• DRIVING AND PEOPLE WITH DIABETES: CAR INSURANCE

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    03 Jun 2010 /  Diabetes
    You must also tell your car insurance company that you have diabetes. Again, this responsibility is yours. It is silly not to tell them, because if you make a claim and have not revealed your diabetes they may refuse to pay, whether the accident was your fault or not. They may also refuse to pay if you have not told the licensing authority.
    Driving with diabetes is not simply a matter of getting official approval. It is important that you and other road users are completely safe. What factors should be considered if you want to drive a car? First, are you at any risk of becoming confused or unconscious? Never drive any vehicle if your blood glucose is below 4 mmol/1 (72 mg/dl) or if you feel hypoglycemic.
    If you need to make a journey just before a meal, eat a snack before you get into the car. You must have glucose in the car, and you should have enough food in the car for an extra meal in case of breakdowns or delays. Some people with diabetes who do a lot of travelling, carry their diabetes travel pack in the car all the time in case they need to spend a night away from home.
    If you feel at all hypoglycemic while you are driving, stop as soon as it is safe to do so, turn off the engine and remove the ignition keys. Then have something to eat. You should also slide into the passenger seat so that you are not ‘in control of the vehicle’. Remember that you may not be thinking straight or be properly coordinated if you are hypoglycemic. I heard of one man who drove five miles while hypoglycemic and left a trail of destruction throughout the entire length of a village street.
    Next, you should consider whether you have any complications of diabetes which may make driving hazardous. An obvious one is diabetic retinopathy. Most people with retinopathy can see well enough to drive but it is important that you have your visual acuity and your visual field (all round vision) checked regularly. If you have had a lot of photocoagulation your visual field may be narrower than before. If you have maculopathy (damage to the area of best vision) you may not be able to see well enough to drive. Cataracts may also block your vision for driving and this may be an added reason to have them removed.
    If you have numb hands or feet from diabetic neuropathy you may not be able to feel the controls of the car very well; and if you have heart trouble, you should discuss driving with your doctor. The current advice is that you should not drive for at least one month after a heart attack. If you have angina that may be brought on by stress, such as road hogs and traffic jams, you should certainly not drive.
    *109/102/5*
    DIABETES

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  • DRIVING AND PEOPLE WITH DIABETES: THE LAW

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    03 Jun 2010 /  Diabetes
    The legal requirements for driving differ in different countries, but most insist that you notify them of any illness that may impair your safety as a driver. For example, the old British driving license states:
    You are required by law to inform Driver and Vehicle Licensing Centre (DVLC) … at once if you have any disability which is or may become likely to affect your fitness as a driver, unless you do not expect it to last for more than 3 months.
    The new license mentions diabetes specifically. The DVLC is now the DVLA. Drug-treated diabetes counts as such a disability because people on drugs which lower the blood glucose (this includes insulin) are at risk of hypoglycemia and confusion or coma. It can be argued that any form of diabetes counts because of the theoretical risk of hyperglycemic como, or the later need for glucose lowering treatment, or because some of the complications of diabetes may make driving unsafe. To adhere to the letter of the law, even diet-treated diabetics should inform the DVLA of their diagnosis, clearly stating that they are not taking blood glucose lowering drugs at that time.
    It is your responsibility to notify the authorities and not your doctor’s. The licensing authority may then request details of your condition from your doctor who can release them only with your consent.
    *108/102/5*
    DIABETES

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  • YOUR CHILD’S HEALTH: ASTHMA MEDICATIONS

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    21 May 2009 /  General health

    Asthma medications come in different forms:

    Solutions to be inhaled as a mist from a hand-held inhaler (metered dose inhaler or puffer, often used with a spacer device), or from a nebuliser driven by a pump.

    Dry powders to be inhaled from a hand held inhaler (spinhaler or rotahaler).

    Liquids, tablets or sprinkles to be swallowed. Combinations of medicines are often necessary.

    Inhaled medicines are far more effective than those swallowed. More of the drug reaches the lungs, where it acts on the airways, and very little reaches the bloodstream. Medicines taken by mouth are absorbed into the bloodstream and may sometimes cause unwanted side effects such as a fast heart rate or irritability. Most children over the age of 3 years can be taught to use a spacer or inhaler of some kind. Younger children can use an asthma pump ( these are also used in older children).

