Syncope or Sudden Fainting
Thursday, October 30, 2008
Syncope is a common disorder of temporary loss of consciousness and posture, described as ‘fainting’ or ‘passing out.’ It’s usually related to temporary insufficient blood flow to the brain and annually affects six per cent of elderly persons and accounts for 3 per cent of emergency department visits. Syncope is an important heart problem, is disabling, costly, may cause grievous injury or may be the only initial sign before the sudden cardiac death. Evaluating cause of syncope is difficult as brain, heart or some metabolic abnormality could be responsible for the same. The probable cause of syncope is established in only 75 per cent of cases. The annual cost of evaluating and treating patients with syncope in United States alone is a staggering 800 million dollars.
The common faint or Vasovagal Syncope
Most of us remember that in our morning school assembly, a student would fall on prolonged standing. On lying flat on the ground he would recover promptly and such episodes were more common during sunny days. This was actually vasovagal syncope or the common faint. This is more common during emotional stress, pain, after a hot shower or in warm environment. It is seen mostly in young women and is more often than not associated with warning symptoms such as nausea, blurred vision or light-headedness. But there are many more forms of syncope, with many causes, apart from the vasovagal syncope.
Tilt table testing and other tools
The gold standard test for the diagnosis of the common faint is tilt table test. This is a simple non-invasive method for recognition of this condition. Keeping the patient in upright position for 30 to 45 minutes at an angle of about 70 degrees performs this test. The test is done on a special mechanized examination table with safety belts and footrest. Sometimes an additional drug is given to enhance the positivity of the test. The positivity of the test is defined as development of syncope or slow heart rate with drop in blood pressure. The syncope observed is usually reversible on making the table horizontal or after giving additional drugs to the patient. The test is generally performed in a susceptible population where recurrent disabling syncope episodes or a single episode has occurred. But in presence of organic heart disease the test is contraindicated.
Other investigating tools for the diagnosis of syncope include careful history taking, holter monitoring, echocardiography, stress testing, signal averaged ECG, event recorder and electro physiology testing. A proper neurological examination completes the appropriate workup for this condition.
The Treatment
The treatment depends on the cause discovered and may include appropriate patient education, increase in salt intake, discontinuation of an offending drug, starting a new drug, pacemaker or AICD implantation and catheter ablation. The latter modalities are performed in specialized centers and are expensive. Cardiac syncope has a poorer prognosis than other forms of syncope. The one year end pint mortality rate has been shown to be as high as 18-33 per cent. Non-cardiac including vasovagal syncope seems to have no effect on overall mortality rates. Patients with syncope should be instructed not to drive until curative treatment has been done.
posted by Healthy Life @ 11:16 PM,
Anxiety and Pregnancy
Thursday, October 23, 2008
Women and babies have been interrelated since the very beginning. It is a natural phenomenon and there is nothing unusual about it. All young women want to bear a child or in other words become a mother. These days even for a career woman the desire to give birth to a child and become a mother is bound to catch up and no other joy can ever replace the joy of becoming a mother in the hustle bustle of everyday life. There are several expectant mothers who suffer from severe stress and emotional turmoil and now the question arises that can pregnancy and the anxiety related to becoming a mother can bring her joy and contentment, equally?
The answer to this question varies from woman to woman. A part of the past life of the expecting mother is always to be brought to light especially when she is going to give birth to a new life.
What things might make it more stressful?
During pregnancy, a woman spends most of her time thinking and being drowned in her thoughts most of the times. The common thoughts during this time are will her new born be normal? will she fail as a mother? Will her baby have to go through the same problems as she had to go in her adolescence? etc etc.This is quite expected as this is a preparatory stage for the mother to love the baby who is growing inside her womb and also her body is preparing to adapt to the changes to meet the demand of the new life which is growing inside of her.
It is seen in most cases that the anxiety during pregnancy triggers stress in the woman. The other factors that might lead to rigorous stress during pregnancy are:
·A current miscarriage: This shakes the woman’s confidence and the woman tends to wonder whether she will ever experience the joy of becoming a mother and see her baby cry for the first time.
·A uncertain income during the pregnancy
·An inconsistent relationship with the baby’s father
·No emotional and moral support
·Unexpected and unwanted pregnancy that might mess up other plans of life.
