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SEIZURES AND EPILEPSY IN CHILDHOOD: UNDERSTANDING YOUR CHILD’S TESTS – VIDEO-EEG MONITORING

The optimal approach to analysis of seizures is to both see and record their onset and their spread. Such an approach is mandatory in situations in which surgery is being considered. When surgery is even an option, it is critical to know the exact area of the brain involved in the origin of the seizures. Video-EEG monitoring allows recording of the EEG from multiple areas of the brain and also simultaneous video recording of the seizures.Video-EEG monitoring can also be useful when there is a question about what the spells really are. The ability to see a spell that is said to be a seizure and to record the EEG at the same time is the definitive way to differentiate seizures from pseudo-seizures.Two examples will illustrate: Sasha was a fifteen-year-old with a severe behavior disorder and seizures. Despite several years of intensive outpatient psychotherapy, he was once again thrown out of school. His family was exasperated. It was clear to both his neurologist and psychiatrist that he used his seizures to manipulate his environment. He was taken off medication and these peculiar episodes, which did not sound like seizures, did not increase in frequency. The family was taught to ignore them and Sasha seemed able to control them. But their persistence and his abnormal EEG remained of concern to his psychiatrist.The only resolution to his problem was to send him to a residential institution where he could be taught better behavioral control. Since the psychiatrist at the institution was uncomfortable dealing with a child with seizures, we brought him into the monitoring unit to see whether all of his spells were pseudo-seizures.Much to our surprise, while most of his episodes were, indeed, pseudo-seizures, at night he had genuine tonic-clonic seizures. Placing him back on medication eliminated these true seizures and allowed the psychiatrist at the institution to concentrate on his behavioral problems.Simon’s seizures began when he was two. They would start in his left foot and spread up the left side. At times, he would have a weakness in the left leg that was thought to be post-ictal paralysis, but at other times the leg was quite normal. Despite intensive attempts with medication, seizures continued to occur several times each day. The EEG showed a focus near the motor strip on the right, and we faced the choice of operating to remove the focus (with the probability of causing paralysis at least of the leg) or of allowing him to continue to have seizures. We decided to wait. After several years, video-EEG monitoring allowed us to see the start of several seizures. The seizures actually began anteriorally in the frontal lobe and then spread into the motor strip. They began in an area that could possibly be removed without damaging his motor ability. Simon was, therefore, put on the list for evaluation with the grid  electrodes placed on the surface of his brain and eventually had successful surgery—without experiencing paralysis.Intensive monitoring allows us to make decisions we were never able to make before. It gives us the opportunity to separate true seizures definitively from pseudo-seizures and more successfully to identify children as prospects for surgery.*87\208\8*

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ENDOMETRIUM (UTERINE) CANCER

In 2000, an estimated 36,100 new cases of uterine cancel were diagnosed in the United States. Most uterine cancers develop in the body of the uterus, usually in the endometrium (lining). The rest develop in the cervix, located at the base of the uterus. The overall incidence of early-stage uterine cancer – that is, cervical cancer – has increased slightly in recent years in women under the age of 50. In contrast, invasive, later-stage forms of the disease appear to be decreasing. Much of this apparent trend may be due to more effective regular screenings of younger women using the Pap test, a procedure in which cells taken from the cervical region are examined for abnormal cellular activity. Although these tests are very effective for detecting early-stage cervical cancer, they are less effective for detecting cancers of the uterine lining and are not effective at all for detecting cancers of the fallopian tubes or ovaries.Risk factors for cervical cancer include early age of first intercourse, multiple sex partners, cigarette smoking, and certain sexually transmitted diseases, such as the herpes virus and the human papillomavirus. For endometrial cancer, a history of infertility, failure to ovulate, obesity, and treatment with tamoxifen or unopposed estrogen therapy appear to be major risk factors.Early warning signs of uterine cancer include bleeding outside the normal menstrual period or after menopause or persistent unusual vaginal discharge. These symptoms should be checked by a physician immediately.*28/277/5*

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ENDOMETRIAL CANCER TREATMENT