    Asthma medications can be divided into treaters and preventers. Some children take both these classes of medication. Your doctor will advise the most appropriate medications for your child to take.

    Drugs used to treat the symptoms of asthma fall into several groups:

    Beta-2 agonists such as salbutamol (Ventolin, Respolin), terbutaline (Bricanyl), fen-oterol (Berotec) These are the most commonly used drugs for the treatment of acute symptoms of asthma.

    *249\90\8*

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  • SEXUALITY, ILLNESS, AND HEALTH: ALCOHOLISM AND SEX

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    19 May 2009 /  General health

    I just drank it away. My sex drive, my erections, my job, my marriage. I just drank it away.

    ALCOHOLIC HUSBAND

    A total of eighty-one men and forty-three women described themselves as alcoholics in the couples groups. Forty-seven of the men reported problems with erections and thirty of the women reported decrease in sexual interest. Even in cases where the physical examination did not reveal liver damage (a frequent consequence of alcoholism and one directly related to sexual problems because of impact on hormonal patterns), erective and sexual-interest problems were present. One woman reported, “I can’t tell you if I am interested in sex or not. I do it a lot. But that doesn’t mean anything. I go to work, too, but that doesn’t mean I want to. When you’re a drunk, you just do things. You’re lucky if you remember what.”

    In addition to liver damage, neurological and circulatory problems occur with excessive drinking. Alcohol in the blood directly suppresses the sexual-reflex system. The body’s immune system is seriously jeopardized by alcoholism, and the generally poor and deteriorating health of the alcoholic seriously affects sexuality.

    Alcoholism, like all health problems, affects the entire family system. I have found that sexual counseling is not effective until the drinking problem and related family and marriage problems are confronted and remediated wherever possible.

    *285\97\8*

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  • YOUR MARILAL HEALTH/THE SUPER SEX RESPONSE MODEL: REFRACTORY PERIOD

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    18 May 2009 /  General health

    All neurological reactions in the human body are followed by a “rest period,” a period during which another neurological response is diminished or impossible. Such refractory periods range from milliseconds to minutes.

    When you enter someone’s home, you may notice a unique odor. After some time you do not detect it (at least in most homes) because of the olfactory refractory period. The principle is the same in sexual response.

    Sexually, refractory periods occur for both men and women. They are not the “beached whale” phenomenon of a man collapsing from sexual fatigue. They are periods of varying duration occurring in both genders during which time direct stimulation to a specific part or area of the body is ineffective, bothersome, or uncomfortable.

    Emotionally, there is also a refractory period. We cannot maintain any emotional state indefinitely. In fact, most emotions last only a few seconds. We must change gears or burn out. The same is true for sex. We need to pause, to rest, to take what I call a PON, or post-orgasmic nap; a POR, a post-orgasmic rest, or even a POS, post-orgasmic sleep.

    The husband said, “I used to think I had no control over it. I just knew that after I ejaculated, I would be immobilized. I learned that feelings changed in my penis after I ejaculated, but that the refractory thing is the same in my wife and not just in the genitals either. I used to think she could go on forever until she finally told me she felt like I did.”

    “Sure,” responded the wife. “I don’t know why men think women are some type of sex machine that once turned on becomes a perpetual-motion instrument that sort of putters out because the man goes to sleep. There are times when to touch my clitoris just hurts. It depends on when, how, and certainly by whom.”

    Talk this issue over with your spouse and you can validate it for your own relationship. Refraction is not just physical, not just male, and not always the same. The early perspectives on human sexuality viewed refraction as a response only in the male. It, as with all of the dimensions of sexual response that I have discussed, does not have to follow a predetermined order. Physical and/or emotional refraction can happen anytime in the sexual interaction, depending on emotional state and area of stimulation. If we are bound by the “cycle” concept, we begin to anticipate refraction as the inevitable aftermath of the goal of orgasm, similar to the exhaustion of the long-distance runner. We can touch, hold, talk, and hold, wait and resume sex later. Super sex depends on learning this concept. It will require considerable unlearning, but the rewards for this effort are new levels of intimacy and sexual fulfillment free from psychologically determined physiological limitations.

