#period triggering muscle weakness episodes

[hyperfixation-tangentopia]

Who's decision was it to not put seats in this Barnes and Noble 😭

[colinwilson11]

Narcolepsy: An Often Misunderstood And Debilitating Sleep Disorder In Global

Narcolepsy is a chronic neurological sleep disorder that affects the brain’s ability to regulate sleep-wake cycles normally. It causes excessive daytime drowsiness along with sudden attacks of sleep throughout the day, known as cataplexies. Gelineau’s syndrome sufferers experience disrupted nighttime sleep as their body transitions quickly and unexpectedly from wakefulness to REM sleep during the day.

Symptoms Of Gelineau’s Syndrome

Some of the main symptoms of Gelineau’s syndrome include:

- Excessive daytime sleepiness leading to unintended naps or sleep attacks, especially during sedentary periods.

- Cataplexies - temporary inability to control muscle tone often triggered by strong emotions such as laughter, surprise or anger. It leads to generalized weakness or paralysis.

- Hypnagogic hallucinations - vivid dream-like hallucinations or false memories that occur when one transitions from wakefulness to sleep. They seem real but turn out to be false upon awakening.

- Sleep paralysis - temporary inability to move or speak upon awakening or falling asleep. It feels like one is frozen, though they are fully conscious and aware.

Causes Of Gelineau’s Syndrome

The cause is thought to be an autoimmune disorder where the body’s immune system attacks and destroys neurons in the hypothalamus that produce hypocretin (orexin), a neuropeptide that helps regulate wake-sleep cycles. Narcolepsy leads to instability in sleep-wake cycles. Some researchers believe Gelineau’s syndrome has a genetic predisposition since it often runs in families. Environmental triggers like infection and immune system triggers are also suspected to play a role in the development of this condition.

Diagnosis Of Gelineau’s Syndrome

Gelineau’s syndrome is often misdiagnosed for many years since symptoms can mimic other conditions. A thorough clinical evaluation by a sleep specialist including medical history, symptoms, and sleep study tests are required to accurately diagnose it. Key tests include a polysomnogram, multiple sleep latency test (MSLT), and sometimes spinal fluid hypocretin/orexin level tests too. The diagnostic criteria are based upon symptoms and MSLT results showing very short time taken to enter REM sleep during naps throughout the day.

Impact On Daily Life And Work

Untreated Gelineau’s syndrome can significantly impact quality of life and work productivity. Constant daytime sleepiness puts one at higher risk of accidents. Social and work life suffers due to non-refreshing daytime naps and inability to stay alert for longer periods. Episodes of cataplexies can be triggered in presentations, meetings or other work situations causing embarrassment. Workers may face reduced efficiency, mistakes and inability to meet deadlines on projects and tasks. They may call in sick frequently or be distracted/late often due to their symptoms. This in turn impacts work performance reviews and career growth opportunities over the long run.

Treatments For Gelineau’s Syndrome

Effective management requires a multi-pronged treatment approach which may include: - Prescription stimulant medications like modafinil and amphetamine salts to reduce excessive daytime sleepiness, improve alertness.

- Tricyclic antidepressants and selective serotonin reuptake inhibitors to reduce cataplexies and help consolidate nighttime sleep.

- Sodium oxybate is commonly prescribed at night for cataplexies, REM sleep disturbances and fragmented nighttime sleep.

- Scheduled naps and lifestyle changes help manage residual daytime sleepiness.

- Consulting an occupational therapist can suggest effective workplace adjustments like flexible scheduling.

- Vitamin supplements and stress reduction techniques provide ancillary support for symptoms.

While there is no cure for Gelineau’s syndrome currently, proper treatment and management can help control symptoms significantly and improve daily function and work productivity. Early diagnosis and treatment leads to far better long term outcomes. With growing awareness and research, hope exists for more effective therapeutics and potential new disease-modifying therapies in future to substantially transform lives of those with this debilitating lifelong neurological condition.

Get more insights on this topic:  https://www.trendingwebwire.com/narcolepsy-understanding-gelineaus-syndrome-an-overview-of-this-misunderstood-sleep-disorder/

About Author:

Ravina Pandya, Content Writer, has a strong foothold in the market research industry. She specializes in writing well-researched articles from different industries, including food and beverages, information and technology, healthcare, chemical and materials, etc. (https://www.linkedin.com/in/ravina-pandya-1a3984191)

*Note: 1. Source: Coherent Market Insights, Public sources, Desk research 2. We have leveraged AI tools to mine information and compile it

[delveinsight12]

Narcolepsy Market expected to rise by 2032 | Companies- Axsome Therapeutics, Inc., Avadel Pharmaceuticals, Suven Life Sciences, Takeda, NLS Pharmaceutics, Vallon Pharmaceuticals, Alkermes, Centessa Pharmaceuticals, Ono Pharma, Harmony Biosciences, Reset Therapeutics, XWPharma, Sunovion Pharmaceuticals, Otsuka Pharmaceutical, ConSynance Therapeutics, Alkermes, KemPharm, expected to drive market

The Narcolepsy market growth is driven by factors like increase in the prevalence of Narcolepsy, investments in research and development, entry of emerging therapies during the study period 2019-2032.

