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TRIALS ON EVENING PRIMROSE OIL AND MS (MULTIPLE SCLEROSIS)

admin — Wed, 15 Sep 2010 12:45:43 +0000

During the 1970s many patients with MS began to take evening primrose oil, without the oil ever having been tested in a trial. Then in 1978 a trial took place in Newcastle, conducted by Professor David Bates and others.

The researchers divided 116 people with MS into four groups. One group was given evening primrose oil (Naudicelle), six capsules a day; one group was given olive oil in capsules; one group was given ‘Flora’ to eat as a spread; and one group was given another spread. No one knew what he or she was taking.

At the end of the two years, there was no significant difference between any of the groups, as measured by the Kurtzke disability scale.

Of all the groups, those who did best were the ones who took the sunflower seed oil spread ‘Flora’. The duration and severity of their attacks were less severe. In this group, the amount of linoleate in their blood went up from 28% before the trial started to 39% at the end of the trial.

Professor Bates came to the conclusion that the amount of polyunsaturates taken has to be enough to affect plasma levels. Only when this level has been achieved does the PUFA have an effect on the severity and duration of relapses.

At the time, the results of this trial were taken to prove that evening primrose oil does not work for MS. But this is not a correct or fair assessment at all, and in fact the results of this Newcastle trial were later re-analyzed by a Canadian doctor by the name of Robert Dworkin. Some years later after the Newcastle study, Dr Dworkin looked closely at its results, but he also pooled these results together with results from two other trials, one jointly in London and Belfast (Millar and others) and one in Ontario.

What Dr Dworkin found was extremely important: patients who had very low levels of disability at the start of the trial, who took polyunsaturates, did not get worse in a two-year period.

This was indeed a crucial discovery – the length of time that a patient had had MS made a difference to the outcome of the trials. The newly-diagnosed, who were 0-2 on the Kurtzke disability scale at the start of the trials, were the ones who showed little change or deterioration by the end of the trial. This applied only to the group which had been treated with PUFAs.

The conclusion from this is that treatment with PUFAs helps to stabilize MS in the recently diagnosed who have no real disability.

So in fact the Newcastle study – far from showing the ineffectiveness of evening primrose oil and other polyunsaturates for MS – does the opposite. But it does show that someone with MS does need to take a certain amount of linoleate for it to be effective.

The trial results do show that six capsules of evening primrose oil on their own, without any additional intake of linoleic acid, is not enough to affect plasma levels of linoleate. The answer, surely, is to take eight to 12 capsules of evening primrose oil a day, plus use sunflower seed oil spread and a cooking oil high in linoleic acid.

Some people have also criticized this particular trial on other scores. Firstly, there was no advice given about cutting down on saturated fats in the diet. (Saturated fats are thought to compete with polyunsaturated fats.) Secondly, the Naudicelle capsules used at that time had orange and black coloured shells which used the dye tartrazine. It is known that tartrazine interferes with fatty acid metabolism. Since then, evening primrose oil capsules have been produced in clear gelatin shells, with none of the same problems.

It is a pity that no one has conducted another trial with evening primrose oil taking all these factors into consideration. Since there has been no scientific evidence in favour of evening primrose oil as a therapy for MS, it is not prescribable on the NHS and has to be bought from chemists or health food shops, or by mail order from the manufacturers. Many people with MS find evening primrose oil too expensive to buy so don’t take it at all.

*29/60/5*

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CHLAMYDIA

admin — Wed, 15 Sep 2010 12:41:14 +0000

Chlamydia is probably the most frequent cause of sexually transmitted disease in Australia today. Amongst men this very small bacteria produces Non Specific Urethritis (NSU). In women chlamydia causes Pelvic Inflammatory Disease (PID), infertility and ectopic pregnancies. Chlamydia can also cause infections in the eye and other organs.

Approximately 300,000 Australian women are at risk of infertility as a result of silent chlamydia infection. Most are not even aware they have the disease. When infection affects men they get some burning with the passage of urine and a slight penile discharge. Women receive no such warning and unless contacted by a treated partner, they receive no notice of the unpleasant complications to come.

Chlamydiae are sensitive to antibiotics such as the Tetracyclines, Bactrim and Erythromycin. Because these small bacteria live and reproduce inside the human host cells, long courses of antibiotics are necessary. Two weeks is the minimum period for treatment. Sometimes chlamydia finds a home in deeper tissues of the body and like herpes become difficult to eradicate. Recurrence appears in up to 15 percent of the treated population.

