Doctorweblog. About Health & Medicine

Diarrhea refers to looseness of the stools, not to the frequency of bowel movements. (Frequent bowel movements with normal stools are not diarrhea.) The number of loose bowel movements per day measures the seriousness of the diarrhea.

Diarrhea in children over the age of five differs in several ways from diarrhea in infants and younger children. Diarrhea is less likely to cause dehydration (a serious loss of body fluids) in older children. The older and large the child becomes, the smaller the chances of dehydration. Serious dehydration is unlikely past six years of age-unless diarrhea is combined with vomiting, which keeps the child from drinking enough liquids.

Viruses in the intestine are the most common cause of diarrhea in older children. Dysentery bacteria and parasites in the intestine are the next most common causes. Respiratory viruses and reactions to certain foods are the least likely cause of diarrhea in older children.

Other diseases may cause long-term, frequent diarrhea in older children (though they are rare or unknown in infants). Ulcerative colitis is a condition in which ulcers frequently appear in the colon (large intestine). Regional enteritis (Crohn’s disease) is a recurring inflammation in the small intestine. The cause of these two diseases is not known. Cystic fibrosis is an inherited disease that affects the lungs, pancreas, sweat glands, and sometimes the liver and other organs. It often causes frequent diarrhea with foul-smelling stools.

Signs and symptoms

Loose, watery stools are the major symptom. There may be mucus or flecks of red blood in the stools. The child may have cramps. There may also be fever, loss of appetite, vomiting, and weight loss, depending on the cause of the diarrhea.

Home care

If the child has both diarrhea and vomiting, treat vomiting first by restricting the child’s diet to clear liquids only. Once the vomiting stops treat the diarrhea by limiting or not reintroducing solid foods – especially those with roughage, fruits (except bananas and apples), vegetables, butter, fatty meats, and peanut butter. Do not give the child milk, since milk may further aggravate diarrhea.

Encourage the child to drink plenty of clear liquids: tea, water, flavored gelatin water, and commercial mineral and electrolyte mixtures.

Precautions

• Do not give anti-diarrheal medications to children, since side effects are common and can be dangerous.

• Isolate an infant from children who are ill with vomiting and diarrhea.

• If there is blood in the stools, high fever, prostration (extreme weakness or collapse), or severe or prolonged diarrhea (more than two to three days), call your doctor. Dysentery may be the cause.

• Report frequent, repeated diarrhea to your doctors. Frequent diarrhea may be a symptom of colitis, enteritis, or cystic fibrosis, especially if there is weight loss.

Medical treatment

Your doctor’s treatment will be the same as home treatment. If necessary, the doctor may request blood tests, X rays of the large and small intestines, and sigmoidoscopy (an examination of the large intestine). In severe cases, hospitalization may be ordered.

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Thinking faster, feeling harder. Some herbal experts see ginkgo biloba as a male godsend. Not only does it seem to help solve erectile difficulties in some men but also it improves cognition (thinking ability). It does this by increasing blood flow without affecting blood pressure. It is one of the most frequently prescribed drugs in Germany and France, says Adriane Fugh-Berman, M.D., former head of field investigations for the Office of Alternative Medicine at the National Institutes of Health in Bethesda, Maryland, and author of Alternative Medicine. It has been shown to help with memory problems, concentration difficulties, depression, and dizziness.

For the best results, take ginkgo in a 50-to-1 extract, says Dr. Willard. That means the label should say that it contains 24 percent flavonoid glycosides – the active ingredient that increases blood flow.

It’s best not to exceed 240 milligrams daily, warns botanist and herbalist James Duke, Ph.D., of Washington, D.C., in his book The Green Pharmacy. Higher doses can cause diarrhea and irritability.

Shrinking an enlarged prostate. Saw palmetto helps, Dr. Tyler says. However, he warns that we should not self-diagnose prostate problems. Let the doctor do that, then discuss alternative treatments, he advises. If the problem is enlarged prostate, then consider the herb. In Germany, doctors prescribe saw palmetto and other herbal remedies nearly 90 percent of the time to relieve enlarged prostates.