Once a diagnosis of endometrial cancer is made, then the main treatment is hysterectomy with removal of the uterus, cervix, fallopian tubes and ovaries, since spread to these organs can occur. If the cancer has spread it is usually only detected following removal of these organs when they are examined under the microscope. When the hysterectomy is undertaken, then the gynecological cancer surgeon usually decides whether or not to remove the lymph glands. Such a decision rests on the presence or absence of ‘high risk’ features, i.e. a high risk of spread to lymph glands.
At the time of surgery, a pathologist is usually present who will examine the uterus closely to see how much of the muscle has been invaded or if the cervix, tubes or ovaries are involved. In any of these cases, especially when the muscle is invaded more than halfway, then lymph gland removal from the pelvic sidewalls is undertaken.
If at the time of surgery the gynecological oncologist feels or sees enlargement of the lymph nodes, then these glands will be removed. If the pathologist finds malignant cells in the glands (the pathologist freezes the tissue, cuts it and then stains it to look at it under the microscope – ‘a frozen section’), then the glands higher up, outside the pelvis along the major blood vessels (‘para-aortic glands’) are also removed. In these circumstances radiation therapy will always be required after surgery and the exact site of spread within the lymph gland ‘chain’ must be ascertained, so that the radiation therapy can be delivered accurately.
Sometimes, if the woman is too overweight and access to the lymph glands is difficult, or they are found to contain malignant cells, the lymph glands may not be removed. Radiation to the lymph node bearing areas is then given, commencing usually six weeks following surgery.
Radiation treatment usually also covers the top of the vagina which is the most common site of recurrence of this cancer. In some cases where the lymph node bearing areas do not require radiation but the top of the vagina does, then brachytherapy’ will be recommended. This involves placing a tube up to the top of the vagina; radiation seeds are then pushed along this tube and high dose local irradiation given. This takes a very short time and four or five treatments are usually required in comparison to the external radiation therapy which is given to the lymph node bearing areas which takes about five to six weeks in sequences of five days, Monday to Friday.
Endometrial cancer has a very high overall cure rate. Should the cancer recur in an area that has not been treated previously by radiation, such as the top of the vagina, or bone, or lymph glands, it will be usually treated with radiation. This can sometimes be curative. For instance, if investigations reveal that the vagina is the sole site of recurrence of endometrial cancer then cure can be expected in many cases.
If the cancer recurs a type of hormonal therapy is often given.
There is a very limited place for anti-cancer drugs (‘chemotherapy’) in recurrent endometrial cancer, since side effects are common and it is not very effective.
*10/144/5*

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RHEUMATOID ARTHRITIS: CAUSES, LYME DISEASE, VIRUSES AND INFECTION

What is the cause of RA?
No one knows for sure exactly what causes RA. Several possibilities have been contemplated over the years, including such infections as the Epstein-Barr virus, parvovirus, Lyme disease, and malaria. However, while these infections may produce symptoms similar to RA, none seems to be the actual cause.

What is Lyme disease?
Lyme disease is an arthritic illness that mimics RA and is caused by a spirochete (a corkscrew-shaped bacterium) called Borrelia burgdorferi, which is usually transmitted by deer ticks.

What is parvovirus?
Parvovirus is a type of DNA virus and is the cause of a childhood infection called “fifth disease” or the “slapped cheek” syndrome. In adults, this condition may cause joint pain that may last for weeks or even months. Though these conditions symptoms may mimic RA, parvovirus is not the same disorder nor does it cause RA.

What is the Epstein-Barr virus?
Epstein-Barr virus is the herpes virus that causes infectious mononucleosis. It has also been suspected as the cause of chronic fatigue, though there is little evidence to support this notion.

Is RA caused by any infection?
Scientists have considered infection as a possible cause; in fact, trials of treatment with the antibiotic tetracycline seemed to help alleviate the symptoms of rheumatoid arthritis in some patients. But there is far too little research in this area thus far, and results have been inconclusive. Scientists are also trying to determine if perhaps some type of bacteria may be the cause.
*6/141/5*

THE FIRST FEW WEEKS OFF DRUGS OR DRINK: THINKING IT THROUGH

The other mental trick is to think through what will happen if you take a drink or drug. Usually when a craving hits you, you think of the first part of drug-using – the pleasurable fix, the first joint or the first drink.
But using drugs or drinking doesn’t end there. You don’t stop at one fix, or one joint, or just one small glass of sherry! After the first enjoyable bit comes the excess, the drugged behaviour, the drunkenness, the passing out, the coming to, the withdrawals, and the appalling hangovers.
And with all these things comes the rest of drug-using and drinking – upsetting the ones who love you, lying, cheating, conning, stealing money, and all the other things addicts and alcoholics have to do in order to support their habit. All these things follow from the first use or the first drink.
When a craving hits you, and you think about the first joys of using, think it through – past the initial pleasure right to the pain that follows.

