Medical Articles, Medicine Information.

Description and Possible Medical Problems

Everyone’s tongue feels coated at one time or another, especially after a few drinks, but a whitish, thick tongue is an indication of oral candidiasis, commonly known as oral thrush.

Oral thrush is caused by the same fungus that causes vaginal yeast infections in women. Candida albicans is a fungus that exists in your body in relatively small numbers. It can rapidly multiply to create oral thrush.

Treatment

Frequently, oral thrush strikes when your immune system has been disturbed in some way. This might be due to illness, to certain medications that can affect your immunity, such as antibiotics or corticosteroids, or to chemotherapy. If not treated, the infection can spread to the roof of your mouth as well as to the tonsils and esophagus. If you think you have oral thrush, see your doctor, who will recommend an antifungal prescription medication such as Mycelex tablets, which slowly dissolve in your mouth, or a nystatin mouth rinse, both of which should be used three to four times a day. Unlike a vaginal yeast infection, oral thrush is not caused by an underlying yeast infection, so home remedies such as drinking cranberry juice and eating yogurt are not effective.

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Balint (1957) was the pioneer of the study of interactions between doctors and patients, and his group training methods have been used widely. Originally, the groups were led by psychoanalysts who were not themselves general practitioners, and whose concern was not the teaching of general practice, but the running of a group where problems met by general practitioners could be studied. Within the Institute of Psychosexual Medicine, Main has extended Balint’s ideas by training doctors experienced in psychosexual medicine, who are not themselves psychoanalysts, to be the leaders of groups where the question of psychosomatic sexuality can be studied.

The method of training is based on case discussion of the member’s ongoing clinical work, and is aimed at developing skills rather than instilling knowledge (Main, 1983). Group members may be disappointed at the length of time it takes to acquire new attitudes and skills. It is important to stress that these groups are not for supervision, where members come for advice about what to do with their patients, but opportunities to think afresh about what is going on in the consultation. The responsibility for the management of the patient remains with the doctor at all times.

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There are the constraints provided by the doctor. The doctor may feel unable to give help because of an awareness of lack of aptitude or skill. Or doctors may find that personal feelings are interfering with the proper objective management of the problems, particularly if similar problems have been experienced personally or to someone emotionally close to them. For example, it may be too distressing to cope with a patient complaining of lack of libido after a miscarriage of a wanted baby if the doctor or the doctor’s wife has recently suffered the same misfortune. It may be impossible to deal with a patient giving a history of sexual abuse if the doctor finds that personal memories and distress are re-awakened. Sometimes social contacts may also make it necessary for doctors to distance themselves from the problem. It is not a good idea, for instance, to take on one’s colleagues for therapy, however much they may want to keep it ‘in the family’. Friends and acquaintances are not well served by agreement to help them informally – a referral to a colleague where a proper patient/therapist relationship can maintain professional standards is in everybody’s best interest.

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The relevance of tensions within a family to a particular sexual difficulty cannot be guessed by the doctor and may not have been appreciated by the patient until she or he can talk freely about whatever comes to mind. Then the listening doctor may be able to make the connection with the patient and they can continue to work together to resolve the problem.

Some people are only too delighted to be able to put the fear of pregnancy behind them and embark on a sexual life free from the nuisance of contraception. For others, as has been suggested, the ambivalence about making the change to the next phase of life can cause problems. At the present time there is often a gap between the onset of menopausal symptoms and the moment when natural infertility can be assured. It is to be hoped that it will not be long before there are hormonal preparations that will allow this gap to be filled more smoothly.

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Now is the time to be particularly aware of the possibility of marital stress, and to watch for any sign of one partner being manipulated by the other. Counselling in depth is not needed by all couples, but there is a much higher incidence of regret among those who are sterilized at a younger age, or at a time of emotional stress. These problems are considered in more detail in the sections that follow.

Perhaps as many as 10% of women regret the operation, and the concept of good care must include an attempt to identify those people at risk of regret before the operation is undertaken. When sterilization is being discussed it is wise to ask both partners to consider how they would feel if their marriage broke down, or if they lost a child, although the reply is almost invariably that they feel they could never replace that particular child. Such a reply may make the doctor feel rebuffed, but it may help the couple to look again at the irreversibility of the operation. Another approach is to enquire how each will feel when their partner is sterile, and to consider which partner might grieve least for their fertility.

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If contraception is required then again the biggest problem can be the doctor’s assumptions about what method is suitable for an individual. When advising on contraception, the skill lies in matching the method to the patient’s needs, preferences and lifestyle, within the limits set by certain medical considerations such as absolute contraindications. Where a disability exists, the type of doctor/patient relationship which may develop and the attitudes to the disability may encourage a more authoritarian style, and the doctor needs to recognize this so that the choice remains with the patient. The prescriber will be assessing the usual indications and contraindications for the methods, weighing up the advantages and disadvantages with the patient, but it is useful to ask oneself in addition, ‘What skill is required to use this method?’ Is it a question of having a good memory, manual dexterity or mobility? It is vital to establish good communication with the patient so that understanding is ensured, especially if there is blindness, deafness or mental handicap. To find a way through a complex set of problems the following maxim is useful: ‘How does the disability affect the contraception, and how does the contraception affect the disability? When both of these sides of the equation are satisfactorily answered, one has a possible choice of method.