The Narcolepsy market report also offers comprehensive insights into the Narcolepsy market size, share, Narcolepsy epidemiology, emerging therapies, market drivers and barriers, ongoing clinical trials, key collaboration in the space, market uptake by key therapies and companies actively pushing Narcolepsy market size growth forward. 

Some of the key highlights from the Narcolepsy Market Insights Report:

Several key pharmaceutical companies, including Axsome Therapeutics, Inc., Avadel Pharmaceuticals, Suven Life Sciences, Takeda, NLS Pharmaceutics, Vallon Pharmaceuticals, Alkermes, Centessa Pharmaceuticals, Ono Pharma, Harmony Biosciences, Reset Therapeutics, XWPharma, Sunovion Pharmaceuticals, Otsuka Pharmaceutical, ConSynance Therapeutics, Alkermes, KemPharm, and others, are developing novel products to improve the Narcolepsy treatment outlook. 

Promising therapies in the Narcolepsy market are AXS-12, SUVN-G3031, TAK-994, Mazindol, ADAIR, Research Programme: Orexin 2 Receptor Agonist, ONO-2909, HBS 102, XW10172, Ulotaront, HBS 102, ALKS 2680, KP 1077, and others.

The total Narcolepsy market size will include the market size of the potential upcoming therapies and current treatment regimens in the seven major markets.

As per DelveInsight analysis, the Narcolepsy market is anticipated to witness growth at a considerable CAGR

Strategise your business goals by understanding market dynamics @ Narcolepsy Market Landscape

Narcolepsy Overview 

Narcolepsy is a rare, chronic neurological disorder characterized by sudden, uncontrollable episodes of sleep. Individuals with narcolepsy experience excessive daytime sleepiness, struggling to stay awake and concentrate throughout the day. They may also have sleep attacks, where they unexpectedly fall asleep without warning. Another symptom is cataplexy, a temporary loss of muscle control that leads to weakness or even collapsing. Cataplexy is often triggered by strong emotions such as laughter or anger. Additionally, people with narcolepsy may have vivid dreams and wake up frequently during the night, with dreams occurring as they fall asleep or upon waking.

The underlying cause of narcolepsy is often a deficiency in hypocretin, a brain chemical that regulates alertness. Due to its rarity and many cases going undiagnosed, the exact prevalence of narcolepsy is difficult to determine. Currently, there is no cure for narcolepsy, but lifestyle changes to improve sleep habits and medication can help minimize the impact of the condition on daily life.

Do you know the treatment paradigms for different countries? Download our Narcolepsy Market Sample Report

Narcolepsy Epidemiology Segmentation 

DelveInsight’s Narcolepsy market report is prepared on the basis of epidemiology model. It offers comprehensive insights to the Narcolepsy historical patient pools and forecasted Narcolepsy patients. The report provides in-depth data of various subtypes and for the same epidemiology is segmented further. The Narcolepsy Market report proffers epidemiological analysis for the study period 2019-32 in the 7MM segmented into:

Narcolepsy Prevalence 

Age-Specific Narcolepsy Prevalence 

Gender-Specific Narcolepsy Prevalence 

Diagnosed and Treatable Cases of Narcolepsy

Visit for more @ Narcolepsy Epidemiological Insights

Recent Breakthroughs in the Narcolepsy Market:

In June 2023, RareStone Group, a rare disease-focused company aiming to establish China’s first rare disease ecosystem, announced that pitolisant (Wakix) was approved by the Chinese National Medical Products Administration (NMPA) for the treatment of excessive daytime sleepiness (EDS) or cataplexy in adult narcolepsy patients.

In July 2023, the FDA evaluated the full protocol of NLS Pharmaceutics’ NLS-1031 research, which is part of the AMAZE program investigating Mazindol ER as a therapy for narcolepsy.

Narcolepsy Treatment Market 

The Narcolepsy market outlook of the report helps to build a detailed comprehension of the historic, current, and forecasted Narcolepsy market trends by analyzing the impact of current Narcolepsy therapies on the market, unmet needs, drivers and barriers, and demand for better technology.

This segment gives a thorough detail of Narcolepsy market trend of each marketed drug and late-stage pipeline therapy by evaluating their impact based on the annual cost of therapy, inclusion and exclusion criteria, mechanism of action, compliance rate, growing need of the market, increasing patient pool, covered patient segment, expected launch year, competition with other therapies, brand value, their impact on the market and view of the key opinion leaders. The calculated Narcolepsy market data are presented with relevant tables and graphs to give a clear view of the market at first sight.

According to DelveInsight, the Narcolepsy market in 7MM is expected to witness a major change in the study period 2019-2032.

Narcolepsy Therapy Assessment

AXS-12: Axsome therapeutics

AXS-12 (reboxetine) is a norepinephrine reuptake inhibitor that is being developed for the treatment of narcolepsy. It increases wakefulness, maintains muscle tone, and improves cognition by modulating noradrenergic activity. Reboxetine has a long track record of safety in Europe and over 40 countries where it is licensed for the treatment of depression. Positive pre-clinical and Phase 2 clinical data in patients with narcolepsy show that AXS-12 improves daytime drowsiness while decreasing cataplexy (sudden loss of muscle control) in an open-label pilot experiment. AXS-12 has been designated as an Orphan Drug by the US Food and Drug Administration (FDA) for the treatment of narcolepsy. The medication is now being examined in the Phase III development stage.

