General health
MENINGITIS IN CHILDREN
Symptoms: fever, stiff neck, headache, vomiting, exhaustion or collapse, convulsions.
Home care:
Meningitis is a medical emergency. Do not attempt home care. Take the child to the doctor immediately.
Precautions
- A child, who is very weak, has a stiff neck, and fever should see a doctor immediately.
- Laboratory examination of spinal fluid is the only way to diagnose meningitis.
- Meningitis can follow an upper respiratory tract or middle ear infection, or certain types of skull fracture.
- Meningitis is often contracted through direct contact with a carrier of the disease who appears quite healthy.
Meningitis is an infection of the meninges, the layers of tissue that cover and protect the brain and spinal cord. Most often, meningitis is caused by a viral infection. Bacterial meningitis is usually caused by one of three types of bacteria: meningococcus, pneumococcus, or Haemophilus influenzae. Meningitis is seldom spread by a person who has the disease. It’s usually contracted by direct contact with a healthy person who is a carrier of the disease, or by inhaling airborne droplets of moisture from that person’s respiratory system. (A carrier is a person who does not get sick with the disease but can pass it on to others.)
Meningitis may be a complication of a skull fracture if the fracture has extended into the nose, middle ear, or nasal sinus. Meningitis can also follow an upper respiratory tract infection or middle ear infection.
Signs and symptoms
The characteristic symptoms of meningitis are moderate to high fever, headache, vomiting, exhaustion or collapse, convulsions, and a stiff neck – the child cannot touch his or her chin to the chest with the mouth closed. Purplish red spots (petechiae) scattered over the body together with fever may indicate one form of meningococcus infection. The diagnosis of meningitis can only be made with certainty by testing spinal fluid obtained by a spinal tap.
Home care
Meningitis is a medical emergency in which hours, if not minutes, count. Do not attempt any home treatment. See a doctor at once.
*148/84/5*
PREVENTIVE MEASURES AGAINST HEART ATTACKS
• Eat more fish oils. Studies of people who consume large amounts of fish (notably the Japanese and the Eskimos) show that they have very low heart-disease rates. Both groups have low blood-fat levels, high levels of high-density lipoproteins (the good, helpful kind) and a reduced tendency for their blood to clot. These people also have a high level of a particular type of fatty acid called eicosapentaenoic acid (EPA). This and its close relative, DHA, are found in fish, fish oils and the fat of marine animals. Many research groups have now looked at the role of fish-oil supplements and found that various risk factors for heart disease can be altered beneficially. The main advantage appears to be that the blood becomes less sticky and so less likely to form clots. This must reduce the risk of heart attacks because they are so often triggered off by a clot in one of the arteries that supply the heart. It is especially encouraging to find that the higher the blood fats before taking fish oil, the more they are affected by the treatment. So far there do not seem to be any drawbacks to taking fish-oil supplements-for example, the blood does not go on getting thinner and thinner. So, by increasing your fish consumption and possibly taking a food supplement of EPA, you can almost certainly reduce your chances of having a heart attack.
• Eat more magnesium-containing foods. Recent work suggests that it is brief spasms of the coronary arteries rather than clots that trigger a significant number of heart attacks. It appears that a deficiency of magnesium could be behind this problem. Eat more fruit, whole grains, vegetables and pulses to enrich your diet with magnesium.
• Make friends and be sociable. Social isolation has been found to be a factor in heart attacks, according to a study of 4,000 men in the US. The most sociable people had fewest heart attacks. In parallel with this an Israeli study found that men who had a good sex life were much less likely to have a heart attack. There is also evidence that loving care reduces the arterial disease that makes a heart attack more likely by narrowing the coronary arteries.
• Control your diabetes if you have Type I (insulin-dependent diabetes) and cure it if you have middle-age onset diabetes. Diabetics have a very much increased risk of having a heart attack and this preventive measure is very worth while.
• Don’t take the contraceptive pill if you have a history of heart disease in the family. It is not known why women have so much less heart disease than men-the hormonal differences are not an adequate explanation-but taking the Pill definitely raises the risk unacceptably for susceptible women, especially after the age of 35.