    *112\97\8*

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  • THE JOY OF PERFECT HEALTH: THE HUMAN BODY – THE PERFECT HEALER

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    18 May 2009 /  General health

    If you cut yourself with a sharp object, the wound heals itself in a few days. If the damage is not excessive, the repair job is so perfect, that in a few weeks you cannot even find the location of the cut.

    All you need to do is not disturb the healing process -protect the wound from getting dirty and keep the separated parts together.

    Now let us analyse in more detail, what exactly happens in such a healing process.

    When you cut yourself it hurts. The pain informs you, which part of your body requires your attention. When you attend the wound promptly by cleaning it with clean water or your own saliva and covering it perhaps, the pain is greatly reduced. If you do not clean the wound, it would be automatically cleaned by the blood flowing from it, and then the blood flow would be stopped.

    During the healing process, the pain is limited or eliminated, unless you try to use the damaged organ too soon -increasing pain informs you immediately that your organ is not yet ready.

    The body performs a repair job on itself. All cells which were separated by a cut are growing to join together again. There are many different types of cells and tissues being reconstructed so they can join together again. Without any mistakes, all blood vessels, muscles, nerves etc. are reconstructed and then connected. Even if some of the tissue is missing, the body replaces it. Sometimes a temporary scar tissue is used, which is later replaced by the optimal tissue selected by the body.

    Note, that all this microsurgery with perfectly adjusted anaesthetic happens automatically within your body. No one has any right to take any credit for such healing. You did the healing for yourself, with the perfect result.

    *11\96\8*

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  • LAW AND MEDICINE – CARRING OUT DOCTORS PRACTICE

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    15 May 2009 /  General health

    He may be out of pocket and he may think the referral practice is ridiculous, but it is the law. No doctor, of course, should ever request such a thing from a colleague.

    Certain notifications are required by law to be made in relation to infectious disease and venereal disease. The doctor is bound to comply with these laws.

    There are laws relating to the issuing of death certificates. There are laws relating to the registration of doctors.

    A doctor is expected to carry out his practice using due care and skill. If he does so and his patient fails to get better or has a reaction to the treatment employed, then the doctor is protected by the law.

    Should a mishap occur and the doctor not use due care and skill, then the patient is protected by the law, and may bring a case for damages against the doctor.

    Fortunately in this country, the whole legal system, the judges, the juries and the solicitors and barristers offering advice, appear to use good sense and reason.

    *479/71/1*

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  • BELL’S PALSY – COMPLICATED PROCEDURE

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    15 May 2009 /  General health

    A small nerve is taken, usually from the foot, and joined from an intact branch of the facial nerve on the other side to the paralysed nerve on the affected side. If it works, the intact nerve supplies motor power to the muscles of both sides.

    A further refinement is to graft small muscles from the foot on to the paralysed muscles as well as a cross-facial nerve graft.

    These intricate procedures have developed with micro-surgery. It may take nine months to assess if these complicated procedures are going to be successful.

    Another approach is to do the simpler static sling as well as the complicated procedure. In this way the appearance is improved immediately and, should the complicated graft not take, a reasonable result is achieved.

    Those who develop Bell’s palsy can take heart from statistics. Almost nine out of 10 will get completely better. Those unfortunate enough to have persistent paralysis can call on the skill of the plastic surgeon to improve their appearance and, perhaps, restore function to the facial muscles.

    *223/71/1*

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  • ENDOMETRIOSIS: HOW CULDOSCOPY IS DONE

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    08 May 2009 /  Women's Health

    Doctors prefer to do endoscopies in a hospital with patients put under local anesthesia. Before the culdoscope can be inserted properly, the woman is positioned on the table in a kneeling position, leaning forward with her bottom higher than her chest and her head resting on her arm. Before the procedure, the vagina is washed to the point of sterilization. This is the first possible snag of culdoscopy. Since complete vaginal sterilization is impossible, there is an inherent risk of infection and doctors must proceed cautiously. After she is coveted with a sterile drape, the doctor administers a spinal or epidural anesthetic, or the woman can be given a painkiller like Demerol as well A specialized speculum is then inserted into the vagina to permit a better view of the cervix. About now, a local anesthetic is injected into the vagina and a small probe inserted blindly through the vaginal wall. When the probe is in place, a larger probe containing the culdoscope is inserted. Looking through the culdoscope, the doctor can inspect the area just behind the uterus, the ovaries, and the tubes. Since the intestines tend to fall forward while in this kneeling position, the doctor has a less obstructed view to check for any abnormality in the area.

