Medical Articles, Medicine Information.

Paul

Paul sat on the side of the hospital bed. He was being discharged after a night in hospital for observation because he felt as if he were having a heart attack. The specialist had told him he had not had a heart attack, but a panic attack. Paul had tried to tell the specialist that of course he had panicked. He had felt terrible and thought he was going to die. Surely, he thought, it was normal to panic under those circumstances.

Julie

The end of Julie’s shift was in sight. Another hour and she could go home, but first she had to hand over to the nurses on afternoon shift. She felt her stomach tighten and her anxiety increase. Julie had never had problems talking in front of other people before but the thought of hand-over today terrified her. She remembered the last few weeks and how it had become increasingly difficult for her to appear ‘normal’. Julie had had her first panic attack at work. Although she knew what was wrong with her, she was having enormous difficulty trying to ‘pull herself together’. She couldn’t control what was happening to her. She knew the other nurses wouldn’t understand if they found out. Julie felt she couldn’t go to any of the doctors at the hospital where she worked, as she was frightened they would make her resign.

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Carolyn

It had been a long and difficult week. Carolyn was glad she now had some time to herself. She curled up on the lounge with a book she had been wanting to read. As she relaxed she felt the tension ease from her body and she felt herself drifting into sleep. Without warning, she felt a wave of incredible energy surge through her body. As it moved through her, her heart rate doubled, she had difficulty breathing, she felt lightheaded and dizzy, a wave of nausea swept over her and she began to perspire. She jumped up and ran outside to her husband. ‘Help me, something is happening to me, I don’t know what but something is very wrong.’

Alex

Alex disliked staff meetings and social get togethers and did what he could to avoid them. He felt more comfortable just doing his job and avoiding any personal interaction with other staff. Now the new owners of the business had arranged a dinner for all staff and their partners and, like it or not, Alex had to go. He had been feeling uncomfortable all day and he knew his anxiety levels were very high. As he and his wife sat down at their table the people next to them began to make conversation. His heart began to race, his breathing became short and shallow, he began to perspire heavily and his hands trembled violently. As he tried to control it, he thought to himself, I shouldn’t have come. This always happens every time I am in this situation.

Jessica

Jessica turned on the ignition of her car. She was feeling very anxious. Is it going to happen today? As she pulled out of her driveway she tried to rationalise with herself for the hundredth time. She wasn’t frightened of driving, in fact she used to enjoy driving before she began to have spontaneous panic attacks. But there was one set of traffic lights where she would sometimes have an attack. There was no pattern to it. Sometimes it happened, sometimes it didn’t. Sometimes she would have an attack after she had driven through the traffic lights; on other days there were no attacks at all. Someone had told her she was frightened of that particular intersection, but she thought that was ridiculous. She was frightened of the attacks and their unpredictable nature, it had nothing to do with the intersection.

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The sympathetic nerves achieve their effects by releasing the hormone noradrenalin from the nerve-tips, which are located close to the organs that they influence. A very similar hormone, adrenaline, can also be generated by a pair of glands known as the adrenals that sit above the kidneys. The sympathetic nerves control the adrenals’ activity, so they are really part of the same system. The inner part of the gland, the adrenal medulla, produces adrenaline, while the outer part of the gland, known as the adrenal cortex, is responsible for producing corticosteroids (‘steroids derived from the cortex’). As the bloodstream carries these hormones around the body, the adrenaline produces the ‘flight or fight’ reaction already described, while the corticosteroids have a great variety of effects. They too are capable of mobilizing glucose, but they also suppress inflammation and inhibit some immune functions. Their main function in emergencies is to release glucose and thus perpetuate the ‘flight or fight’ reaction initiated by adrenaline and noradrenalin – they have a longer-lasting effect on the body.

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Impotence is defined as a permanent inability to maintain an erection. As a result, sexual activity—including masturbation—reaches a near standstill. Sometimes impotence results because a man’s sexuality changes with age: after the age of 50, his sexual activity can decline rapidly. One study shows that sexual activity in a man drops by 10% in his 50s, 20% in his 60s, 20% more when he’s in his 70s, and 50% or more in his 80s.