Read saw palmetto labels carefully, Dr. Tyler advises, and purchase a brand that contains 85 to 95 percent fatty acids and sterols. The fatty acids and sterols contain the plant medicine that benefits prostate tissue, so you want to be sure that you’re getting a potent percentage of that. A usual dose is 80 to l60 milligrams twice daily, says Dr. Tyler.

Coping with depression. Several active principles in the herbal remedy Saint-John’s-wort are proving to be effective antidepressants for mild to moderate depression. It doesn’t work instantly, though. Although it can be taken as a tea, it is best consumed in capsule or tablet form, standardized on the basis of hypericin, a marker, not necessarily an active component, advises Dr. Tyler. Follow label dosage directions carefully. The antidepressant effect should be evident within six weeks.

Solving stomach upset. Ginger, the cooking spice and the flavor in real ginger ale, is a great stomach-soother and a pleasant motion-sickness preventive, says Dr. Tyler. This root can stop nausea quickly. You can make a tea with 1/2 to 1 teaspoon grated fresh ginger, or with 1 teaspoon ground ginger.

Warning: It does have a pepper-like bite. If you prefer, you can eat some crystallized ginger candy. Or drink real ginger ale (not “artificially flavored”). For motion-sickness prevention, take the cure 20 to 25 minutes before you take off, of course.

Sleeping easier. Valerian is a mild tranquilizer that has been shown to help people fall asleep. And it doesn’t leave you with the morning hangover associated with other sleeping pills, Dr. Tyler says. Valerian smells terrible, so it is better taken in capsule form than in a tea. Follow the instructions on the label, advises Dr. Tyler.

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The anesthetist will then begin your anesthetic, and will remain with you throughout the whole operation to make sure you are asleep and that the function of your heart and lungs is satisfactory. Once the anesthetic has been injected into the tube in your hand or arm, you will fall asleep within seconds. The drug which makes you go to sleep may sting a little as it enters the vein from the cannula, but this feeling does not last long.

Several different types of drugs will be given to you during your operation:

1 induction agents to bring on sleep;

2 maintenance agents to keep you asleep;

3 analgesics to stop you feeling pain after the operation;

4 anti-emetics to help stop you feeling sick after the operation.

If local anesthetic is injected into the wound during surgery, you will have little or no pain for a few hours after you wake up.

After your operation

When your operation is over, the anesthetist will stop giving you the drugs that were keeping you asleep and you will probably be taken to a recovery room or step-down ward.

The recovery room

The nurses in the recovery room are specially trained to care for patients coming round from anesthetics after an operation. You will stay in this room, still watched over by monitoring equipment, until you are fully awake and ready to be returned to your own ward.

If you are in pain when you wake up, tell a nurse in the recovery room as you can be given an injection or tablets to relieve it.

The step-down ward

If you are going home on the same day as your operation, you may be taken to a step-down ward. The nurses on this ward will make sure that you are fit to go home and that your journey will be safe and pain free. They will also want to be sure that you have a responsible adult to care for you once you are at home, and should give you advice about how to manage your recovery over the next few days.

Back on the ward

If you are not going home the same day, you will be taken back to your own ward, where the anesthetist may visit you before you leave. This visit is to ensure that you are having adequate pain relief and have no ill-effects from your operation. Do tell the anesthetist if you have any concerns or questions.

Side-effects of the anesthetic

There are side-effects which can occur after anesthesia, but these do not normally last longer than a couple of days. A sore throat is quite common, and is caused by the dry gases breathed while you are asleep, or by the tube which may have been put down your throat to help you breathe during your operation.

If you feel unwell, or have pain anywhere other than at the site of your wound, do tell the anesthetist – or a nurse on your ward – so that the reasons for it can be discovered.