Narcolepsy Key Companies

Axsome Therapeutics

Avadel Pharmaceuticals

Suven Life Sciences

Takeda

NLS Pharmaceutics

Vallon Pharmaceuticals

Alkermes

Centessa Pharmaceuticals

Ono Pharma

Harmony Biosciences

Reset Therapeutics

XWPharma

Sunovion Pharmaceuticals

Otsuka Pharmaceutical

ConSynance Therapeutics

Alkermes

KemPharm

Narcolepsy Therapies

AXS-12

SUVN-G3031

TAK-994

Mazindol

ADAIR

Research Programme

Orexin 2 Receptor Agonist

ONO-2909

HBS 102

XW10172

Ulotaront

HBS 102

ALKS 2680

KP 1077

For more information, visit Narcolepsy Market Analysis, Patient Pool, and Emerging Therapies

[kaydoespharmacy]

Cold

Symptoms – sore throat, sneezing, runny/blocked nose, cough, mild fever, pressure in ears, headache, myalgia (pain in muscles)

Duration – 1-2 weeks, symptoms peak 2-3 days, incubation period 10-12 hrs

Referral criteria – suspected flu, earache not responding to analgesia, sinus pain not responding to decongestants, no improvement after 10-14 days self-medication

Complications - immunocompromised, who smoke, and with comorbidities such as diabetes mellitus, congestive heart failure, asthma, chronic obstructive pulmonary disease, cystic fibrosis, and sickle-cell disease

Sinusitis – prolonged nasal congestion and facial pain

LRTI - acute bronchitis, acute exacerbation of asthma or chronic obstructive pulmonary disease (COPD), and community-acquired pneumonia

Acute otitis media – common in younger patients

Differential diagnosis

Meningitis – high fever, drowsiness, blank expression, vomiting, loss of appetite, high pitched screaming, non-blanching rash, photophobia, severe headache, malaise

Upper airway obstruction – noisy breathing, drooling, inability to swallow.

Nasal foreign body – persistent discharge from 1 nose with no other symptoms

Management – paracetamol or ibuprofen for headache, muscle pain or fever – only continue use if distressed, change to other agent if not alleviated, don’t give both together

Paracetamol contraindicated in – liver/kidney problems, epileptic

Ibuprofen contraindicated in – pregnancy, perforated stomach, increased bleeding, severe HF, kidney or liver problems, high BP, asthma, hay fever

Intranasal decongestants – improve breathing and promote sleep and has fewer S/E than oral decongestants. Ephedrine HCL 0.5% nasal drops for 12 and older p 1-2 drops 4x daily for 1 week – contraindicated – diabetes, hypertension, hyper thyroidism, CVD, high BP, MAOI in last 2 weeks

Oral decongestants – relieve nasal congestion (phenylephrine) – max 1 week

Antitussive (cough) – dextromethorphan

Expectorants (guaifenesin)

Chlorphenamine or Beecham’s (contains phenylephrine and paracetamol) (Sedating antihistamine – dries up secretions)

Counselling points

Go to GP if

fever for more than 3 days

symptoms worsening after 5 days

symptoms not better after 10 days

follow up meeting

risk and complicated patients within the week

young children – 1 week

Headaches

Types of headaches

Primary – not associated with other conditions – migraines, tension types, cluster

Secondary – associated with other conditions – trauma/injury, vascular disorders, hyper-tension, withdrawal such as opioids, analgesics, or alcohol. Bacterial or viral infection.

Features of serious headache – referral

New severe or unexpected headache – sudden onset reaching max intensity 5 mins and new onset in over 50s

Progressive or persistent headaches that changed dramatically

Associated features – fever, impaired consciousness, seizure, stiffness, photophobia, neurological deficit, cognitive dysfunction, atypical aura (greater than 1 hour) or aura 1st time in patients using combined oral contraceptives.

Dizziness, visual disturbance, vomiting. Head trauma up to 3 months prior, triggered by coughing, sneeze, or physical exertion. Worsened by standing or lying down.

Compromised immunity

Diagnosis

Migraine without aura – at least 5 attacks lasting 4-72 hrs with unilateral location (half the face), pulsating, moderate to severe pain and aggravated by or causing avoidance of routine physical activity. Attack comes with nausea and/or vomiting, photophobia and phonophobia

Migraine with aura – 2 attacks with visual aura (zigzag lines or blind spots), pins and needles, speech/language symptoms, motor weakness, vertigo.

