MOUNTAIN EXPEDITIONS FOR PEOPLE WITH DIABETES: WATER, HYPOTHERMIA, HYPOGLYCAEMIA AND KETOACIDOSIS

June 3rd, 2010
Water
If clean water is not readily available the group will also need to carry some. This is especially important in very hot weather as a large amount of fluid is lost as sweat, and dehydration can occur; I have had to treat heat stroke in the Lake District in Britain (in a non-diabetic). In very hot weather your food should also be very salty because salt is lost in sweat. People with diabetes are prone to cramp and need plenty of salt to replace what is lost by sweating. Quinine-containing drinks such as bitter lemon or tonic may help.
Hypothermia
The dangers of hypothermia and hypoglycemia are especially applicable here.
Janine suddenly became unconscious from hypoglycemia while eating her lunch after a cold, wet, windy mountain walk. She rapidly became very cold. She was revived by glucose rubbed inside her mouth, started shivering and then regained consciousness. It took some time to warm her in a sleeping bag with another group member and hot, sweet drinks.
Hypoglycemia and ketoacidosis
Hypoglycemia can be recognized by someone stumbling, slowing down, getting muddled about navigation, showing sudden exhaustion, argumentativeness or suddenly losing consciousness. Many people with diabetes, who are not used to walking long distances, lose their ability to distinguish between tiredness and hypoglycemia. If you are tired, eat something. A word of warning- you can overdo the eating. Obviously, you can check your blood glucose if you are not sure whether you are tired or hypoglycemic.
Prolonged exercise make ketosis worse. If you have high or moderately high blood glucose levels, or have not been feeling very well, check your urine for ketones. If you have moderate or heavy ketones do not go on an expedition. You may develop ketoacidosis and then you will be a danger to yourself and your friends. You need more insulin and should not exercise heavily until you have got rid of the ketones. As a general principle, if you are not well, stay at home. It is not fair to saddle your friends with someone who may collapse on top of a mountain many hours away from the nearest telephone. They are morally obliged to help you and they may be put at risk trying to sort you out.
*105/102/5*
DIABETES

MOUNTAIN EXPEDITIONS FOR PEOPLE WITH DIABETES: SAFETY, EQUIPMENT, TRAVEL PACK AND FOOD

June 3rd, 2010
Safety in numbers, with good equipment
If you cannot read a map, learn how to do it or go with someone who can. The minimum size for a party is four- one person to stay with a casualty and two to go for help. The party always travels together, moving at the speed of the slowest person. Wear good walking boots and make sure that they do not rub your feet. Wear clothing appropriate to the area you are going to and the time of year, and carry windproof and waterproof clothes whatever the weather. Sun in the valley is not incompatible with pouring rain and howling gales on the mountain tops. The party should carry adequate overnight shelter for an emergency and the means to keep themselves warm in the shelter (for example, a tent and two sleeping bags for four people). They should also carry a stove and fuel. Everyone should have a map, compass and whistle, and know what to do with them.
Diabetic travel pack and food
Each of the diabetics should carry his own diabetic travel pack, twice as much food as he expects to eat for meals, six double snacks and emergency glucose. As a rough guide we use the MBE – Mars Bar Equivalent – for snacks (based on the standard size Mars Bar). Diabetic walkers should learn to eat as they travel, and remember that they need to travel slowly in the mountains because of this need for frequent snack stops. If you are in a diabetic group inexperienced in mountain walking, add at least an hour for every three you have calculated from distance and ascent that the journey will take.
The continuous exercise of mountain walking uses up a lot of energy and it is very important that you do not become hypoglycemic. The group leader should stay at the back of the group to pick up people who have slowed down because of hypoglycemic attacks or other problems, and make sure that no one gets left behind.
I have been astonished by the quantity of food that some students need to eat when out on an expedition.
Seventeen-year-old Bill, on twice-daily insulin – which he had reduced by 20 per cent – led a group of six people with diabetes over a steep ten mile route in the mountains. During the day he ate a huge breakfast, lunch and evening meal (each about double his usual calorie and carbohydrate content), seven Mars bars, six high fibre bars, a packet of glucose tablets and three apples. His blood glucose before bed that evening was 4 mmol/1 (72 mg/dl).
*104/102/5*
DIABETES

YOUR CHILD’S HEALTH/ASTHMA MEDICATIONS: THEOPHYLLINE

May 21st, 2009

Theophylline (Elixophyllin, Nuelin, Theo-dur) These drugs are taken by mouth, and are not used as often nowadays because of their bitter taste. They have also been associated with common side effects such as nausea and vomiting, as well as headache and school learning difficulties. They are often useful for night cough, and the long-acting version is sometimes used in children with chronic asthma, but they generally are no longer used as the first line or sole drug in asthma. Ipratropium bromide (Atrovent) This drug is sometimes used, but again not often as a first choice drug.