*84\116\2*

TO THE BIOMEDICALLY ORIENTED PSYCHIATRIST: POLARIZATION

Defining psychosis as a process reversal and as an unusual or extreme state implies that the client’s ability to exist in a given environment is disturbed. This means that the psychiatrist has to be acutely aware of her client’s resistances to the world and also of her own resistances to the client, for process reversal polarizes the environment. The world around an individual in the midst of a process reversal always becomes her opposite, just as the client becomes the secondary process for the world. Without understanding what is happening, a therapist usually finds herself acting out the opposite part of a client’s pattern, the cop to the robber, the optimist to the depressive and so on, instead of making both processes more accessible to the client.
If the therapist becomes antagonistic to the patient s state, both are in for trouble. Creative work with an extreme state requires you to be outside the state and outside of its polar opposite, while simultaneously getting inside and fully empathizing and appreciating it. But the latter is only possible when you are not caught in it.
The psychiatrist is faced with many unanswered questions. Why is one client susceptible to one type of process reversal rather than another? Our knowledge at present indicates only how patients become psychotic and how to deal with them. We know that individuals with weak primary processes become schizophrenic under stress, in contrast to becoming physically ill. Individuals with strong primary processes, on the other hand, become psychosomatically ill and experience process reversal as a temporary fever or debilitating handicap. Where there is an edge against violence, epilepsy is common. The following hypothesis needs testing as well; people attached to a primary process of peace become addicted to drugs or endorphine effects such as those produced by physical exercise. What kinds of belief systems are present before the onset of catatonic states? Can retardation be altered through processing?
*143\227\8*

PREVENTING COLDS: AIR THEM OUT

A further problem in enclosed spaces is the enforced breathing of recycled and potentially contaminated air. Studies by Dr. Dick suggest that good ventilation can help disperse nasty cold (and flu) viruses. The “old wives” who spun tales may have known this when they recommended opening the bedroom window at least a little while you sleep. At home or work, a forced-air ventilation system can help, if it is kept in working order. If the air is heated by radiators or an electric baseboard, consider using fans to help keep it circulating. On a plane, of course, there’s nothing you can do to cleanse the air, which makes keeping yourself well hydrated all the more important. Those who believe in the protective value of vitamin С (despite the lack of scientific evidence) might also try taking about 1,000 milligrams of vitamin С just before a plane trip and perhaps a second dose after landing.
*15\296\2*

QUESTIONS ON STRESS BREAKDOWN: HAVE I HAD ENOUGH SLEEP?

Sleep is essential for the proper functioning of the nervous system. The nerve cells most easily affected by lack of sleep are the inhibitory neurons which are responsible for our inhibitory reserves. We need our inhibitory functions to make u tolerant, patient and able to forgo our needs temporarily so as to fit in with the needs and rights of others. We know from personal experience how just being without sleep for a day or two can   make   us   impatient   and   irritable   and,    later,   quite disinhibited.
Without adequate sleep the nervous system is unable to process information adequately; anxiety symptoms will occur when we try to get through our usual workload without having had sufficient sleep. People who say they’re becoming ‘unraveled’ ‘frayed at the edges’ from lack of sleep, are using imagery similar to William Shakespeare’s, in Macbeth, Act II, where he has Macbeth saying:
Sleep that knits up the raveled sleeve of care,
The death of each day’s life, sore labour’s bath,
Balm of hurt minds, great nature’s second course,
Chief nourisher in life’s feast. . .
Shakespeare says it all, really, in describing the recuperative function of sleep and its relationship to stress breakdown.
But how much sleep is enough sleep? I think it is best for the body to decide. If a person needs an alarm clock to wake up in the mornings, that person is not having adequate sleep.

*10/129/5*

ALLERGIES: DIETARY CONSIDERATIONS AND BIOLOGICAL TREATMENTS

In my opinion, most allergies are the result of feeding babies such foods as cereals, meat, whole cow’s milk, etc., before they reach the age of 10-12 months. Before that age, babies lack proper enzymes needed for the digestion of these foods, which causes allergic reactions. Babies raised on mother’s milk alone (provided mother is healthy) until the age of at least 8 months, most likely will not develop allergies later in life, unless subjected to severe malnutrition or an extremely toxic environment.
Another common cause of allergies is today’s processed foods loaded with thousands of chemical additives, many of which are powerful causes of allergy. Those who have allergic sensitivities should avoid all foods that might possibly contain chemical additives or residues, and eat only organically produced foods free from man-made chemicals.