Pain relief

The house surgeon and nurses on your ward will be able to give you analgesics to control any pain. However, if these drugs are not enough, do tell the anesthetist or ward staff, which may be able to give you something more effective.

The amount of pain suffered after a breast operation varies from person to person. Some women have pain or slight discomfort for only 12 to 24 hours and will not need any pain-killing injections after this. Others may need injections for up to 3 days after their operation.

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Unfortunately, we know very little about the characteristics of women with endometriosis as no comprehensive research has been undertaken to study this issue. But the findings of several minor and non-comprehensive studies are outlined below.

Age

Endometriosis usually only affects women during their menstruating years. It does not occur before the onset of menstruation and it is rarely found in women following the menopause.

Traditionally, endometriosis was said to be a condition of women in their 30s and 40s. Since the introduction of laparoscopy the majority of gynaecologists now believe that endometriosis most commonly affects women in their late 20s and early 30s. Furthermore, most gynaecologists believe that endometriosis is rare in teenagers and uncommon in women under the age of 25. But this belief is also beginning to be questioned.

Research by the Endometriosis Association shows that most of the women with endometriosis were diagnosed in their late 20s and early 30s. In fact, 55% were diagnosed between the ages of 25 and 34. The average time from the onset of symptoms to diagnosis was 6.8 years and 43% of the women believed that they had first experienced their symptoms before the age of 20.

The study also revealed that the women who reported their symptoms to a doctor before the age of 20 took an average of 8.8 years to get a diagnosis. In contrast, those who were aged 30 to 34 when they first reported their symptoms took an average of only 1.4 years to get a diagnosis.

It would therefore seem that women with symptoms of endometriosis are being diagnosed when they reach their late 20s and early 30s because that is when their doctors consider endometriosis as a possible diagnosis for their symptoms — despite the fact that they may have reported their symptoms for many years previously.

Consequently, the Endometriosis Association believes that endometriosis is probably more common in teenagers and young women under the age of 25 than is generally acknowledged.

This belief is supported by several studies which have investigated the incidence of endometriosis in teenagers with chronic pelvic pain. These studies have found that approximately half of the teenagers investigated for chronic pelvic pain had endometriosis. It also appears that endometriosis is being diagnosed more frequently in teenagers as more of them are given the benefit of a laparoscopy.

Race

Traditionally, it was believed that endometriosis was a condition confined almost exclusively to white Caucasian women and that it was rare in Asian, Jewish and black women. Since the introduction of diagnostic laparoscopy it is now realized that endometriosis can affect women of all racial backgrounds.

Whether or not there are any differences in the incidence of endometriosis between various racial groups is not known because it is impossible to determine the incidence of endometriosis in women in general, let alone within particular groups.

Delayed childbearing

Traditionally, it was believed that endometriosis was a condition that affected women who had delayed childbearing and that having children provided some sort of protection against developing the condition. It has now been shown that endometriosis is frequently found in women who have had children.

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An increasing number of people in the West are finding that a spiritual dimension to their lives is invaluable to their physical and mental well-being. Since antiquity humans have felt the need to commune with supernatural beings, and almost every culture has a concept of God. To many, Christians included, an essential part of their God is his ability to heal sickness and even to prevent illness. Examples of miracles abound in historical and religious literature and there is little doubt, given the enormous power of the mind over the body, that such phenomena can be real enough. Current research into parapsychological phenomena makes it all much easier for us to believe in today than it would have been for those living in biblical times, but even so there are still sceptics.

There is little doubt that we are learning in the West that humans are far more remarkable than we previously thought. Telepathy, clairvoyance, clairaudience, psychokinesis and the ability to heal are so well documented that it is difficult to be sceptical about them any longer. What is interesting is the idea that we all possess such gifts as a part of being human beings but that most of us have lost them. Research in Russia, for example, has found that most people can be taught to dowse and to develop all kinds of parapsychological abilities they never knew they had. Susceptible people can learn such skills in as short a time as a weekend.