• The weather, particularly the invasion of cold fronts and rapid falls in barometric pressure, has been linked to admissions to hospital with heart attacks. Things you can do to prevent heart attacks occurring in these circumstances are to avoid exposure to cold, especially the combination of vigorous exercise and cold. It is no coincidence that so many men die from heart attacks every year shifting snow from in front of their homes. The use of a light face-mask helps maintain temperature and humidity and can be a useful preventive.
*166/72/5*
STEPS THAT WOMEN CAN TAKE TO PROTECT THEIR HEARTS
It is true that women who develop heart attacks tend to be older than their male counterparts; and they are at more risk from heart attacks if they have high blood pressure and diabetes. So if you have one or the other, or both, of these conditions (they often go together), you must be particularly careful to keep it under good control.
For high blood pressure, that means
• Taking the correct antihypertensive drugs
• Having monthly blood pressure checks For diabetes, it means
• Strict control of weight—the BMI (Body Mass Index) should be strictly between 20 and 25, and preferably closer to the lower figure
• Frequent small meals containing large amounts of fiber
• Multiple injections of small amounts of insulin each day
• A daily diary of your blood glucose (booklets for keeping records of blood glucose, insulin doses, and food intake are available from your doctor)
• A monthly visit to your diabetic clinic
Hypertension among women has not been studied nearly as much as it has been among men. Some researchers question whether the findings about men apply directly to women. Several hypertension medications affect blood lipid levels and these effects may be different and perhaps counterproductive for women, possibly affecting their sex life. Potential changes in sexual response for women on certain blood pressure medications have been ignored by researchers and unquestioned by family doctors. These holes in research are rapidly being filled by current studies, so keep your eyes open for new information as it is released.
The female hormone estrogen appears to protect women against heart attacks—a protection that falls away after menopause. So why not try hormone replacement therapy (HRT) after your menopause to keep your heart attack risk low? In a large study of American nurses, HRT halved the risk of coronary disease in postmenopausal women. Worries that HRT might cause breast cancer appear to be unfounded, but there is very definite evidence that it greatly reduces the risk of ovarian cancer—and also, surprisingly, of rheumatoid arthritis. Nevertheless, women who have many close relatives with breast cancer should probably avoid HRT; there may be a very small risk that it can accelerate the development of an already existing growth.
The good news for women about heart disease is that the very strong risk in men with high cholesterol levels probably does not apply to women. Younger women naturally have higher blood cholesterol levels than men of the same age, but most of it is of the beneficial HDL type. Only if there is obvious hyperlipidemia, or a history of early deaths from heart attacks in women in the immediate family, should a high cholesterol level in a woman be taken as something to worry about, and needing a special diet or drugs.
*105\86\8*
MANAGING ANGINA: THE CARDIOLOGY UNIT
The aim of a modern cardiology unit is to find the cause of your symptoms. Most of the time, in angina, this will be atheroma, affecting one, two, or all three of your coronary arteries. The tests to be performed in the clinic should identify the problem in sharp detail, so that any corrective treatment is planned for your own individual needs.
You will be asked to undergo exercise testing, special EKG tests, and X-ray investigations, including perhaps a radioisotope heart scan, an echocardiography, and finally a coronary angiogram.
The thought of all those tests, especially after you have been told you may have an at-risk heart, is daunting and frightening. Please do not let it worry you. In modern cardiology units, everything is done to make sure you are relaxed and calm. The staff are highly specialized, having concentrated on heart investigations for years, and know very well what entering such a unit means for their patients.
I have visited many such units, all of them staffed by cheerful, kind, and dedicated nurses and doctors, who can make even the most apprehensive patient feel relaxed. The atmosphere is never somber—there is no “gloom and doom.” The feeling is more of a professionalism dedicated to helping people back to a normal life, with much to look forward to. They have every reason to be cheerful, because they succeed in their aims with the vast majority of their patients, and since the development of coronary care units, the death rate from ischemic heart disease has dropped dramatically.
The first investigations aim to find the underlying cause of the symptoms. They will rule out such problems as heart valve disease (one clue being a heart murmur heard through the stethoscope), high blood pressure, an overactive thyroid, or anemia. If patients are found to have one of these problems, they will be given treatment and their angina should recede. Sometimes the heart clinic finds evidence of esophageal spasm (a form of cramp), and will refer you to a gastrointestinal specialist for treatment.