One aura spreading gradually for 5 mins and 2 or more occurring after

Each aura lasts for 5-60mins which is unilateral

Management – stop combined oral anticontraception – contraindicated

Ibuprofen 400mg, paracetamol 1g, advise med to be taken at start of attack – follow up 2 weeks

Tension type – recurrent episodes lasting 30 mins – 7 days with NO nausea or vomiting. May have phot/phono phobia

Bilateral (across head landscape), pressing or tight (not pulsating), mild to moderate pain, not aggravated by physical activity

Management – simple analgesia – paracetamol or NSAID

Identify comorbidities such as stress, mood disorders, chronic pain, sleep disorders to manage

Cluster headache – 5 attacks of severe/very severe unilateral orbital (around ONE eye), forehead or temporal pain lasting 15 mins to 3 hrs with nasal congestion, runny nose, eyelid oedema, sweating, facial slushing, fullness in ear or restlessness

Attacks occur between one every other day and 8 per day for more than half the time the disorder is active

Management – REFER

Advise to avoid triggers and risk of medication overuse, identify and manage comorbidities – insomnia, depression, and anxiety

Medication – occurs 15 days per month and have a pre-existing headache disorder. Regular overuse of drugs for 3 months

Management – withdrawal from medication and advice around this

Sinusitis

Sinusitis usually follows a cold and lasts less than 12 weeks

If over 12 weeks becomes chronic – risk groups are allergic rhinitis, asthma, immunosuppression

Symptoms

Adults

Nasal blockage (obstruction/congestion), nasal discharge, facial pain/pressure, frontal headache, loss, or reduction of smell, altered speech indicating nose blocked. Tenderness, swelling. Redness over cheekbone, cough, headache worse when bending or lying down. Toothache.

Children

Nose block, discoloured nasal discharge, facial pain, pressure and or cough at day or night-time

Bacterial sinusitis

More than 10 days, discoloured, pussy discharge (from 1 nose), severe local pain (1 side), fever over 38 degrees, deterioration after milder sickness

Refer to hospital immediately

If they have symptoms of acute sinusitis and;

Severe systemic infection

Intraorbital or periorbital complications, including periorbital oedema or cellulitis, displaced eyeball, double vision, or new reduced vision

Intracranial complications, including swelling over frontal bone, symptoms or signs of meningitis, severe frontal headache, or focal neurological signs

Refer to GP

Severe symptoms, painkillers don’t work, symptoms worsen, symptoms don’t improve after 1-week, recurrent infection, sudden worsening, antibiotic failure, unusual or resistant bacteria, recurrent episodes, immunocompromised, allergic cause

Treatment

Acute with symptoms less than 10 days

DON’T OFFER ANTIBIOTIC, assure that it usually self resolves without bacterial complications. Symptoms managed

Paracetamol or ibuprofen for pain, headache, and fever

Use nasal saline spray or decongestants spray

Clean nose with saltwater solution (boil 1 pint of water and add 1 teaspoon of salt and bicarbonate soda. Wash hands, stand over sink, cup the palm of 1 hand and pour small amount of solution into it. Sniff water into 1 nostril at a time, breath through mouth and allow water to pour into sink, don’t let it go into your throat. Do 3x daily)

Acute for 10 days or more with no improvement

High dose nasal corticosteroid for 2 weeks for over 12s (mometasone 200mcg 2x daily)

Counsel that It may improve symptoms but won’t make the infection any shorter, could have systemic effects, may be difficult to use correctly.

Symptoms should get better 3-5 days of treatment – REFER if not

1st line antibiotic for adult

If not life threatening - phenoxymethylpenicillin 500 mg four times a day for 5 days.

Is systemically unwell, symptoms of more serious illness or high risk of complications - co-amoxiclav 500/125 mg three times a day for 5 days.

Allergic or intolerant to penicillin - clarithromycin 500 mg twice a day for 5 days.

Pregnant or intolerant to penicillin - erythromycin 250 mg to 500 mg four times a day or

Children 1st line

Phenoxymethylpenicillin

1 to 11 months, 62.5 mg four times a day for 5 days. 

1 to 5 years, 125 mg four times a day for 5 days. 

6 to 11 years, 250 mg four times a day for 5 days. 

12 to 17 years, 500 mg four times a day for 5 days.

If very unwell - co-amoxiclav

1 to 11 months, 0.25 mL/kg of 125/31 suspension three times a day for 5 days. 

1 to 5 years, 5 mL of 125/31 suspension three times a day or 0.25 mL/ kg of 125/31 suspension three times a day for 5 days

6 to 11 years, 5 mL of 250/62 suspension three times a day or 0.15 mL/kg of 250/62 suspension three times a day for 5 days. 

12 to 17 years, 250/125 mg three times a day or 500/125 mg three times a day for 5 days.

If allergic or intolerant to penicillin – clarithromycin

Under 8 kg, 7.5 mg/kg twice a day for 5 days. 

8 to 11 kg, 62.5 mg twice a day for 5 days. 

12 to 19 kg, 125 mg twice a day for 5 days. 

20 to 29 kg, 187.5 mg twice a day for 5 days. 

30 to 40 kg, 250 mg twice a day for 5 days. 

12 to 17 years, 250 mg twice a day or 500 mg twice a day for 5 days.

2nd line – if symptoms are still worsening after 1st line treatment for 2-3 days

Adults – co-amoxiclav 500/125mg TD x 5 days

Children – specialist advice

ANTIHISTAMINES can be prescribed for allergic triggered sinusitis

Diabetes type 1

Body stops making insulin and the blood sugar (glucose) level goes extremely high - persistent hyperglycaemia (random plasma glucose of 11mmol/l or more). We must control glucose level with insulin injections, healthy diet and reduce the risk of other health complications. Typically occurs in children and young adults.

Symptoms of T1D- Frequently thirsty, pass a lot of urine, tiredness, weight loss and feeling generally unwell. Develops quite quickly, over days or weeks, as the pancreas stops making insulin.