It appears that western thinking and behaviour inhibits these intrinsic-or some would say God-given-abilities. A doctor working in a very primitive area of Africa was astonished at how the local people regularly and quite naturally communicated with each other over long distances without speaking. They quickly lost this telepathic ability once they came into regular contact with westerners because, they said, they felt so much in awe of the cars, watches, explosives and so on. These things, they said, seemed to dwarf their ‘simple powers’.

Much of the maintenance of good health and even the curing of ill health resides, I believe, in these realms of the mind that are currently called parapsychological. Some, in different parts of the world, attribute them to God or Gods, others to the wondrous nature of mankind. Needless to say I am in no position to say which is correct but I do recognize a higher force of health and ill health than man and his personal behaviour. The healing power of one person upon another is a skill that has been all but lost in many westernized cultures although it is being revived among certain Christian groups, especially in the charismatic wing of the church. Of course for many so-called primitive people the laying on of hands and absent healing are a long-established part of their culture. With the increasing interest in the mystical and the supernatural and with a growth of ‘natural’ medicine in the West I feel sure that all of this side of healing and maintaining health will be of greater importance in the future.

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Maureen Pence lost 45 pounds by drowning her appetite before every meal.

Maureen, of Pottstown, Pennsylvania, had resigned herself to being overweight. She liked to eat and dined out often. But when her father, a retired physician, suffered a heart attack, her attitude changed. At age 31, she knew that she had to get serious about slimming down. So she followed the standard weight-loss advice, trying to eat healthier and exercise more. This was easy enough—when she was at home.

Maureen’s job as a production manager for a chemical company required her to eat out frequently with clients. Finding something relatively healthy to order from the menu usually wasn’t a problem. But the portions were huge, and Maureen—well, she was hungry.

Then one day, Maureen drank a full glass of water before she went to a restaurant. She found she wasn’t as ravenous when she ordered, and she didn’t wolf down her meal. In fact, she left some of her food uneaten. Quite by accident, she had discovered a weight-loss trick.

“I started drinking a big glass of water before all my meals and taking sips between bites,” Maureen says. “I was amazed at how full it made me feel.”

Gradually, she was able to lose 45 pounds. Today, at age 36 and 153 pounds, Maureen is a slender and happy size 10.

WINNING ACTION

Start every meal with water. Like Maureen, you can keep your appetite in check by drinking an 8-ounce glass of water before every meal. And make sure the water is ice cold; your body has to burn almost 8 calories to raise the water temperature to 98.6°F. In fact, if you were to drink eight 8-ounce glasses of ice-cold water a day, you’d burn about 62 calories. That adds up to more than a pound’s worth of calories in just 2 months.

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Migraine remedies often contain a drug to reduce nausea and vomiting (antiemetics), as well as a pain-killer. One problem in migraine, is that absorption from the stomach is much reduced once an attack starts, so that pain-killers taken by mouth have little effect. Anti-emetics can improve the absorption of the painkiller, so they are useful for migraines, even if nausea is not a symptom. The main drugs used are buclizine, cyclizine and metoclopramide. These are safe drugs with few side effects.

Because of the problem of non-absorption, it is very important to take migraine treatments as soon as an attack begins – or in advance, for those patients who have advance warning of their attacks, in the form of visual

disturbances, mood changes etc

Composition of migraine

preparations containing painkillers and other drugs

Midrid – paracetamol, plus a sedative, and a sympathomimetic

Migraleve – paracetamol, codeine and buclizine (anti-emetic) in the pink tablets; paracetamol and codeine in the yellow tablets.

Migravess – aspirin and metoclopramide

Paramax – paracetamol and metoclopramide (anti-emetic)

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Fish: the family concept is irrelevant when it comes to fish, because all the fish in the main group eaten (the bony fish) share a special type of protein known as a parvalbumin. The paralbumins are known to provoke allergic reactions, and they probably account for the fact that many people are sensitive to all the types of fish they have tried. It is uncertain whether paralbumins are found in the other main group of fish, the sharks, rays, skates and dogfish (cartilaginous fish). The two groups are only very distantly related, and it is possible that people sensitive to bony fish could tolerate cartilaginous fish.