It is very essential to be mentally stable during pregnancy and settle all the worries and doubts with her close friends, family members and doctors. It is not impossible to deal with anxiety and pregnancy. Like other crisis of life, pregnancy and anxiety can be very easily dealt with. The pregnant woman is the right person to determine what is best for her baby. No matter what all expecting mothers want to emerge as the best mother and would always want to do the best for the welfare of her child.
However, note that anxiety and pregnancy do not bear good results for the child. Several studies reveal the fact that if the mother is stressful and over anxious during her pregnancy then her baby is bound to develop stressful behavior later in life. Between the 12th and 23rd weeks the baby in the mother’s womb is mostly likely to be affected by its mother’s stress and anxiety.
What good can come out of it?
Other than harboring some negative thoughts the expecting mother makes preparations to deal with anxiety and pregnancy. Several bodily changes take place during pregnancy.
One of the major concerns during this time is that whether their anxiety disorders will affect the unborn and worsen the pregnancy conditions and also after the baby is born whether they will be able to take care of the baby properly or not. Obviously, a great concern is whether or not the symptoms of their anxiety disorder will worsen during the pregnancy, and if they will be able to care for the baby after it is born. Whether intake of different medicines will affect the baby or not is also a cause of concern. All these thoughts however can elevate the levels of stress in the expecting mother.
The following facts can offer some hope for anxiety and pregnancy:
·During the pregnancy period and breast feeding period the medicines for anxiety disorders are quite safe for the baby.
· About 40% of women experience a precise decrease of the anxiety pattern during pregnancy. However during postpartum the set of anxiety symptoms may return.
·The intake of medicines for anxiety disorders by the expecting mother can actually help in preventing the development of anxiety disorders in the baby later in life. If the mother’s symptoms are not treated properly then however it may result in lower birth weight of the baby.
What can be done during pregnancy to deal with anxiety?
About 10% of women develop anxiety symptoms during pregnancy. Following the steps below will definitely help them to deal with the situation in a better way.
·Seek advice from your doctor about your plans to either become pregnant, or that you already are. The doctor’s instructions and medications will help you to deal with your anxiety and pregnancy strategically.
·Bond with your partner in a more strong and intimate way. This would ensure support and love which would help in dealing with the situations in a better way.
·Relax. Pursue hobbies according to your liking. Talk to your friends, go for walks, practice gardening. All these activities will divert you mind and keep your stress under control.
·Open up to your husband or partner and close friends and discuss your causes of stress. This will definitely help.
posted by Healthy Life @ 11:16 PM,
Chronic Pain Syndrome And Chronic Pain Management And Treatment - Part II
Thursday, October 16, 2008
This is not only true for chronic soft tissue type pain but also is reported in conditions such as rheumatoid arthritis (20). Examples of chronic nociceptive pain include pain from cancer or arthritis. This phenomenon, allodynia, is common in chronic degenerative arthritis, low back pain, and severe irritable bowel syndrome and interstitial cystitis. Common types of chronic pain include back pain, headaches, arthritis, cancer pain, and neuropathic pain, which ... This workshop is somewhat focused on arthritis, but is general enough that anyone experiencing chronic pain will gain new skills to deal with their pain. Although sometimes there's no explanation for chronic pain, it is often associated with a well-known, even common condition, such as arthritis, fibromyalgia or migraine. This can include severe arthritis pain, severe lower back pain, severe neuropathic pain, chronic migraine, etc. Cats can experience chronic pain due to a number of conditions including arthritis, joint malfunction and back pain. neck aches, knee arthritis, knee arthritis, knee arthritis, knee arthritis, arthritis, arthritis, numbness, headaches, joint pain, severe headache, chronic arthritis, body achesLymphangioleiomyomatosis ...
Therapy
It is for this reason that physical therapy programs for chronic pain often provide training in home reconditioning exercises. Antidepressant therapy may be effective in relieving sleep complaints associated with chronic pain. Individuals treated at the Chronic Pain Centre work closely with an interdisciplinary team including psychology, physical therapy, occupational therapy, nursing and pharmacy. Intraspinal opioid therapy for chronic nonmalignant pain: Current practice and clinical guidelines. 2 Sufferers of chronic pain and chronic illnesses may benefit from counselling or therapy as part of their coping strategy. Opioid therapy for chronic nonmalignant pain. Patient chart for review of efficacy of therapy for chronic pain. Patient chart for initiation of therapy for chronic pain. Another fairly new type of therapy for chronic pain is magnetic stimulation. According to Dr.
