Health News resources and information

Description and Possible Medical Problems

Though midlife adults who keep active by exercising regularly have stronger musculoskeletal systems than sedentary people, their activity makes them prone to injuries that people who are inactive rarely encounter.

While sedentary adults are prone to hip fractures because they have fragile bones and tend to carry themselves unsteadily, men and women who are active are more likely to injure their coccyx, or tail-bone, which can be extremely painful. A swift kick in the rear by a playful son, daughter, or grandchild may cause a severe pain accompanied by a loud crack. A patient of mine had a chair pulled out on him in jest, which, of course, is a common trick. He heard a crack, felt a sharp pain, and had a severe ache in his tailbone for at least two months.

Treatment

If you’ve injured your tailbone in a fall, its discomfort will cause a limitation in your activity, which is necessary to the healing process. You’ll probably find that sitting is altogether too uncomfortable or that only one position is possible.

Aspirin or acetaminophen will help ease your discomfort as the tail-bone heals. If, however, you have a sharp pain in the bone that doesn’t subside within a few days, it’s important that you see your doctor; you may have fractured or cracked your tailbone, and medical attention is necessary. Your doctor will prescribe a nonsteroidal medication such as Motrin and may suggest bed rest of a few weeks or more.

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Description and Possible Medical Problems

Some people occasionally have trouble swallowing food or water. Usually it’s due to nervousness or anxiety, and it tends to clear up as soon as they calm down a bit. Others, however, may find that one minute they have difficulty swallowing and the next this problem either improves or worsens.

If you’re experiencing these symptoms, you may have a rare condition known as myasthenia gravis. Though it is an uncommon disease, many people are aware of it because of its striking, often fickle characteristics. Besides trouble swallowing and chewing, other symptoms of myasthenia gravis include muscle weakness, most often in the face and neck and later in the rest of the body. Your entire body might also become progressively weaker as you chew.

Women are affected more often than men by this disorder, which is caused by an immune system imbalance that affects the nervous system. In effect, the body actually experiences a series of electrical short circuits, which cause it to be fine one minute but weak the next. The thymus, a gland in the chest that helps regulate the immune system, is responsible for the development of myasthenia gravis in approximately 20% of the people who have the condition. In the other 80%, the cause is unknown.

Treatment

Myasthenia gravis cannot be cured, but the disease can be regulated with rest, improved diet, and medication, such as Tensilon or the corticosteroid prednisone, which may help stimulate your immune system. If your doctor determines that your myasthenia gravis is due to a malfunctioning thymus gland, he may recommend an operation to surgically remove the gland; after the procedure, your health will remain stable. Keep in mind, however, that myasthenia gravis is a rare disease. In fact, I have seen only three cases of the disease in all my years of practice.

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About 20 percent of American women have fibrocystic breasts, a condition in which small tender lumps can be felt within the breasts. Composed of distorted fluid-containing milk ducts and fibrous tissue, these lumps usually become tighter and more tender at the time of menstrual periods, when they may become so painful as to interfere with sleep.

Please note that we no longer talk about fibrocystic “disease,” since we now realize that this condition is merely a variant in texture of the normal breast. It is not precancerous. Nevertheless, fibrocystic breasts often become so tight and uncomfortable that many women need treatment of one kind or another to relieve the pain.

According to the Journal of the American Medical Association (244:1077), vitamin E may be what they are looking for. It was found that fibrocystic occurrences disappeared or decreased in 22 of 26 women who took this vitamin in doses of 600 units daily for 12 weeks. Possibly vitamin E acts as an anti-hormone, blocking the effects of the breast-stimulating hormone prolactin, which is normally produced by the pituitary gland.

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While there is no doubt that dietary supplements of nicotinic acid help to lower the blood level of cholesterol, some people have been taking it in such excessively large doses that they have injured their livers.

The Southern Medical Journal (76:239) reports the case of a man who took about four grams (4,000 mg) of nicotinic acid daily for several months and became ill with fever, jaundice (yellowness of the skin), nausea, vomiting, and pain, swelling, and tenderness in the abdomen. Tests showed that his liver function was seriously disturbed. All of these problems quickly subsided after he stopped taking nicotinic acid.

However, not believing that a vitamin (nicotinic acid is a member of the vitamin B complex) could cause illness, he started taking large doses of nicotinic acid again a year later. Once more he suffered with the same symptoms, which were again proved to be due to liver toxicity, and which, for the second time, subsided when he stopped taking nicotinic acid.

The medical literature contains 11 more case reports of patients with liver disease who had been taking three to four grams of nicotinic acid daily. These doses are 30 to 40 times greater than the 100 mg daily doses recommended as an adjunct in controlling the blood cholesterol. Limiting one’s intake of animal fat and cholesterol, however, must remain the cornerstone of any program to prevent atherosclerosis.