Drugs used to prevent asthma are seen as increasingly important. They act either to reduce the effects of inflammation, which is the main underlying cause of the disease, or to minimise the effects of some of the cells in the airways which contribute to the inflammatory response. The drugs used for prevention include: Sodium cromoglycate (Intal) This is inhaled on a regular basis, irrespective of whether the child has symptoms or not.

*247\90\8*

SEXUALITY, ILLNESS, AND HEALTH: ARTHRITIS AND SEXUALITY

May 19th, 2009

I have learned to hate sex. It hurts, my whole pelvis hurts with every thrust. I just can’t do it anymore.

WIFE WITH ARTHRITIS

Some of the symptoms that come with the various forms and degrees of arthritis include numbness, joint pain, weakness, fatigue, and some muscular atrophy. The primary effect on sexuality seems to be in sexual movements that accompany intercourse.

Of the 118 patients with some form of connective-tissue disorder or arthritis, 26 had stopped having sex. Fatigue and pain were the most frequent reasons given. I learned in the interviews, however, that most of these patients were trying to have sex at night or in the morning. These two times are typically the most painful in the cycle of symptoms for most arthritis patients, particularly patients with rheumatoid arthritis.

I suggested the following steps for the husbands and wives with arthritis in the couples group.

1. Try a warm bath or shower before sex. The temperature of the water may lessen some of the pain in the joints and make movements easier.

2. .Change the time of day you try to have sex. Late morning and early afternoon seem to be good times for less severe symptoms for my patients, but find your own sex time. Don’t be bound by the nighttime trap.

3. Use warm compresses even during sex. Apply them just prior to posture changes, and incorporate them into the sex play.

4. Try the posture of the future. Mounting and thrusting are not sexual prerequisites.

5. If what you are doing hurts, don’t only stop and change the activity, but discuss it later. There may be ways to make adjustments. Symptoms are always changing. What does not feel good today might feel great later.

6. Emotional state can affect some forms of arthritis directly. The stress of anxiety, fatigue, and work or family pressure is as damaging as postural pressures. Look to your emotional posture as much as you look to your sexual position.

*283\97\8*

YOUR MARILAL HEALTH/THE SUPER SEX RESPONSE MODEL: PHYSIOLOGICAL ORGASM

May 18th, 2009

This dimension of the super sex model refers to the contractions of the muscles in the pelvic area followed by a detumescence. In males and in some females, physiological orgasm is accompanied by emission of fluid. Whipple and Perry report that females experience a buildup and discharge of muscle tension in the pubococcygeal muscles and in the orgasmic platform (the area that can contract in the outer third of the vagina in response to sexual stimulation). They add that the buildup and disharge of myotonia in the deeper muscles of the vagina results in the uterus contracting and pushing down, causing the orgasmic platform to open, resulting in what they call an “A-frame” effect in the vagina. The former response, called the “tenting response,” is not typically involved with emissions in the female. The A-frame response can be involved in such emission, probably related to the Skene’s glands (glands around the urethra) and stimulation of the Grafenberg area (Whipple and Perry called this the G spot.)

Men in my interviews reported different types of physiological orgasms as well. Some felt more of an “opening” sensation similar to that of the A-frame orgasm, while others felt the contractive response of the tenting type.

“I definitely know when I come. I feel this tensing, then a series of pulsations,” reported the wife.

“I feel like that, too,” said the husband. “It’s like I’m going to come, then I come. It is just like strong pulses in the groin.”

The physiological orgasm was the emphasis of the first three perspectives, with a focus on the body response rather than “psy-chasms.”

*110\97\8*

THE JOY OF PERFECT HEALTH: ALTERNATIVE MEDICINE

May 18th, 2009

People have been curing themselves in various ways for many thousands of years. Over this time, some techniques have proved to be quite effective and popular. Almost every civilisation in the past had its own selection of best medical practices. We are very fortunate today, that some of this information is still available and we can take advantage of the accumulated wisdom of many generations of talented and enlightened people.

Please let me point out, that the original principles of orthodox medicine essentially support the view, that the patients should be able to seek another opinion.

A growing number of people, especially when confronted with a diagnosis of a disease considered “incurable” by orthodox medicine (such as advanced cancer for example) turn to alternative forms of treatments, which were proven through centuries. To the surprise of orthodox doctors, many of such patients succeed in greatly improving their state of health and surviving for many years, against all predictions and expectations based upon medical statistics.

The alternative techniques include, among others :

• Acupuncture

• Massage

• Herbal therapies

• Nutrition and diet

• Fasting (an extreme form of diet)

• Ayurvedic (ancient Indian) therapies

• Spiritual healers

• Oxygen and ozone therapies

• Meditation and relaxation therapies

• Radionics and electro-magnetic therapies

• Going to famous mineral springs in the mountains (Lourdes in France for example), drinking the water and bathing in it.