Home Remedies

Chlamydia means that condoms are the rule until there is some certainty that a sexual relationship is one on one. Chlamydia infection is silent in women, those with a history of frequent sexual activity with multiple partners should have a test for chlamydia when ever they present for a pap smear. A swab of the cervix and an anti cancer smear are easily done at the same time. Chlamydia is also detectable through the use of a blood test.

*28/131/5*

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HEALTH CARE OF OLDER PEOPLE: WHEN TO CHOOSE A GERIATRIC SPECIALIST

admin — Tue, 01 Jun 2010 13:43:23 +0000

As long as you select someone who seems aware of your needs, your physician need not have formal training in geriatrics. If you have several disabling conditions or are in your eighties or beyond and need to change doctors, however, it makes sense to search out a geriatric specialist. If a doctor has been recommended as specializing in geriatrics, find out exactly what training he or she has had. Ask about plans to take the newly developed licensing examination in the field.

If you live in an urban area, explore the possibility of getting care from a hospital-based geriatric service. Geriatric services offer state-of-the-art team care for disabled older people-workers from a variety of disciplines collaborate to keep people functioning independently. If this type of service is available, the care is likely to be excellent. You will be surprised at the attention and the sensitivity to your needs. People committed to geriatrics are a special breed; they combine technical skill with heart. When necessary, they are even happy to make house calls.

Another alternative you may have is a freestanding geriatric center. To understand what services this type of institution can provide, let’s examine the offerings of one – the Metropolitan Jewish Geriatric Center in Brooklyn, New York.

The Metropolitan Jewish Geriatric Center provides what it calls an “umbrella approach” to geriatric care, addressing the full spectrum of needs of older people who are having some trouble functioning independently. It offers inpatient services and a variety of outpatient programs. There is long-term home health care for people who are housebound: all the nursing, rehabilitation, and medical services of a nursing home are offered in a patient’s own home. There is the day hospital, a center open from nine to five offering activities, meals, nursing, and rehabilitation. There is the hospice program for people who are terminally ill. (Hospices minister to dying patients and their families, offering counseling and treatment directed toward pain control and comfort rather than cure. To enter this program, now covered by Medicare, a person must be judged as having no more than six months to live and must be willing to abandon curative treatments.) There also is an Emergency Alarm Response System (EARS). For a small monthly charge a subscriber’s telephone is hooked up to a central switchboard. Someone calls daily to check in. If there is no answer, a neighbor comes by to check. The older person living alone has the comfort of knowing help will arrive in a medical emergency.

There also is Elderplan, an HMO specifically for people over sixty-five. By paying a fixed sum, enrollees are entitled to all the outpatient services the center offers plus traditional medical and hospital care and care in a nursing home.

Except for Elderplan, all the programs offered at this geriatric center are now available in many communities. They are components of what is called a continuum of care. They exist to prevent nursing-home placement, to keep people with disabilities functioning in the community.

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GENERAL HEALTH

HEALTH CARE FOR OLDER PEOPLE: THE HMO ALTERNATIVE

admin — Tue, 01 Jun 2010 13:42:32 +0000

Increasingly, rather than selecting a private doctor, you may have another choice – joining a health maintenance organization or HMO. Rather than paying a physician for each appointment, if you join an HMO you pay a fixed sum in advance that entitles you to almost all (or all) of your medical care: checkups and routine care, laboratory tests, the services of specialists, hospitalization costs. There are two major types of HMOs – group practice and individual practice.

Group-practice HMOs provide all their outpatient services at a centrally located health facility, usually staffed by primary-care doctors, specialists (e.g., in eye care, hearing, surgery, gynecology), and additional personnel such as technicians and nurses. The clinic offers laboratories, X-ray services, a pharmacy, and perhaps ambulatory surgical care. On enrolling, a subscriber selects one of the primary-care doctors as a personal physician who is responsible for coordinating care. On routine visits patients may see a specially trained nurse practitioner.

Individual-practice HMOs provide primary care in the private offices of doctors under contract to the HMO. Joining this type of HMO may make getting to the doctor easier if you choose someone with an office near your home, but you may not receive the wide range of services you would get by joining a group-practice HMO.

A major advantage of joining an HMO is more financial peace of mind. Your medical bill is already paid. There are no large out-of-pocket expenses you might abruptly incur. There also is no economic deterrent to calling the doctor if you are ill, since visiting four times a month costs no more than once a month. And because HMOs have to operate within a fixed budget, they have an incentive to deliver services in an economical fashion. Studies show that, on average, people who use HMOs spend less for health care.