Pathophysiology of T1D- Autoimmune disease (environmental & genetic factors). Antibodies attach to the beta cells in the pancreas destroying the cells that make insulin (pancreatic islet cells).

Diagnosing T1D- Simple dipstick test to detect glucose in a sample of urine BUT only way to confirm the diagnosis is to have a blood test to look at the level of glucose in your blood (level of 11.1 mmol/L or more in the blood sample indicates that you have diabetes) PLUS a fasting blood glucose level is taken (level of 7.0 mmol/L or more indicates that you have diabetes).

Management- Should be offered multiple daily injection basal-bolus insulin regimens as the first-line choice. Twice-daily insulin detemir should be offered as the long-acting basal insulin therapy. Once-daily insulin glargine may be prescribed if insulin detemir is not tolerated, or if a twice-daily regimen is not acceptable to the patient. Insulin detemir may also be offered as an alternative once-daily regimen. There are multiple types of insulin…

Rapid Acting- Insulin Aspart (Novorapid®), Lispro (Humalog®) and Glulisine (Apidra®)

Short Acting- Soluble insulin (Actrapid®)

Intermediate Acting- Isophane (Insulatard® or Humulin I®) & NPH - neutral protamine Hagedorn

Long Acting- Insulin glargine (Lantus®), detemir (Levemir®)

Combination insulins (biphasic)- e.g., Novomix 30®, Humalog Mix 25®, Humalog Mix 50®, Humulin M3® and Insuman Comb 50®

Diet & Lifestyle- Diet low in fat, salt, and sugar and high in fibre and with plenty of fruit and vegetables. If you are overweight try to lose weight, increase your physical activity even if it’s only going for a walk (community groups)

Other Health Complications- Get regular checks with your GP, podiatrist, and optometrist. Also get the flu jab every year.

Complications – microvascular, macrovascular (MI, stroke), metabolic (diabetic ketoacidosis) and hypoglycaemia (blood glucose less than 3.5mmol/l)

Psychological complications – anxiety, depression, and eating disorders and those at increased risk of developing autoimmune diseases

Suspect DKA in diabetics – greater than 11mmol/L

Increased thirst and urine frequency, inability to tolerate fluids, persistent vomiting, diarrhoea, visual disturbance, lethargy, fruity smell on breath, deep sighing when breathing and dehydrated

Management

HbA1c levels target of 48mmol/mol or lower - Measure 3-6 months but more often if not controlled

Self-monitoring – need glucose monitor, lancet, finger pricking device and testing strips

Taught at diagnosis and review technique 1 yearly.

Before breakfast, 2 hours after meals, during illness, before driving, if they feel hypo – at least 4 times a day including before and after meals and before bed.

More frequency required (up to 10x daily) if

Target HbA1c not achieved, frequency of hypo increases, during illness, before, during and after sports, planning, during and while breastfeeding.

Target glucose readings

Fasting plasma glucose level of 5–7 mmol/L on waking.

Plasma glucose level of 4–7 mmol/L before meals at other times of the day.

For adults who choose to test after meals, plasma glucose level of 5–9 mmol/L at least 90 minutes after eating.

Agree bedtime target plasma glucose levels with the person. This should:

Consider the timing of the last meal and its related insulin dose.

Be consistent with the recommended fasting level on waking.

Provide information of effects of food and drinks – carbohydrate training (match carb quantities to insulin doses)

Educate to be careful of body weight and diets, feasting and fasting, fibre and protein intake, diabetic foods and sweeteners, alcohol intake, matching carbs with insulin and physical activity

Advice on alcohol – avoid drinking on empty stomach, eat carb snack before and after drinking (extra insulin not required). Measure glucose more regularly and maintain it with carb intake. Alcohol can exacerbate or prolong hypoglycaemic effect.

Exercise – lower glucose levels and reduces CVD risk and can help weight

Sick day rules – never stop or skip insulin – dose may need altering seek advice. Check blood more frequently – 1-2 hours including in the night. Check blood or urine ketone levels – 3-4 hours including night and if 2+ or 3mmol/l or higher then contact GP immediately.

Maintain normal meal pattern where possible if not then replace meals with carb rich drinks, milk, fruit juices and sugary drinks. Aim to drink at least 3L of fluid to prevent dehydration.

Offer multiple daily injection basal-bolus insulin regimens as the first-line choice to all adults with type 1 diabetes.

Offer twice-daily insulin detemir as the long-acting basal insulin therapy

Offer a rapid-acting insulin analogue injected before meals for mealtime insulin replacement

If a multiple daily injection basal–bolus insulin regimen is not possible and a twice-daily mixed insulin regimen is preferred

Insulin pump therapy is recommended as a treatment option for adults with type 1 diabetes mellitus if condition isn’t controlled by treatment

Diabetes type 2

The body still makes insulin however, you do not make enough insulin for your body's needs OR the cells in your body do not use insulin properly (insulin resistance means you need more insulin than normal make to keep glucose levels down. Occurs mainly in people aged > 40 but inc diagnosed in younger people, commonly associated with obesity, physical inactivity, raised blood pressure, dyslipidaemia, and a tendency to develop thrombosis (CV risk).