Most of the rest of the patients seen with angina in the cardiology unit have atheroma affecting the coronary arteries. The next aim is to find out how serious they are, and to estimate the risks of a fullblown heart attack in the near future. That means getting as many details as possible of how the heart is performing at the time of an angina attack. The two ways of doing this, initially, are to use a stress test or a Holter monitor.
*85\86\8*
HELP YOUR ANGINA/EXERCISE: DON’T OVERDO IT!
Don’t overdo the exercise. If you have started off at the normal weight for your height, and you find you are losing a pound or two, you are either doing too much or not eating enough to replace the lost energy. Don’t replace the heart attack risk with the problems of fad dieting. James Fixx wrote that the best runners looked too thin.
They may, but your objective is not to be one of the best runners. Your aim is to enjoy your exercise while getting your heart as fit as possible. Being a beanpole has disadvantages, and is not necessarily as good for you as being in the normal BMI range—that is, an average build. Of course, if you start by being overweight, losing the extra pounds through exercise is a bonus, provided that when you reach your ideal weight, you stay at it.
Another “don’t” is to get too obsessive about your weight. I don’t recommend regular weighing, as it tends to focus on that one aspect of health, to the exclusion of others. It can cause disappointment, sometimes even despair, if the pounds do not roll off quickly and steadily. That is a mistake, because the exercise will alter your body shape, making you leaner and trimmer, without necessarily causing your weight to change much. Your fat is being replaced by more muscle tissue, and that is more important than losing weight in itself.
So instead of focusing on your weight, follow your progress by looking in a long mirror once in a while. You will know better from your shape and your muscle tone that you are improving, and that will boost your confidence rather than undermine it.
*61\86\8*
THE HIGH-RISK APPROACH TO REDUCING CHOLESTEROL: THE LONDON CIVIL SERVANT STUDY
Lowering a particular population’s cholesterol level by advice on health alone can be done, if it is approached with enthusiasm. In a study of London civil servants aged forty to forty-nine years, half were given simple dietary recommendations aimed at lowering blood cholesterol. Over only four months, the average blood cholesterol level fell by 10 percent, but, more importantly, the percentage of men with a blood cholesterol over 240mg/dl changed from 53 percent to 25 percent. After eighteen months, only 23 percent of them had blood cholesterol figures above 240mg/dl.
This must have greatly reduced their potential for a premature heart attack. When the cholesterol levels were divided up into five equal blocks from the lowest to the highest, it turned out that only 7 percent of the heart attacks occurred in people in the lower two-fifths. Thirty-one percent of the heart attacks occurred in the top one-fifth for cholesterol level. This is a strong argument for lowering a high cholesterol level into the normal range by changing your lifestyle.
*41\86\8*
EVIDENCE FROM NORWAY CONCERNING ANGINA AND HEART DISEASE
The first clues to the causes of heart disease came from Norway. Before the Second World War, Norwegians enjoyed a very high standard of living—and a very high rate of angina and deaths from heart attacks. Then came the Nazi occupation.
From 1940 onwards, Norwegians no longer had tobacco. Many were forced into jobs that were physically hard. Their milk, cheese, and beef were exported to Germany, and they had to rely much more on fish as a staple food. As a nation, they lost weight and their blood pressures fell. At the same time, Norwegians were under great stress. For four years, they lived constantly with such fear and anxiety as we can hardly imagine today.
What happened to the heart attack rate under such conditions? It fell .. . steeply! There was also an even steeper drop in the numbers of hospital patients who had thromboses (blood clots) after surgery.
However, that Norwegian natural experiment, which was probably mirrored in countries such as the Netherlands, also occupied by the Nazis, has lessons for people today.
The first is that, even when the answers are obvious, it is almost impossible for people to accept them if it means having to adopt a completely new approach to life. It took until the 1980s for the medical profession to accept the implications of the Norwegian experience, and only then after many other studies had confirmed them. For nonmedical people, the message has still not penetrated, or it is not heeded, until they are suddenly faced with the possibility of their own mortality!
The second, and more encouraging, lesson from Norway is that it takes only a short time, less then a year, for a change in lifestyle to improve your chances of avoiding a heart attack and early death from heart disease. It does not seem possible that the lifestyle change could have reversed years of atheroma, but it may have made other differences to the supply-demand equation in the workings of the heart—such as making it much less easy for clots to form within the affected arteries.
*21\86\8*
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