Treatment
Comprehensive multidisciplinary treatment of chronic pain: a follow-up study of treated and non-treated groups. However, seldom do chronic pain patients with insomnia receive a behavioral treatment for insomnia. Money matters: A meta-analytic review of the association between financial compensation and the experience and treatment of chronic pain. Models of chronic pain management through denial are based on the proposition that chronic pain occurs as a consequence of compensation and inappropriate treatment. The treatment of psychological distress in patients with chronic neck pain after whiplash. Many people suffer with chronic pain, unaware that there are a variety of treatment options that can help them live more normal lives. If you have chronic pain, you should seek out information about these various treatment options. The treatment of chronic pediatric pain would benefit from the development and support of cooperative pediatric chronic pain research consortia. The good news is that safe and effective medical treatment for chronic pain is currently available. A major barrier to be overcome, however, is that chronic pain is often not viewed as a physical illness worthy of treatment. This is the first of a two-part article on chronic pain and its treatment. Ideally the treatment of chronic pain would be to prescribe effective pain medications. When pain persists in spite of medical treatment, as is the case in chronic pain syndromes, the issues become even more complex. The acupoints illustrated throughout this article are without question some of my favorite for the successful treatment of chronic pain. And problems such as constipation, nausea and anxiety that may accompany chronic pain or its treatment can be effectively treated.
Management
One of the problems with chronic pain management is that the brain habituates to pain-killing drugs, requiring higher and higher doses. The interdisciplinary team at the Chronic Pain Centre is made up of health care professionals who have expertise in the management of chronic pain. For all these reasons, it is extremely important that all Anesthesiologists recognize the frequency, consequences and management challenges of chronic pain in this population. The management of chronic pain in older persons. For example, assessment and management of chronic pain in children should be a mandatory part of pediatric residency. Both feature a wide range of links, tips and pain management strategies that will be of benefit to sufferers of Chronic Pain. There are a number of management strategies for chronic pain such as acupuncture, massage therapy and pain-killing medications. The management of chronic pain in older adults. The relative merit of systemic versus neuraxial opioid administration for chronic pain management was not addressed in the these guidelines. The Guidelines recognize that the management of chronic pain occurs within the broader context of health care, including psychosocial function and quality of life. Analyses of aggregate outcomes are essential to continuous quality improvement of chronic pain management in the clinical setting. In addition, research involving people with chronic pain has helped develop effective management approaches. Algorithm for the management of chronic pain. Management of chronic pain in children.
Care
A recent survey of primary care physicians (8) noted that only 15% enjoyed treating patients with chronic pain. The prevalence of borderline personality among primary care patients with chronic pain. care of yourself, chronic pain is different. Knowing what the causes are and being able to describe your symptoms to your health care team can help you manage chronic pain. To equip the qualified clinical practitioner with the necessary knowledge and skills to implement and run a primary care chronic pain control clinic. Tell the patient that chronic pain is a complicated problem and for successful rehabilitation, a team of health care providers is needed. Personal care plan for chronic pain. To raise awareness among the health care community, policy makers, and the public at large about issues of living with chronic pain. Family care Chronic pain, like chemical dependency, affects the entire family. Involvement in the program's family groups increases understanding of chronic pain and addiction. Expert physician care is generally necessary to treat any pain that has become chronic.
Treat
Now, there's a way to treat chronic pain without pills but with the simple push of a button. Reimbursement policies should reflect the multidisciplinary complexity and efforts required to assess and treat children with chronic pain. Try not to rely on sedative or hypnotic medications to treat the fear many chronic patients show of activity or fear of increased pain. Interventional techniques refer to procedures that are performed in an attempt to diagnose and treat chronic pain.