But health problems and illness can also cause impotence. Stress can be one factor; heart disease may be another, since an erection occurs when the tissues in the penis fill with blood. If there is a problem with getting the blood to these tissues, an erection cannot occur. And high blood pressure can also cause impotence, as can prostate disease. After a man has prostate surgery, he may be in doubt about his sexuality; however, the surgery can also permanently alter his physical ability to achieve an erection.

Medications, such as drugs to control blood pressure like beta-blockers, can also be responsible. Smoking and alcohol both dilate the blood vessels, which again means there’s less blood available to reach the penis. Depression is also a very common cause of impotence, and an underlying medical illness such as stroke or cancer can not only cause a man to lose all interest in sex but make him physically unable to have an erection.

Ask yourself the following questions:

1. Have I been depressed or ill lately?

2. Am I unable to have and maintain an erection at all? Or am I comparing it to the erections I had when I was 20 years old?

3. Have I become suddenly impotent, or has the condition developed more slowly?

4. Am I unable to achieve an erection all the time or only occasionally?

5. Are my legs cold or swollen?

6. Have my breasts or testicles become enlarged?

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If you have diarrhea and notice that it has become bloody, you should see your doctor right away, especially if you have a fever and feel weak along with a general malaise.

Bloody diarrhea can be a sign of a viral or bacterial infection that is becoming more severe. It can also occur if you have a long history of ulcer disease or as the first indication of a bleeding ulcer. In this case, you will probably have a stool that is black and tarry or resembles the consistency of putty. If blood appears on the surface of the stool, it is probably due to hemorrhoids.

If bloody diarrhea occurs in a person in his 40s or 50s, it’s possible that a condition known as diverticulitis, a sudden infection in the lower left-hand part of the intestine, may be the cause. Diverticulitis appears when the small pockets in the large intestine—called diverticula— become inflamed because small particles of food, especially seeds, get caught in them, resulting in inflammation and infection. Diverticulitis occurs most often among sedentary people who eat a high-fat, low-fiber diet. If you have diverticulitis, you may also have a fever. If you have a history of irritable bowel syndrome or colitis, you’re more likely to develop diverticulitis. People with irritable bowel syndrome become used to living with an unpredictable bowel, but if diverticulitis develops, you will find that the pain is worse than usual and occurs over the entire abdomen.

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If the shortness of breath does not disappear with rest or quickly recurs during any kind of physical activity, it is a medical emergency and professional care should be sought.

Your doctor will perform a number of tests, including a complete medical history and physical exam, a blood test, a chest X ray, an electrocardiogram, an echocardiogram, a stress test, and/or an angiogram.

Once you’ve been admitted to the hospital, your heart will be constantly monitored with electronic monitoring and blood tests to see if the heart has been damaged. The treatment will depend on what shows up on the various tests. The problem could be angina pectoris. If you do have angina pectoris, your medication might include beta-blockers, nitrates, and calcium channel blockers, depending on your age, your health, and the condition of your heart. Your doctor might also recommend that you carry sublingual nitroglycerine tablets to place under your tongue whenever you experience chest pain or shortness of breath.

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As the skin ages, it becomes thinner and naturally less resistant to bacteria, viruses, and allergens that can irritate it, either on the surface or below, in the epidermis.

A variety of infections and allergens can cause the skin to appear red and swollen. Most are easy to treat.

Sometimes an insect bite, a scratch, or inflammation of a hair follicle can become infected and cause the surrounding skin to become red and swollen. This frequently occurs when bacteria enter the skin through the wound and then cause an infection. Frequently, however, an infection occurs when the skin has come into contact with a substance that has caused an allergic reaction—anything from poison ivy to a new brand of makeup.

Because older skin is also more sensitive to trauma, sometimes it may seem as though your skin is constantly red and irritated. Fortunately, this doesn’t have to be the rule for you.

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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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