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Other than diuretic drugs (discussed above), most drugs used in hypertension work by relaxing the muscular walls of the blood vessels and are more likely to cause side effects because they relax other muscles, too. For example, they can cause difficulty in passing urine (due to relaxation of the bladder muscle), constipation (by relaxing the intestinal muscles), and sometimes impotence in men.

Even without drug treatment, many people feel dizzy momentarily after suddenly standing up. Called postural hypotension, this occurs when, for a few moments, blood pools in the veins of the legs and does not get up to the brain. Blood vessels slackened by drugs are more likely to cause this effect, and patients taking multiple blood pressure medications may have severe postural hypotension and even lose consciousness if they stand up too quickly or stand still for too long (movement assists the circulation).

Whenever people on blood pressure drugs feel dizzy, they should immediately stretch and yawn and move their legs to boost the circulation. Hypertensive patients liable to dizziness under these conditions should never shut themselves in a telephone booth, because being held upright after fainting could be fatal. The combined effects of blood pooling in the legs and continuing to remain propped upright prevents a life-sustaining blood supply reaching up to the brain. Falling, although it may cause injury, instantly lowers the head so that blood can flow into it by gravity.

If side effects become a frequent problem, the situation can be corrected by changing the dosage or by switching drugs. This needs to be done under medical supervision. Whatever happens, hypertensive patients must continue taking some medications regularly every day because, without it, their lives will be shortened.

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Unusual Dietary Cravings

Iron deficiency can cause a condition called pica, which is the compulsive eating of almost anything, including dirt or clay (geophagia), starch (amylophagia), and ice (pagoph-agia). Not just an occasional zany impulse, pica is the continuous obsessive craving for the unconventional dietary experience.

A case reported in the Annals of Internal Medicine (94:660) illustrates a potential complication. A 74-year-old woman with iron deficiency had a craving for magnesium carbonate, which she ate several times a day. In quantity, magnesium acts as a laxative and causes the too rapid transit of food through the intestines, with failure of absorption of dietary ingredients, including iron. So, in this case, as in many others, iron deficiency caused pica and thereby made itself worse.

Pica and its complications usually respond rapidly to an injection of iron.

Tea Drinking as a Cause of Anemia?

Many things can influence the amount of iron we absorb and retain from our food. If we lose blood or become anemic for any reason, iron absorption usually increases, so that when iron is in short supply, we compensate by absorbing it more efficiently. Our ability to absorb increased amounts of iron when necessary, however, is variable, a human inconsistency which has always puzzled hematologists.

Now, according to the New England Journal of Medicine, tea-drinking may help to explain some of these differences in iron absorption. It has been found, for instance, that tea reduces iron absorption from food by as much as 95 percent. Whereas in some diseases this could be helpful because there is already too much iron in the body, if you have a problem absorbing iron, or there is inadequate iron in your diet (most vegetarians need to take iron), you may want to limit the amount of tea you drink.

Iron Deficiency Correction

Anemic nomads in Africa suddenly came down with tuberculosis and other infections when iron was added to their food. Iron deficiency, it seems, had been protecting them by preventing bacterial growth in their tissues.

Now, according to Pediatrics, the same sort of thing has been observed in the United States. Adding extra iron to infant formula, it has been found, encourages growth of contaminant bacteria in the milk. Fortunately, the iron in human milk, unlike that in cow’s milk, is bound to a special protein and is not available to bacteria. If mothers nurse their babies and take sufficient iron in their food, their babies will get all the iron they need in the safest possible way.

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Whereas pneumonia in children and younger adults tends to be an easily recognized illness with abrupt onset, flushing of the skin, fever, cough, shortness of breath, and pain in the chest on breathing, the same infection in older people causes so many fewer and less dramatic symptoms that the disease may be easily overlooked, Emergency Medicine (18#1:52) reports.

In the elderly, therefore, pneumonia is often left undiagnosed and untreated until it is too late, and is a common cause of death. Even when the doctor examines an older person who has pneumonia, he may not find any typical signs during the first few days of the illness. Often, the only abnormalities may be slight fever, lack of desire for food and drink, signs of dehydration (such as dryness of the mouth, hollow cheeks, sunken eyes, and little if any urination) with mental slowness and loss of alertness.

Older people with these clues of illness, therefore, should be taken to the hospital without delay so that X-rays and blood tests can be performed to establish the diagnosis, and so that treatment can be started without delay. In some cases, however, the doctor may not wish to move the patient. Instead, he will make a tentative diagnosis of pneumonia without X-rays or tests and start treatment at home with an antibiotic, such as penicillin, right away.