Dietary considerations
The Airola Diet with emphasis on whole grains, seeds and nuts and raw fruits and vegetables, all organically grown. Avoid milk (or ice-cream) and wheat, if patient is allergic to them. Yogurt and other soured milks are usually well tolerated. Goat’s milk is also well tolerated. Those suffering from allergies are usually deficient in manganese. The diet should include an abundance of manganese-rich foods: buckwheat, nuts, beans, peas, blueberries.
The most common allergens (according to Dr. Coca) are: eggs, wheat, white potato, milk, and oranges, in this order of frequency. To determine foods to which the patient is allergic, we advise using Dr. Coca’s “Pulse Test”.

Biological treatments
Fasting is an excellent way to remedy allergies. Repeated short juice fasts will eventually result in better tolerance of previous allergens.
After the juice fasting, the patient can try a mono diet: only one food – vegetable or fruit – such as watermelon, carrots, grapes, or apples, should be consumed for one week. After that, one more food is added to the diet. One week later, the third food is added, and so on. After four weeks, the protein foods can be introduced, one at a time. As soon as the patient notices an allergic reaction to a newly-added food, it should be discontinued and a new food tried. This way all real allergens can be eventually eliminated from the diet.
Note: If the patient is using antihistamine drugs regularly, they should not be withdrawn abruptly, even during fasting, but discontinued gradually, replacing them with vitamin С in large doses (which acts as a natural antihistamine), up to 3,000 mg. daily.

*1/103/5*

RHEUMATOID ARTHRITIS: MUSCLES AND STRUCTURES IN SYNOVIAL JOINT

Muscles are important contributors to joint function and stability. They serve as stabilizers and protectors of joints in addition to being the source of power for all movement. As you might expect, muscles provide the strength required to allow movement to take place at the joint. Combinations of muscles acting in unison can result in a wide range of motions. This is how we can use the same joint (the shoulder) to reach behind our back, across our chest, and over our head. We do so by activating different muscle groups.
In addition to movement, the muscles also provide stability for a joint in a given position. For instance, if you raise your arms to comb your hair, certain muscle groups contract to lift your arms above your head. After your arms are raised, the muscles continue to work to keep your arms elevated while you use your hands and wrists to comb your hair. Similarly, when you are standing in line without moving, your muscles are contracting to allow your body to stand erect without collapsing at the hips or knees. Even without movement, then, muscles are critical: they allow us to retain the stationary position of our joints.
Lastly, the muscles automatically protect the joints during movement without requiring conscious thought on our part. As an illustration of this property of muscles, recall the last time you unexpectedly missed a step while walking down a set of stairs. Your muscles did not expect or prepare for the missed step and your knee or hip felt the jolt of unprotected movement. If the step had been anticipated, the appropriate muscles would have contracted, acting much like a shock absorber on a car to protect the joints for the step. This automatic protection function of the muscles results in a reduction of the impact on the joints in the course of daily living.
Muscles are attached to bone by tendons, which are similar to ligaments except that they connect muscle to bone instead of bone to bone. Because the tendons are located at the end of muscles, they move when muscles tighten, or contract. To demonstrate this to yourself, “make a muscle” by bending your arm at your elbow. At the same time, feel the area on the inside of your elbow for a ropelike structure at the end of the biceps muscle. This is a tendon.
The tendon is surrounded by an envelope known as the tendon sheath, in which the tendon slides back and forth. This sheath has a lining (similar to the synovial membrane) which permits easy gliding. When muscle tendons are in good health, they provide excellent support for the joint, much as ligaments do. Tendons and their tendon sheath can become inflamed, however, from overuse (producing a condition called tendinitis) or from RA (producing a condition called tenosynovitis).
Another structure located near the joints which help the tendons and muscles move smoothly over bone is the bursa. Bursae are sacs located between or under muscles which help the muscles slide without resistance or friction. If these structures become inflamed they can become filled with fluid, a condition known as bursitis.
*5/209/5*



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