Research
Research has shown that the chance of people with chronic pain becoming addicted to pain-relieving drugs is extremely small. ...my research with patients with chronic pain and other chronic illnesses in...enormous success. Targeted government and private funding for research in pediatric chronic pain should be augmented. Current research should soon yield ways of formulating and delivering NMDA receptor-blockers that will ease most chronic pain syndromes without causing such adverse effects. The research evidence is strongest for these patients regarding the risk factors for chronic pain. But for chronic pain, research has shown that they tend to make pain worse, causing the patient to need larger and larger doses. Of the little research done on chronic pain, researchers had previously focused on damaged nerve fibers as pain conduits.
System
With chronic pain, the pain signals keep firing up the nervous system for months, even years, either continually or as flare-ups. Recent animal studies have shown that remodeling within the central nervous system causes the physical pathogenesis of chronic pain. In chronic pain the nervous system may be sending a pain signal even though there is no ongoing tissue damage. Much of the identifiable findings in chronic pain patients will be referable to the peripheral nervous system.
posted by Healthy Life @ 11:16 PM,
Chronic Pain Syndrome And Chronic Pain Management And Treatment - Part I
Thursday, October 9, 2008
Suffer From Chronic Pain
Each year tens of millions of Americans suffer from persistent pain known as chronic pain. Individuals with chronic pain are less able to function in daily life than those who do not suffer from chronic pain.
Chronic pain patients suffer from poor sleep quality and depressed mood rather than pain intensity, duration, or anxiety. Clinical Implications Chronic pain patients suffer from poorer quality of sleep than do healthy control subjects. Many people suffer chronic pain in the absence of any past injury or evidence of illness. Although more than one in five Americans live with chronic pain, women are more likely to suffer from chronic pain conditions than men. If you or a family member suffer from chronic pain, you know that the search for relief is an ongoing process. But some people suffer chronic pain in absence of any past injury or evidence of body damage. At least 25 percent of Americans suffer from back pain. One fourth of these individuals, back pain is chronic and unremitting.
Experience
If you're grappling with chronic pain, one of the earliest and most wrenching emotions you experience is a deep sense of loss. In fact, a number of people with SCI experience chronic pain in areas that otherwise have no sensation. Lascelles' experience, owners are usually more concerned about pain from surgery than pain associated with chronic conditions. The path to chronicity of pain is characterised by failed attempts to adjust and cope with an uncontrollable, frightening, and adverse experience.
Problem Of Chronic Pain
RSD or RSDS is a neurological problem and one of the symptoms is constant chronic burning pain. It is now appreciated that the phenomenon of wind-up is crucial to understanding the problem of chronic pain. Chronic pain in children is an important problem and more action is urgently required to overcome the embarrassing lack of data on childhood pain. Some believe that many factors work together to produce chronic pain, rather than a single disease or medical problem. The longer pain goes on the more susceptible it is to other influences and developing into a problem.
Source From Injury
Some people develop chronic pain out of the blue, with no injury or illness to trigger pain signals. Once chronic pain that has been caused by an injury or surgery is managed, patient recovery may be faster. an injury, and chronic pain with no identifiable pain generator (e.g. The injury transformed her into one of millions of Americans tormented by chronic pain. In stark contrast to acute pain, persists beyond the amount of time that is normal for an injury to heal. In some cases this may stem from an injury incurred during an accident or an assault.
Stress
Managing stress and managing chronic pain go hand in hand. Stress Ask most chronic pain patients what their most significant source of stress is, and they will usually tell you that it is pain. Physical, psychological, and emotional stress may worsen chronic pain. Predictors of posttraumatic stress disorder symptom severity level in chronic low back pain patients.
Prevalence
Statistical analysis The prevalence of recent pain, chronic pain, and severely disabling chronic pain were summarised as percentages of respondents with 95% confidence intervals. Croft et al [11] found the prevalence of chronic pain to be slightly lower in postal survey non-responders. A small number of previous studies have sought to collect data on the prevalence of chronic pain from non-responders. The prevalence of severely disabling chronic pain in this sample was 3.0%.