Does this emphasis on efficiency lead to poorer service? Although doctors opposed to HMOs reason that a system where people are paid beforehand no matter what they do offers a built-in incentive to provide minimal, cursory care, the reverse seems to be true. When researchers at Johns Hopkins Medical School reviewed the literature comparing HMO care with traditional fee-for-service care, nineteen studies showed that HMOs provided better care, a handful found the two types of care comparable, and only one or two found HMO care inferior.

On the other hand, the serious drawback to joining an HMO is the lack of freedom. HMO subscribers must use a certain hospital; when they need a specialist, they must visit someone under contract to the HMO. Many people decide against joining because they are not prepared to give up the right to go to the doctor or hospital of their choice.

Furthermore, only a fraction of HMOs accept Medicare. (Some HMOs not under contract to Medicare provide what is called Medicare “wraparound,” offering coverage for current subscribers, who then become eligible for Medicare.) Probably in part because of this, only a small minority of the elderly are enrolled in HMOs.

If you are interested in an HMO and able to enroll, use the same considerations in evaluating it as you would in selecting a private physician: cost (Does the HMO accept Medicare? How expensive is joining? What services are covered?); accessibility (How easy is it to get there? Will a doctor see you promptly if you are ill?); quality (Is the clinic overcrowded and unattractive? Are the doctors on the staff well qualified? What is the affiliated hospital like?).

James Doherty of the Group Health Association of America, a national organization of HMOs, also suggests finding out if the HMO is “federally qualified.” Federally qualified HMOs are approved by the Health Care Financing Administration. Your state insurance department will also have information about the quality of a prospective HMO.

*142/159/5*

GENERAL HEALTH

NORMAL SLEEP PATTERNS: INFANCY

admin — Thu, 21 May 2009 06:58:45 +0000

The sleeping pattern begins to change in the first 6 months. This is a time of considerable irregularity, as babies’ neurological systems mature at different rates, but in early infancy sleeping patterns tend to coincide with feeding times — that is, babies wake to feed.

By 6 weeks of age, babies are awake for longer periods during the day, as they begin to take an increasing interest in their environment and interact with their care-givers. By 6 months their sleep is less linked to feeding patterns. Rather than sleeping for most of the time, they are awake for longer periods and seem to have several naps during the day. Some infants, to the great delight of their parents, are already sleeping through the night.

Between 6 months and 1 year of age, sleep patterns change considerably. The typical baby will sleep 10-12 hours at night and have two naps during the day. A greater number of babies sleep right through the night. Some may wake several times but will often go back to sleep with a minimum of fuss. This is also the time when they begin to establish more regular and predictable patterns of sleep and feeding and playing. There is still variation, depending on temperament and other factors. This is also the time when patterns are easily disrupted by illness. Many sleep problems have their genesis during this period, with parents unwittingly interfering with their babies’ sleep cycles, for example waking him for a feed. It is important that your baby be allowed to develop his own sleep patterns with minimal parental interference.

*151\90\8*

FRACTURES – SCAPHOID; COLLES’ FRACTURE

admin — Mon, 18 May 2009 06:26:56 +0000

Is easily broken. This is a common injury following a fall, for instance from a horse. It is recognised by a swelling and a deformity over the collarbone. Often a grating may be felt or a grating sound may be heard when the arm is moved.

Falls on the extended hands of young adults often fracture a bone in the wrist, known as the scaphoid. This will produce tenderness and pain near the base of the thumb. Although the wrist may still be used, this fracture is often missed and is regarded as “just a sprained wrist.”

It is a serious condition and requires at least 12 weeks in plaster. If neglected and not immobilised for at least two or three weeks, the bones may not heal quickly and could require five or six months in plaster, or even an operation at the end of that time.

Elderly people, particularly women, when they fall on the wrist, may break the lower part of the radius, the main forearm bone. This is obvious by the formation of a particular type of swelling at the lower part of the forearm, just before the wrist. It looks like and is in fact called the “dinner-fork deformity.” As the two broken ends may be driven one into the other (impacted), there is often still considerable mobility left in the wrist, and it doesn’t just hang limp. Put the arm in a sling and seek medical aid.

*631/71/1*

GALLSTONES – CONCLUSION

admin — Fri, 15 May 2009 09:06:14 +0000

The drugs need to be taken for as long as a year and the stones may re-form when they are stopped.