Symptoms of T2D- Gradual (weeks-months) and can be quite vague at first. Frequent thirst, passing large amounts of urine, tiredness, which may be worse after meals. Some people also develop blurred vision and frequent infections, such as recurring thrush.

Management- Metformin HCl 1st choice for treatment of all patients (à weight loss, red risk of hypoglycaemic events and long-term CV benefits). Has an anti-hyperglycaemic effect, lowering both basal and postprandial blood-glucose conc. It does not stimulate insulin secretion and therefore, when given alone, does not cause hypoglycaemia. If metformin contra-indicated/not tolerated trial MR formulation or initial treatment should be a sulfonylurea e.g. gliclazide OR a dipeptidyl peptidase-4 inhibitor e.g. linagliptin OR Pioglitazone.

Insulin- can be added if intensification of treatment needed. If needed, bedtime basal insulin should be initiated, and the dose titrated against morning (fasting) glucose.

Diet & Lifestyle- Avoid foods heavy in saturated/trans fats, beef and processed meats, sugary drinks, high-fat dairy products and salty/fried foods & have fibrous fruits and vegetables, high omega-3 fatty acid food and poly/monosaturated fats. Lose weight and inc physical activity (min 5 x 30 min brisk walk / week) and smoking cessation.  Also see optician regularly in case of damage to retina, GP and podiatrist.

EXTRA INFO FOR BOTH

Holiday- Pack about x3 the amount of insulin needed, test strips, lancets, needles or glucose tablets you would use, in case you need it (take cool bag to avoid insulin getting too hot). Carry your medicine in your hand luggage just in case checked-in bags go missing or get damaged (insulin can freeze and render it unusable). If injecting (i.e. will have needles/sharps) get a letter from your GP that says you need it to treat diabetes. If you use a pump or CGM, check with your airline before you travel about taking it on board as may require paperwork for medical equipment. If you use a pump, pack insulin pens in case it stops working. Take plenty of snacks in case there are any delays. Do not put your pump through the hand luggage scanner – let airport security know so they can check it another way.

<18 & Diabetic- Paediatric diabetes care team until 18 will help w injecting insulin, testing blood glucose levels, and diet. They can give advice on school or nursery and talk to your child's teachers and carers. Initially, every 1 - 2 weeks but will eventually be every 3 months.

Check Ups Needed- Annually get feet checked by podiatrist to check for loss of feeling in your feet, and for ulcers and infections. Get your eyes checked to check for any damage to blood vessels in the eyes, and checks for high blood pressure, heart, and kidney disease by your GP, also ensure to book in annually for a flu jab. Every 3 months have a blood sugar test (HbA1C test) checks your average blood sugar levels and how close they are to normal when newly diagnosed, then every 6 months once you're stable (~48-53 mmol/mol recommended).

Education- free education courses to help you learn more about and manage your diabetes, your GP will need to refer you. Diabetes UK run local charities for extra support, their website plus the NHS website offers a lot of diabetes information and advice. Maybe invest in a medical ID to carry w you.

Extra Lifestyle Advice- Eat a meal w carbs (e.g. pasta) before you drink alcohol and make sure people around you can recognise a hypo, choose diet soft drink mixers where possible, check your blood glucose regularly/before bed/the next day, drink plenty of water the next day. Avoid hypos by eating the right amount of carbs before, during and after exercise, adjust your insulin and check your blood glucose regularly, drink plenty of water. Recommended to have HbA1c <48mmol/mol when pregnant as high blood glucose levels can harm your baby, especially in the first 8 weeks of pregnancy, also a risk of having a large baby, which can cause complications during labour. Speak to your diabetes team If you're planning to get pregnant or if you get pregnant unexpectedly.

Item for disposal

Method of disposal

Needles

Sharps bin

Lancets

Sharps bin

Used blood test strips

Sharps bin

Leftover/expired insulin

Sharps bin/return to pharmacy

DVLA- tell the DVLA you’re diabetic or you could get fined due to hypoglycaemia/low sugar levels crisis. Check your blood glucose no longer than 2 hours before driving, check your blood glucose every 2 hours if you're on a long journey, travel with sugary snacks and snacks with long-lasting carbs, like a cereal bar or banana. If you feel your levels are low: stop the car when it's safe, remove the keys from the ignition, get out of the driver's seat, check your blood glucose, and treat your hypo, don't drive for 45 minutes from when you feel normal again.

Sharps Removal- Patients issued a sharps bin from the diabetes clinic/hospital on first diagnosis. Some pharmacies offer this sharps disposal service, or the diabetes clinic do too. Can arrange w GP/LHB for sharps collection (Cardiff Council does NOT offer kerbside sharps disposal)

Other Technologies- Insulin Pump (attached to skin via tiny tube which is replaced every 2-3 days & pump moved to diff part of body) will deliver a set background amount of insulin into blood day and night, can add your extra mealtime insulin using the pump. Continuous glucose monitoring (CGMs) means you can check your sugar levels at any time (see patterns in your levels, sends an alert if glucose too high/low) but as interstitial fluid sugar readings are a few mins behind your blood sugar levels you'll still need to do finger-prick checks every now and then. It’s a sensor you attach to your abdomen which needs replacing every 7 days, but some models can be worn for months. Free Style Libre is a flash glucose monitoring system measures your glucose levels continuously throughout the day via interstitial fluid (few mins behind). Attach sensor to your arm and a reader will scan to see your sugar levels (can also use a smartphone app to scan the sensor), sensors usually last for 14 days.