    As with laparoscopy, there is a range of therapeutic procedures, though more limited, that may be performed while the culdoscope is in place, fine operating instruments may be inserted through it for use in minor operations, the most common of which are tubal sterilization and the removal of small adhesions.

    Aftereffects of culdoscopy are usually not troublesome. If you are scheduled for one, expect minimal pelvic pain for a day or two after surgery. Doctors will advise abstinence from intercourse for three or four weeks or until complete healing has occurred. Unlike laparoscopy, which is not as debilitating, culdoscopy will require rest at home for a week or two and avoidance of stress-filled work schedules.

    *48\43\4*

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  • SKIN CARE: SYPHILIS

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    08 May 2009 /  Skin Care

    Syphilis is capable of producing the most varied of all skin changes. It may also mimic a wide variety of internal diseases. Consequently it is essential to bear in mind the possibility of any unusual rash being due to syphilis.

    Syphilis is a chronic infectious disease caused by the bacillus Treponema pallidum, which is acquired by intimate contact with an infected person or as a congenital infection in infancy. In the western world it is most easily transmitted, under moist conditions, by genital or oral contact. It may also be transmitted by an infected mother from the fifth month of pregnancy onwards. In underdeveloped countries a form of syphilis occurs which is spread by intimate contact rather than by sexual intercourse; it is usually associated with bad living conditions and poor hygiene.

    In Europe, from 30000 to 40000 cases of contagious syphilis are registered every year, the greatest incidence being amongst homosexual men. As with all venereal diseases, it is more common during times of unstable social conditions and war. After World War II cases rapidly declined. However the past 20 years has seen a marked resurgence. The reasons for this are speculative but may include the following: increased travel, both tourist and migratory; altered moral standards; a more liberal attitude to homosexuality; the effect of oral and intrauterine contraceptives on human sexual behaviour; the diminished use of condoms, and the widespread use of drugs.

    Syphilis may be thought of as occurring in four stages. Primary infection occurs 10-30 days after contact, and takes the form of a persistent chancre or sore. Associated with this there are enlarged tender lymph glands. The chancre usually appears on the genitals, in the anal area, or in or around the mouth. It may take 3-8 weeks to heal, leaving a small scar. At this stage, it is best diagnosed by a direct bacterial examination of the sore.

    Secondary syphilis will usually occur 1-2 months after the primary stage. This stage may manifest a wide variety of different rashes, and is best diagnosed by appropriate blood tests. At this time the person is highly contagious, and bacteria may be found on most parts of the body. This stage may persist for up to two years. The rashes may resemble measles, chicken pox, hives, drug allergies, tinea, eczema, warts, and psoriasis, to name but a few conditions. However invariably there are other associated symptoms, such as a fever, tiredness, patchy hair loss, joint pains and headaches, particularly at night. This stage is also accompanied by enlarged, but not tender, lymph glands.

    Latent syphilis, which is the stage without symptoms, may last from 2-20 years. It is only diagnosed from an adequate history and positive blood tests.

    The final stage, tertiary syphilis, may affect all organs of the body; more commonly, though, it affects the heart, brain, and liver. In the skin it appears either as odd patterns of grouped nodules or large, painless ulcers. This stage is not infectious.

    The treatment for syphilis is penicillin. For primary and secondary stages, this is either given on ten consecutive days or in one very large single dose. These people require follow-up treatment, including blood tests for two years. Contact tracing of people who are likely to have become infected is an essential part of the proper management of this contagious and important disease. Cases of syphilis which are of longer than 12 months duration require more intensive therapy over a longer period.

    *76\44\4*

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