If treated in time, most cases begin to respond within 24 hours and thereafter gradually improve until they have become normal again after several days. Complications and slower responses are common, however, when treatment is delayed, if there is an underlying illness (such as heart failure), or in the very old. Since pneumonia is so common, so easily overlooked, and so potentially dangerous, we must all be alert to this possibility, even when an elderly person appears to be just vaguely unwell.

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Because of the way the bones and discs are loosely strung together, the backbone, or spine, is very flexible and allows for bending and other kinds of bodily movements.

Backaches may be due to many causes. They may be the result of a slipped disc, sacroiliac strain, sciatic neuritis, arthritis, poor posture, or emotional tension. If you have a backache that persists, I would advise a medical check-up. If you are otherwise healthy but develop frequent backaches, they may be due to any of the following causes:

Your mattress may be soft and sagging, thus curving your spine when you sleep. If you do not want to get a new bed and mattress, use a bed board between the mattress and the bedsprings.

It may be that your posture is wrong. Incorrect posture is one of the commonest causes of backache. When your back is thrown out of shape by poor posture or strained from carrying too much weight, the bones, ligaments, nerves, and muscles are either pressed closely together or stretched too far apart, causing pain. For illustrations of good and bad posture, see diagrams on pages 19-20.

You may be carrying too much at one time, for instance, a heavy shopping bag in one hand. This tends to curve your spine to the right or left, causing the back muscles and ligaments to become strained.

Your work habits may be wrong. If you must sit at a typewriter or desk all day, do not slump, but sit upright. When you sit or stand correctly, you will develop a strong, pain-free back. The internal organs are not squeezed together, and it is easier for them to function well. Also, you will breathe better. If your job requires that you do a lot of bending, make sure you take time out at regular intervals to stretch and straighten up.

Watch out for draughts. Try to avoid sitting with your back exposed to draughts from hallways, open doors, or windows.

In women, backaches may be due to abnormalities in the position of the pelvic organs. These are sometimes related to past pregnancies, but women who have not been pregnant may also have such backaches.

Emotional tension creates muscular tension. Stress pain is just as real and severe as pain attributed to any other cause.

When you get a backache that persists despite the above measures, go to your doctor for a check-up. The pain may be due to a minor condition, such as poor posture, or to a more serious disorder, such as a tumour.

Ruptured vertebral disc (slipped disc)

Between the bones of the spine lie discs made of cartilage. This is the firm material that shapes the nose and ears. Sometimes the discs slip out partially from between the spinal bones and press on the nerve roots emerging from the spinal cord. The condition was not fully understood until recent years, and the symptoms were attributed to sciatica, lumbago, or other ailments.

Treatment of backache and other back conditions

Improvement of posture, operations for slipped discs and tumours, massage, and X-ray treatment for certain tumours are among the kinds of treatment the doctor will recommend, depending on the cause.

For the occasional, mild backache, a simple home treatment may help greatly. In addition to taking two aspirins every four hours and resting on a hard mattress, moist heat—such as from a shower or tub of water—at a temperature only slightly above body temperature will give great relief.

Bursitis

This is an inflammation of the lubricating parts around joints. Our joints would creak and wear out if there were no efficient oiling system. Sometimes the smoothly working bursas around the joints become inflamed. When they do, there is severe pain.

Bursitis may occur in an acute or chronic form. In an acute attack, the inflamed bursa may be felt as a tender swelling near the shoulder or whichever joint is affected.

Chronic bursitis may follow the acute attack. There is continued pain and limitation of motion around the joint. In the shoulder, an X-ray will usually reveal calcium salts that have been deposited in one of the important bursas around the joint. If rest, heat, and medicines do not relieve the condition, surgery may be required to remove the deposits or free the area of chronic inflammation.

Disabling infections of the bones

Until the introduction of medicines that destroy staphylococci and streptococci, prolonged disability frequently resulted from bone infections produced by these germs. They can cause an acute infection of the bone called acute osteomyelitis. This infection, which creates acute pain and fever, generally strikes at the long bones of the arms and legs. Children and young adults are most often affected. Prompt treatment with penicillin and other antibiotics will usually eradicate the infection. If not, surgery will be required to drain the affected area.

Miscellaneous disabilities

There are many congenital and acquired disabling conditions that affect the joints and bones in addition to those already described. I list a few common ones, especially those that can be helped.

Congenital dislocation of the hip

This condition is present at birth, more frequently in female than male children. However, it may not be evident until the child starts to walk. Then it will be noticed that the gait is not symmetrical. It is extremely important to diagnose this condition before the child does much walking with the weakened hip joint. At this time, proper treatment can cure the condition without surgical operation. If the condition is neglected even for a year or two, surgery will be needed to reconstruct the hip joint.