Depression
This pattern has to be changed if depression, stress, and chronic pain itself are to be conquered. This is because the consequences of chronic pain and the symptoms of depression look very similar. Depression Persons with a chronic pain problem often show decreases in meaningful and enjoyable activities. Depression is often associated with chronic pain and may need to be treated as a separate, but related, condition. Living with chronic pain can lead to loss of appetite, depression, and exhaustion. The consequences of unrelieved chronic pain in this population, similar to others, include depression, decreased socialization and sleep disturbance. Influence of chronic pain on mood and psychosocial function, utilizing age-specific scales (e.g., geriatric depression scale). Nelson and Diane...and depression in patients with chronic pain was investigated. Counselling may also be of some help in addressing the depression which so often accompanies chronic pain or illness. Levels of anxiety, depression and self-rated health were described for respondents with severely disabling chronic pain and contrasted with respondents reporting no pain. Psychological therapy for anxiety and depression is helpful in managing the emotional consequences of chronic pain. This is not the case and if somebody has chronic pain and depression, 'you have to treat both', he says. Our research provides further evidence that chronic pain and depression are quite independent", Dr Clauw said. There are many factors that affect the development of chronic pain such as age, level of disability, depression, or the presence of nerve damage. Schatzberg suspects that the presence of chronic pain should be added to this list as a symptom for assessing depression.
posted by Healthy Life @ 11:16 PM,
Stress
Thursday, October 2, 2008
Defined simply, stress is the body’s reaction to a threat or challenge resulting from a situation (called a stressor) that can be either positive or negative. The body does not differentiate between psychological and physiological stress.
Physical Symptoms:
Physical changes when under stress may include tense muscles, pounding heart rate, cold or clammy hands, headache, sweating, and a feeling of butterflies in the stomach, dry mouth, stomach ache, heartburn, colds, fatigue, constipation, teeth grinding, skin rash and back pain.
Mental and Behavioral Symptoms:
Irritability, anxiety, apathy, nervousness, depression, hostility, forgetfulness, confusion, short temper, overeating, under-eating, overly emotional, excessive smoking/drinking and withdrawal from relationships.
Other signs of stress include talking faster than normal, biting one’s nails, pacing, restlessness, hyperactivity, distractibility, and trembling. Under chronic stress the person will seem tired, restless, and feel out of control.
How to get rid of Stress?
Research has shown that best tension reliever is physical exercise. It is a great remedy for stress. No other thing comes near exercise in reducing stress. Exercise also helps you sleep by relaxing the tense muscles.
Positive Benefits:
1. Exercise is a diversion that enables you to relax due to a change in environment or routine. It also serves as an outlet to dissipate emotions.
2. It improves blood flow to your brain, bringing additional sugars and oxygen that may be needed when you are thinking intensely.
3. When you think hard, the neurons of your brain function more intensely. As they do this, they can build up toxic waste products that can cause foggy thinking. By exercising you speed the flow of blood through your brain, moving these waste products faster.
4. Exercise can cause release of chemicals called endorphins into your blood stream. These give you a feeling of happiness and positively affect your overall sense of well being.
5. There is also good evidence that physically fit people have less extreme physiological responses when under pressure than those who are not. This means that fit people are more able to handle the long term effects of stress, without suffering ill health or burnout.
In addition to a regular exercise program, you can incorporate these stress reducing exercises.
1. Do some gentle neck rolls to help get rid of the tension. Let your chin drop slowly forward. Slowly roll you head to you right shoulder, back, left shoulder and front. Now do the same in the opposite direction. Do it slowly and repeat 10 times.
2. Inhale 10 deep breaths. Fill your lungs full, hold and exhale slowly, ridding all the air. Repeat. The fresh dose of oxygen will also recharge your energy.
3. Lie on the floor or sit in a comfortable chair. With your hands at your side or on the chair arm, visualize each part of your body, beginning with you toes and moving up. Take your time and feel you body relax, bit by bit.
4. Sit on the edge of your chair, and lean forward, resting your chest on your knees with your hands and head hanging loosely. Slowly unroll you back, vertebra by vertebra, until you’re sitting up nice and straight. This is an excellent exercise for unknotting your back
5. Stand and stretch with you hands over you head. Swing down to touch your toes, bending your knees if you need to. Repeat 5 to 10 times. Now place your hands on your hips, with your legs apart. Bend forward until your chest is parallel. Turn your head and body slowly to the left, then right forward. Repeat five to 10 times.
posted by Healthy Life @ 11:16 PM,