Testing blood glucose

Glucose monitor, specific in-date test strips, primed lancing device and cotton wool pad.

PRIMING LANCET

Twist cap off lancing device

Place fresh lancet into device so grooves line up and twist off the cover, so the needle is visible – change lancet every time so you don't get skin infections

Replace device cap - it should click and then adjust the depth metre – how far the needle will puncture – this is personal preference

Pull sliding barrel at bottom of device back to prime the lancet

CALIBRATING MONITOR

Turn on monitor – put new in-date test strip inside it and test it with in-date control solution – to make sure readings are correct

Do this every time you open a new pack of test strips, if you damage your monitor and if you think the readings are wrong.

TESTING process

Wash hands with warm water and soap and dry. Then rub hands for 10 seconds – warms hands to improve blood flow to fingers

Turn on monitor and place strip inside and wait for it say it’s ready for blood

Place device firmly on side of the finger (less nerves so less painful) and press release button then remove device from site. - change fingers regularly to stop hardening of skin.

Wipe first drop of blood away with cotton pad, use second one to test make sure by touching the blood onto the test strip

If successful wipe blood with cotton pad and apply plaster

Note readings

Remove cap of device exposing lancet. Place lancet cover on table and press lancet hard into this blue plastic cover – this will cover the needle and make it easy to remove

Place lancet and cotton pad in bin

Injecting insulin

Inject in stomach, thighs, or buttocks. Inject an inch away from previous site. Prevents lumps – this reduces absorption of insulin.

check that its correct insulin and is in date. Always check manufacturer’s instructions.

Wash hands with soap and warm water

Attach needle to pen – peel back cover, screw cap onto pen, remove white outer cover and the green cover to expose needle – change needle every time

Dial to 2 units and push plunger so you can see insulin coming out – to make sure no air stuck in there – can take multiple goes in new pens

Set correct dose

Press directly into skin and inject slowly – count to 10 

Remove needle straight without bending it

Use the white outer cap to remove the needle and dispose in yellow sharps bin

Asthma

Symptoms – episodic, worse at night/early morning, triggered by exercise, infection and exposure to cold air or allergens. Triggered by emotion and laughter in children. In adults by NSAIDS and BB use.

Common with atopic eczema, dermatitis and allergic rhinitis and family history

ACUTE EXACERBATION OF ASTHMA IN ADULTS

First-line treatment for acute asthma is a high-dose inhaled short-acting beta2 agonist (such as salbutamol) given as soon as possible. For patients with mild to moderate acute asthma, a pressurised metered-dose inhaler and spacer can be used. For patients with acute severe or life-threatening symptoms, administration via an oxygen-driven nebuliser is recommended, if available. If the response to an initial dose of nebulised short-acting beta2 agonist is poor, consider continuous nebulisation with an appropriate nebuliser. Intravenous beta2 agonists are reserved for those patients in whom inhaled therapy cannot be used reliably.

In all cases of acute asthma, patients should be prescribed an adequate dose of oral prednisolone. Continue usual inhaled corticosteroid use during oral corticosteroid treatment. Parenteral hydrocortisone or intramuscular methylprednisolone are alternatives in patients who are unable to take oral prednisolone.

IN CHILDREN OVER 2

First-line treatment for acute asthma is an inhaled short-acting beta2 agonist (such as salbutamol) given as soon as possible. For children with mild to moderate acute asthma, a pressurised metered-dose inhaler and spacer device is the preferred option. The dose given should be individualised according to severity and adjusted based on response. For children with acute severe or life-threatening symptoms, administration via an oxygen-driven nebuliser is recommended, if available. Parents/carers of children with acute asthma at home, should seek urgent medical attention if initial symptoms are not controlled with up to 10 puffs of salbutamol via a spacer; if symptoms are severe, additional bronchodilator doses should be given as needed whilst awaiting medical attention. Urgent medical attention should also be sought if a child's symptoms return within 3-4 hours; if symptoms return within this time, a further or larger dose (maximum of 10 puffs of salbutamol via a spacer) should be given whilst awaiting medical attention.

COPD

Symptoms - persistent respiratory symptoms and airflow obstruction, which is usually progressive and not fully reversible, exertional breathlessness, chronic/recurrent cough, or regular sputum production, wheeze

Treatment – education on condition and risk factors, smoking cessation, pneumococcal and flu vaccination yearly, treatment of associated comorbidities

1st line – SABA or SAMA to relieve breathlessness and improve exercise tolerance – reviewing medication, adherence, and inhaler technique regularly

THEN IF they have NO asthmatic features or no features of steroid responsiveness – offer LABA AND LAMA

If they continue to have day-to-day symptoms, consider 3-month trial of LABA+LAMA+ICS

If NO improvement go back to LAMA+LABA only but if it works continue and review annually

If they have asthmatic or steroid responsiveness features offer LABA+ICS if they have day to day symptoms of 1 severe or 2 moderate exacerbations a year, then offer LABA+LAMA+ICS

WITH ICS DISCUSS RISK OF USING ICS including pneumonia

Acute exacerbation of COPD – triggered by infections, smoking and environmental pollutants