Clubfoot

This is another congenital condition that seriously affects the foot. It can be corrected by early treatment. Sometimes only strapping or a cast is required. Serious cases will need expert orthopaedic surgery, as advised above for congenital hip disease.

Frozen shoulder

This very disabling limitation of motion of the important shoulder joint may develop after bursitis. The condition, which results from bands of adhesions around the joint, can also be due to other causes. If exercises, rest, and medicines do not help you, then a doctor who has had experience in the technique may free the adhesions by manipulation of the shoulder under anaesthesia.

Fractures

Fractures usually cause only temporary disability. 1 however, if the bone does not heal properly, there may be disability for life. Fractures in elderly people tend to knit poorly and may need special attention. In the growing child, fractures must be set correctly so that there is no interference with growth.

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Parents should try to recollect their own reactions and desires in adolescence. If they remember how they resented the authority of their parents, they will understand why their children object to strict rules. If they recall their fantasies and daydreams and grandiose plans, they will listen with tolerance, rather than derision, when their children plan to remake the world or to become poets, missionaries, or explorers. Parents must realize that their children’s adolescence may be stormy while theirs was quietly miserable, or vice versa.

Psychiatrist Dr. Benjamin Weininger points out that adolescents frequently have the correct attitude towards living. They are idealistic, intense about life, and hopeful that they can participate in making life better for everyone. The adolescent may not be very practical in his attempts to reach his ideals, but his idealism is worth our consideration and respect.

Our job is to help the adolescent reach the goal of maturity. We have already talked about how to help the child reach sexual maturity. There are a number of things we can do to help in the attainment of social maturity. Here are some practical measures:

1. Let the teenager feel he has a place in the family. Discuss or at least explain family decisions.
   
2. Give him the details of the family budget. Present a true picture of what things cost in terms of the parents’ outlay of time and energy. Let him see that his share is a reasonable one, and not the result of an arbitrary decision.
   
3. Encourage a sense of responsibility about money. Give the teenager a regular allowance—once a month, for those 16 or over.
   
   1. Do everything you possibly can do to enable an adolescent boy or girl, or one who is approaching adolescence, to have friends.
      
   2. Give the adolescent a chance to leave home. Younger children can first go to camp or to visit relatives. Then let them go to visit friends. Older and more mature adolescents should be permitted to take jobs away from home during summer vacations. These breaks from home life give the adolescent valuable training in self-confidence. They also help reduce the tensions that adolescents generate in their rebellion against home rules and restrictions. The adolescent soon learns that there are rules anywhere he goes.
      
   3. Let the teenager decide on his own career, and try to get expert guidance for him. If your daughter wants to enter a profession rather than marry at the age that her mother did, let her work it out in her own way. Do not add to the social pressure that often makes a girl marry before she is ready for it. Similarly, if your son is willing to give up a lucrative family business for the lesser financial return of some other work, let him follow his own interests.
      
   4. Help your children learn to know you as individuals, not just as parents—as human beings who may make mistakes but want to do the best for their children because they love them. It is better to show your love than it is to talk about it. One way to show your love is by remembering that the growing egos of adolescents need psychological nourishment as much as their growing bodies need food. But be careful not to praise your children for qualities they do not possess. They will either suspect you of being insincere or think you believe that they are, which will make them feel inadequate and insecure. Surely you can find plenty of good things you can truthfully say about your children!
      

How will you know when the time has come? Usually, you will know you are in labour by one or more of the following signs:

1 Show. This is the passage of blood-tinged mucus, usually only a small quantity, from the vagina.

2 Breaking of the bag of waters. This rupture of the membranes may be indicated by a gush of water from the vagina or by a slow leakage.

3 Labour pains. The first two indications are quite plain in most cases. Always call your doctor if either of them occurs. Labour contractions are harder to identify for a woman having her first baby. She is apt to be fooled by false labour, which usually consists of contractions of the uterus at irregular intervals, with or without pain. True labour pains are painful, rhythmical and accompanied by contractions of the uterus. The pain may be slight, but it usually increases to a peak and then fades away. The pain is cramp-like at the beginning, when it seems to be located in the small of the back. In a few hours it moves around to the front. Even at the beginning, true labour pains are usually spaced quite regularly, with a pain-free period between. The contraction of the uterus can be easily felt by placing the hand on the abdomen. The doctor has probably told you to call him if the contractions come every ten minutes or so. Even then he may want you to wait so your stay at the hospital will not be so long. Do not worry if the membranes rupture before labour contractions set in.

Induced labour

If, for some reason, the doctor feels he should start or speed up the beginning of your labour—for example, if the baby is past due and quite large—he can rupture the membranes quite easily. Labour usually occurs shortly after this. Or he may speed up the labour by giving you an enema, or medicines such as pitocin. Never attempt to speed up labour yourself.

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