The main use, then, of CDC, is in those with cholesterol stones for whom surgery is a considerable risk or who have stones in inaccessible areas such as deep inside the liver.

While the concept of dissolving gallstones is an intriguing idea and seems more attractive to sufferers than operation, it is a possibility for only a few and operation remains the most effective treatment.

Most sufferers lose all their symptoms following removal of the gall bladder and can function satisfactorily. The bile is produced at a constant rate and drips down into the duodenum rather than being concentrated and entering in spurts.

Unfortunately, a few people will not lose their intolerance to fatty food and we are not sure why.

My advice is that, if your gallstones are causing trouble, you will be better if you and your gallbladder are parted.

*375/71/1*

FIBROADENOMA OF BREASTS – INTRODUCTION

admin — Fri, 15 May 2009 07:07:02 +0000

Not all lumps in the breast are due to cancer.

A frequent finding, particularly in young women, is that the lump is due to a fibroadenoma.

These are benign, that is, non-cancerous tumors which consist of both fibrous and glandular tissue. They are smooth, hard and freely moveable in the surrounding breast tissue and rarely become larger than a pea.

The doctor may be confident of the diagnosis, yet breast cancer is so common, so feared, and its treatment has such poor results if the diagnosis is made late, that most surgeons agree all breast lumps should be examined.

Small cysts may form in the breast and these can both be diagnosed and treated by inserting a needle into the cyst and withdrawing fluid for examination.

Even before removing what appears to be a benign lump, the surgeon will talk to his patient to find out her wishes should he discover that the tumor is malignant.

The normal procedure is to operate, remove the lump and subject it to frozen section.

*124/71/1*

BABY AND CHILDHOOD DIGESTIVE SYSTEM DISORDERS: HOW THE DIGESTIVE SYSTEM WORKS

admin — Fri, 08 May 2009 08:31:50 +0000

Have you ever wondered how your tummy system works? When you poke something into your mouth it vanishes. We all know that. But vanish where, and what happens to it?

As you probably know, the bowel, or intestinal, system really begins at the mouth. From the mouth is a continuous canal to the far end, to an opening we call the anus. It is actually a single tube which we arbitrarily divide into segments and call by different names.

The oral cavity is guarded by gums and teeth in front, and the tongue sits in the lower part. A baby is born with gums but no teeth in sight. That’s fortunate for the breast-feeding mum. Have you ever thought how terrible it would be breast-feeding a baby with the full component of twenty sharp milk teeth? Ouch! No, several months pass before the baby is endowed with a first set of teeth.

The oral cavity leads directly into the pharynx, passing the two red tonsils on each side, and the pharynx gives way to the oesophagus, or food pipe. This leads to the stomach via a small valve.

Digestion starts when food mixes with saliva in the mouth. But in the stomach it receives a major boost—the wall is lined with many glands which pump potent acid and some other digestive chemicals, called enzymes, into the mass of food. It tends to become a mixed-up mass, largely fluid in nature.

The stomach is merely a dilated part of the bowel. It houses the food until the valve at the far end allows it to pass into the next part, called the duodenum.

At regular intervals, the stomach valve (called the pyloric valve) opens and the fluid starts its long trek down the bowel. Firstly it traverses the duodenum, which then leads into the small bowel (firstly named the jejunum, and later the ileum) Here various extra enzymes are added, and much of the nutritional elements of the food is absorbed by the bowel wall for use in the body.

At the far end of the small bowel (named ‘small’ not because of its length, for it is very long, but because it is narrow in diameter), it dilates into an area called the caecum. This is where the small bowel connects to the large bowel (‘large’ because it is very wide in diameter, although it is quite short in length, in contrast).

Here the appendix occurs as a small worm-like organ (about the thickness of a pencil). It has an opening where it joins the caecum. It is several centimetres long and has a blind, closed far end; if its opening, or mouth, becomes blocked then trouble looms, for germs can easily establish a foothold and set up an acute infection which we refer to as acute appendicitis.

In the large bowel, fluid (mostly water) is reabsorbed by the walls, making the contents much firmer. From the large bowel, the canal continues as the rectum. There, in the rectum, the residue of the bowel contents is stored until a suitable time when it can be passed. When this occurs, it gently passes down a much narrower tube, called the anal canal.

