Rickets and Osteomalacia
  5. Vitamin E: Mild Hemolytic Anemia in newborns (very rare)
  6. Vitamin K: Bleeding diathesis

Ninety-seven years after the first discovery, vitamins fall into two groups:

A, D and K can dissolve in fat hence are called fat-soluble vitamins while the B complex and C dissolve in water and are called water-soluble vitamins.

Vitamin deficiency is far more rampant in developing countries than it is within the developed world because the diets in each region often defer drastically with the former more likely to be lacking in daily essentials. Also, there is a higher tendency to use vitamin supplements or multivitamins within developed countries. In fact, Australia and New Zealand have established acceptable dosages of vitamin supplements for babies. Both countries have very low incidences of Rickets (Vitamin D deficiency) with most occasional cases being found in premature babies. However, some Caribbean countries have a very high rate of the disease although Vitamin D can be produced in the body with the aid of sunlight.