Crustaceans, Phylum Crustacea:

crab, lobster, crayfish, shrimp, prawn. A very large group, including many different families. Many patients react to all forms of Crustacea, so the family concept does not seem relevant here. There may be.some common allergen in all of them, as in fish. Also see the section on unexpected reactions, below.

Molluscs, Phylum Mollusca:

mussels, cockles, winkles, oysters, clams, scallops, squid, cuttlefish, octopus, snails (escargots). Again, this is a very broad group, but the family concept does not seem to be relevant here, because people who are sensitive to one type are usually sensitive to them all.

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Others who may be concerned about their nutritional status, but cannot afford individual testing and see if they show any signs of deficiency. These are not foolproof signs, however – the same symptoms can be produced by other forms of illness, and there are several deficiencies that do not appear in the table because they produce no clear-cut signs. But if you do show some of these signs, then there is a chance that you are lacking certain nutrients, especially if your diet has not been good. The simplest and cheapest answer is to take a general supplement. This may be slightly more expensive than run-of-the-mill vitamin tablets but it is far more likely to do you good – and not to do you any harm. It is also free of artificial colours, unlike most commercial preparations which come in lurid shades of red or orange as an indication of their health-giving properties! Avoiding colourings is important if you are embarking on an elimination diet.

One sign that you may notice is white spots on the fingernails. These can be an indication of zinc deficiency, and if you show no other deficiency signs, and generally eat a good diet, then taking a zinc supplement may be all you need to do. Zinc is relatively safe and non-toxic, so a sensible supplement is unlikely to do any harm.

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There is evidence that people with food intolerance have more leaky gut walls than healthy individuals – so they let more undigested food molecules through. This has major health implications which will be considered later, but how does the gut become more leaky in the first place?

Inflammation, produced by immune attack, can make the gut wall more leaky. One source of inflammation is disease – any gut infection that produces diarrhoea may inflame the gut wall. In babies, such infections are often the start of food intolerance.

Alternatively, foods themselves might provoke inflammation of the gut wall, if there is a localized allergic response to them. This is not something that most allergists would agree with – they see IgE/mast cell reactions to foods (see p29) as being all-or-nothing affairs which produce immediate and unmistakable symptoms. The idea that there might be a small-scale, localized IgE reaction, whose main effect is to make the gut more permeable, is not widely accepted. The main evidence in its favour is the effect of a drug, sodium cromoglycate, on some patients with food intolerance.

The effects of this drug have mainly been studied in migraine patients. If such patients undertake an elimination diet, a large proportion of them get better and can then identify one or more foods which provoke their symptoms. Each time a culprit food is eaten it will provoke a migraine -but not if sodium cromoglycate is given in advance. Sodium cromoglycate is

known to stabilize mast cells and prevent them from releasing their inflammatory mediators. And the drug is not absorbed from the gut in any appreciable quantity. So the logical conclusion is that it prevents reactions to culprit foods by blocking mast-cell reactions in the gut wall.

There is a third way in which the gut wall might be made more leaky. We all produce a special type of IgA antibody called secretory IgA or SIgA. The production of SIgA is stimulated by the Peyer’s patches, and it pours out into the gut, where it binds to its target antigen. By binding to antigens, and locking them into immune complexes, SIgA effectively makes them much bigger. The bigger they are the more difficult it is for them to pass through the gut wall. So SIgA reduces the number of food molecules that cross the gut wall – and the number of microbes, because SIgA is made to these as well. Like IgA in the blood, SIgA does not cause any inflammation.

There is some evidence that people with food intolerance have less SIgA than healthy people. However, there are patients who have severe deficiencies of SIgA, and, although they are ill in other ways, they show no more signs of food sensitivity than the population at large. This suggests that SIgA deficiency alone is not enough to cause food intolerance.

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