At the end of this is a valve, called the anal sphincter. When this releases, the final, unwanted debris is expelled from the digestive system via an aperture called the anus. Afterwards, the valve re-closes, and stays closed until another bowel movement is made.

*48\87\2*

THE SECOND MONTH

admin — Fri, 08 May 2009 08:25:31 +0000

Activity

Baby’s actions start to become a little more smooth. If sitting up, the head still tends to flop but there is greater firmness of the neck muscles; the head can be kept erect for longer periods. The baby instinctively realizes the necessity of keeping the head clear and free from being buried in pillows or objects if lying on the floor. So, at all times there is an increasing effort to hold the head up, at about 45 degree angle. The baby often tires after a few minutes, but this skill gradually improves. Even when lying on the back, the baby often tries to hold the head slightly upwards.

Limb movements (arms and legs) may be less jerky, and much smoother.

Noises may startle the baby, and he or she may twitch involuntarily in the hands and feet if disturbed or if there is a sudden noise.

Objects, such as a toy or your finger, placed in the baby’s hands may still be grasped reflexively; but a tentative effort may be made to knowingly grasp at things. Often the baby will hold objects for short periods before dropping them.

He or she may strike out at near objects, such as mother’s face, if coming within close range.

Talk

The 2-month-old baby still does a lot of crying. This is a good thing, for it helps aerate and expand the developing lungs. The throaty noises of the first month are continued, but the baby will also start cooing in a soft manner. The noises are baby talk, and nothing like a grown child or adult, at this stage.

Mind

Mental development starts to become apparent. Much of the waking time is spent staring at the walls or objects within range. Eye movements wander around in a circular fashion. If there is some object, such as a bright toy, or a light, this will be followed; the baby becomes capable of following an object from one side to the middle line and gradually towards the opposite side, but it then tends to be lost. Things fairly close can be focused on, and the attention kept for increasing lengths of time.

Sudden noises or distractions will cause an obvious body reaction. The baby’s face may show a reaction, such as recognition or possible fear.

Lights, bright colours and moving objects gain the baby’s attention, which may be maintained for a short time. Attention may be fixed on one or two single objects, rather than several consecutively.

The baby tends to grasp for an object that has his or her attention or may strike at it. At this age the baby is able to grasp and retain an object, such as a light toy, for a while but then often drops it. This action tends to be made under control, rather than the automatic reflex it previously was.

The baby becomes stimulated at seeing familiar objects, such as a toy, and happy and often excited at seeing faces he or she recognises such as mother, father, brothers and sisters—and may stare at them intently, often bursting into a smile (as every joyous mother knows) when recognition dawns on baby’s face. Individuals start to be associated with certain favourable actions; for instance, mother and food become synonymous. The baby begins to show a preference for people over inaminate objects. Will often stare at a face intently, giving an impression of profound wisdom. This may end in a happy smile of recognition.

The baby may commence to show a preference for the right or left side, tending to grasp with the right hand, for instance; may sleep on the same side.

Shadows passing over the face, such as waving his own hand in front of him, will make him blink.

Objects as well as moving humans are regarded with a quizzical, intent gaze.

Actions are often repeated over and over, apparently for the sake of movement rather than for any productive end point. Tends to do one thing at a time.

The baby starts to distinguish between different persons, voices, objects.

Relationships

Personality is starting to develop, and the baby starts showing happiness, unhappiness or distress. If upset, he may suck his fingers, thumb or hand to calm himself down. Often he will use this method for slipping off to sleep.

Tends to give a smile of recognition at members of the family. Will react similarly with others. May show signs of stimulation and happiness when seeing people he or she knows. Will intently look at the person. Or will physically react by actively moving the limbs, breathing in and out rapidly with anticipation and excitement, or gurgling and making baby talk. If crying, may stop when seeing a familiar face, or if held or nursed.

However, the baby usually likes being handled and enjoys eating. These are more important than the social aspect of being with others.

If there are others present, the baby will often stay awake for longer periods of time. If encouraged, will ‘perform’, often for hours, and this usually means difficulty settling down to sleep. Pre-sleep-time excitement is often a major problem after these unwise incidents.

Night feeds tend to lessen, to one only.

Bowel actions are often associated with feedings, and the bowel reflex commences. Often there are two actions a day.

The sleep programme tends to change. The baby may sleep for up to seven hours at night and may remain awake for nine to ten hours a day. There may be several sleep periods during the day.

Baby enjoys the warmth of a bath each day, and finds this a very happy occasion as shown by physical movement.

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