• removing some blood from the body

• going to bed and inducing sweating

• taking sauna

This list is probably not complete, but nevertheless, just by taking a look at it, it is hard not to notice the extreme diversity of healing techniques. They range from purely physical methods concentrating on the physical body (herbs, diet, oxygen, massage, physiotherapy etc.) to purely spiritual methods, totally ignoring the physical body (spiritual healing, meditation etc.). Several techniques (Acupuncture, Ayurveda) combine the extraordinary accurate and detailed knowledge of both the mind and the body.

To me, the most striking is the absence of surgery. I think, there is a reason for it. The design of our body is actually perfect. The mind-body system as a whole has been designed to function perfectly, to defend itself against disease, and to rebuild any damaged parts for as long as we wish. Our wise ancestors did not try to improve the design by removing or changing parts.

*9\96\8*

LAW AND MEDICINE – INTRODUCTION

May 15th, 2009

Despite what some patients may think of us, and despite what some of us think about ourselves, doctors are not above the law.

The law is set down for all citizens to obey and we as a learned profession do ourselves and the law a disservice if we attempt to bring it into disrepute.

Being called as a witness to court is a time-consuming business and if one is a witness to an accident, it may be a full day lost from work.

However, for most individuals this may happen only once or twice in a lifetime.

For those doctors involved in treating workers compensation or road accident cases, a court appearance may occur almost every week.

But doctors are involved with the law in many other ways.

Speed limits on the road are absolute, but if a doctor is travelling to an emergency and he exceeds the speed limit, he still breaks the law.

Should he be apprehended by a policeman, a simple and polite explanation will usually result in the policeman waving the doctor on his way or asking him if he requires a police escort.

*477/71/1*

BELL’S PALSY – DESCRIPTION

May 15th, 2009

The seventh cranial or facial nerve passes through a hole in the bony skull just below the ear, to run forward under the parotid salivary gland to supply the muscles of the face.

This nerve can be injured by tumors of the parotid gland or by operations in this area. As this is a motor nerve supplying stimulation to the facial muscles, interference with its function may lead to weakness or paralysis.

The most common cause of facial palsy is inflammation of the nerve.

The swelling causes it to be compressed in the bony canal it passes through to enter the face. Compression leads to loss of function.

In most cases the cause of the inflammation is unknown, although it is thought that some cases may be due to exposure to cold or a draught.

The condition, usually called Bell’s palsy after Sir Thomas Bell, who was professor of surgery in Edinburgh in the 1830s, usually comes on suddenly and may be partial or complete. The person often notices it on awakening.

The paralysed face is flat and without expression, the eyelid cannot be completely closed and food and drink may dribble from the side of the mouth.

*222/71/1*

ENDOMETRIOSIS: THE DIFFERENCE BETWEEN LAPAROSCOPY AND LAPAROTOMY

May 8th, 2009

Unlike laparoscopy, which is, in a way, exploratory surgery, laparotomy is a much more serious consideration, and should not be thought of as routine. Exploratory laparotomy is a major surgical procedure. The doctor makes a horizontal or vertical incision in the abdomen in order to explore the abdominal cavity for any abnormality or to remove tumors or cysts. This procedure is not used routinely as a diagnostic tool, but if a woman has a large pelvic cyst or mass that needs to be removed, a laparotomy might be indicated and might help treat the patient. Surprisingly, endometriosis often is discovered when something else is suggested, such as pelvic infection or pelvic tumors.

Sharon’s instincts about her condition were right from the start; she would have been better off searching for a specialist in endometriosis. Specialists are a good bet because they have experience in treating endometriosis on a regular basis, frequently are involved in research on the disease, and are more skilled with the laparoscope.

*46\43\4*

SKIN CARE: TREATMENT OF MOLES

May 8th, 2009

There are four common reasons for the treatment of moles:

1. Diagnosis of a mole as being of the type that is statistically more likely to become malignant; such a mole would be the large, hairy ‘bathing trunk’ naevus.

2. The presence of changes suspected to be malignant.

3. The occurrence of functional changes within the mole. These may be irritation, trauma, or infection.

4. Cosmetic reasons. In this case removal is only successful if the result improves the appearance of the individual. The choice of surgical technique is therefore important.

There is absolutely no foundation for the widely-held misconception that surgical interference with a mole will cause it to become malignant. This may have arisen from the result of inadequate treatment of what in fact was already an early malignant melanoma, not a simple mole. All doubtful moles should be excised with an adequate margin and submitted for pathological examination. No moles should ever be simply destroyed by cauterization or similar treatment without adequate pathological examination. Removal for cosmetic or functional reasons does not necessarily have to be complete. Elliptical excision and suturing may be avoided and a very satisfactory cosmetic result obtained by a shave excision. This entails shaving the mole off flush with the skin surface, and stopping bleeding with light electro-desiccation.

*73\44\4*

Random Posts