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If your eyes are frequently drier than you’re used to, you should see your eye doctor. He may recommend that you use artificial tears to moisten your eyes. Artificial tears are a prescription medication that comes in either eyedrops or an ointment. You should use them as needed.

Tips and Precautions

Don’t make the mistake that some people with dry eyes make of relying on over-the-counter solutions such as Visine that primarily reduce redness and irritation in the eye. The chronic use of any over-the-counter preparation isn’t a good idea without your doctor’s approval, and products such as Visine work by shrinking the tiny blood vessels in the eye. Using these products beyond the manufacturer’s recommended length of time may not only cause you to develop a dependency on them but may permanently damage your eyesight. If your eyes are frequently dry and uncomfortable, see your eye doctor for a diagnosis; he’ll prescribe the right kind of medication.

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Description and Possible Medical Problems

In our society, suicide is most often talked about in context of a teenager or a middle-aged man who’s become despondent because he’s lost his job or his spouse. More common than people think, however, is the high rate of suicide among elderly people. Chronic illness, the loss of a spouse, and financial insecurities can all spark thoughts of suicide in an elderly person.

There are two classifications of suicide: active and passive. An active suicide is when a person attempts suicide by herself, sometimes through physical harm, such as hanging or electrocution. In the elderly, active suicide often involves either stopping medication or taking too much or abusing alcohol, often in combination with an overdose of medication. Passive suicide seems to be in the news every day, since this kind of suicide involves having someone else take responsibility for the act.

Signs of suicide include not only the actual attempt but complaints of severe pain, both physical and emotional. Frequently, a person who is considering suicide feels isolated and lonely and believes her family doesn’t care about her. Other signs may include making sure her affairs are in order by making out a will and paying all her bills. I had one patient who had her cat put to sleep right before she made a suicide attempt. In fact, once all of her arrangements are made and everything is cleared up, a person who is thinking about suicide may find that her loneliness will change to euphoria since she may feel that now she has a way out.

Treatment

Be aware of the signals that indicate that a person is thinking about suicide. If a close friend or family member complains of feeling hopeless, is depressed about the future, and starts talking about suicide, even in an offhand manner, she needs immediate medical attention. If she won’t seek it out for herself, you’ll have to do it for her.

Don’t wait. Get help now. Call 911 if the person is threatening to kill herself, or call one of the suicide hot lines in the community. Then, after the crisis has passed, work with the person to get psychiatric counseling on either a private or an individual basis; I’ve found that even joining a church or other social group can help a person become less depressed.

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The treatment for hallucinations depends on the underlying cause, whether it’s a physical illness or an emotional one. If the hallucinations are caused by an infection or a fever, these conditions will need to be brought under control with medication, either aspirin or antibiotics. If the hallucinations are the result of drug or alcohol withdrawal, a person may need to be hospitalized and/or sedated. For people with a long-term psychiatric illness or Alzheimer’s disease, ongoing treatment that includes therapy, medication, and support will be necessary.

The family of a person who is having hallucinations faces special problems; some don’t know whether to force the person into treatment or to agree with the hallucinations, like saying that you “see the rats, too.” I’d say that your criterion for deciding what to do should be based on keeping the person from hurting herself. The important thing to keep in mind is that not only does the person with the hallucinations need support, but you and the other caregivers need support in order to learn how to cope with the situation. Ask your relative’s doctor for advice.

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Description and Possible Medical Problems

If a patient tells me that he’s never had an anxious moment in his life, I tell him that either he’s not human or he’s lying.

We all know the physical signs of anxiety—sweaty palms, increased heartbeat, and a feeling of panic. Usually, the anxiety passes in time. For some people, however, anxiety can become overwhelming, even crippling. A person who is having a panic attack can develop heart palpitations and start to hyperventilate. His hands might become numb as a result of the hyperventilation. In rare cases, the hyperventiliation becomes so severe that he heads for the emergency room because he’s positive that he’s having a heart attack. Once I was on a plane over the Atlantic when a fellow passenger developed a panic attack so acute that he was absolutely convinced that the plane was going to crash before we landed.

Treatment

If you feel anxious and begin to hyperventilate, breathing into a paper bag will calm you and help you to breathe normally again. For some people, however, the anxiety can become so crippling that it can make it impossible for them to cope with even small problems. These people can benefit greatly from psychiatric intervention with regular therapy sessions and medications such as BuSpar, Xanax, and Valium. Relaxation and exercise can also have a soothing effect on people who are prone to anxiety attacks.

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