Severe breathlessness, increased cough, increased sputum production and change in colour, increased wheeze, and chest tightness, cold or sore throat, reduced exercise tolerance, ankle swelling, increased fatigue, and acute confusion

FOR SEVERE exacerbation – ADMISSION

FOR non-severe – increase dose or freq of SABA and maybe change to nebuliser for ease of admission

If no contraindications with significant increase in breathlessness – offer 30mg oral prednisolone OD x 5 days or if caused by infection then amoxicillin 500mg TD x 5 days, doxycycline 200mg day 1, 100mg OD x 5 days, or clarithromycin 500mg BD X 5 days

Epilepsy

Cause – abnormal excessive or synchronous brain activity

Symptoms

Short-lived (less than 1 minute), abrupt, generalised muscle stiffening with rapid recovery — suggestive of tonic seizure.

Generalised stiffening and subsequent rhythmic jerking of the limbs, urinary incontinence, tongue biting —suggestive of a generalised tonic-clonic seizure.

Behavioural arrest — indicative of absence seizure.

Sudden onset of loss of muscle tone — suggestive of atonic seizure.

Brief, 'shock-like' involuntary single or multiple jerks —suggestive of myoclonic seizure.

Management

During seizure – protect from injury by placing in recovery position. If tonic-clonic seizure is prolonged (more than 5 mins) or recurrent – emergency buccal midazolam or emergency admission

Annually reviewed – assess seizure control, how it’s affecting QOL, adverse effects and compliance with drug

Women of childbearing age – 13 to 60

Epileptic women not treated with drugs or on non-enzyme inducing antiepileptic (except lamotrigine) – contraceptive options are same as general population

Woman on exyzme-inducing drugs – drug can reduce effectiveness of combined hormonal contraception, progestogen-only pills, transdermal patches, the vaginal ring, and progestogen-only implants. OFFER medroxyprogesterone acetate injections or an intrauterine method (copper intrauterine device or the levonorgestrel-releasing intrauterine system)

Woman on lamotrigine – oestrogen containing contraceptive reduces efficacy of lamotrigine

USE progesterone only instead but educate them to report signs of lamotrigine toxicity

Category 1 (ensure the person is maintained on a specific manufacturer's product) — phenytoin, carbamazepine, phenobarbital, primidone.

S/E – common and usually mild, advise to report and can usually be fixed with dose adjustment or change of drug

Sedation and dizziness, suicidal thoughts and behaviour, acute psychotic reactions, weight gain and loss, skin rashes.

Safe in pregnancies – lamotrigine (Lamictal) and levetiracetam (Keppra) are safest options

Anxiety

Uncontrollable widespread worry and range of cognitive and behavioural symptoms

Slow onset and symptoms don’t usually improve but are better controlled with intervention

Diagnosis – worry associated with restlessness, insomnia and muscle tension, fatigue, poor concentration, irritable. ALWAYS ask about alcohol and drug use including OTC

Treatment

Establish diagnosis and severity of anxiety and any other comorbidities (usually insomnia and depression and whichever is the most pressing is treated first) – explaining the disorder and treatment opportunities and starting them with active monitoring of symptoms either self or through regular meetings

Offer CBT – non-facilitated self-help for 6 weeks, individual guided self-help, educational groups

High intensity CBT, applied relaxation or drug therapy

Drug therapy – 1st line is SSRI (sertraline, paroxetine, or escitalopram) 2nd line SNRI (duloxetine or venlafaxine). If both contraindicated or intolerable then Pregabalin.

Review effectiveness and ADR every 2-4 weeks during first 3 months then every 3 months.

Counsel on common effects during treatment initiation (suicidal thoughts and worsening of anxiety) but importance of reporting this instead of withdrawing from drug

SSRI – don’t take NSAIDS or if prescribed take with PPI

For pregnant women step 3

DO NOT give benzo or antipsychotics in primary care

Benzodiazepines (SCH 3 and 4)

Most commonly used anxiolytics and hypnotics

Short rem relief (2-4 weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress

use to treat short-term ‘mild’ anxiety is inappropriate

Sch 4 CDs, apart from temazepam

Sch 3 (CD no register) and midazolam

Pharmacological effects of benzodiazepines

Sedation, sleep induction

sleep, but can still cause arousal

decreased anxiety, amnesia at higher doses

muscle relaxation (both midbrain and spinal effects)

anticonvulsant activity

Reduced aggression

Depression

Persistent low mood and/or loss of pleasure in most activities and range of emotional, cognitive, physical, and behavioural symptoms

Diagnosis

Low mood

Loss of interest/pleasure from normally pleasurable activities (anhedonia)

Reduced energy (fatigue)

Low self-esteem; feelings of guilt

Inability to think/concentrate

Altered psychomotor activity

Sleep disturbance; early morning wakening

Altered appetite

Suicidal thoughts

Diagnosis requires 2 core symptoms plus 2 or more others present for most of the day on most days for the last 2 weeks

Differential diagnosis

Ensure symptoms are not caused by physical illness, alcohol, medication, or illicit drug use

The symptoms aren’t caused by normal grief (death of family) – maybe consider very long grief

Never been a manic (severe levels of high mood) or hypomanic (to a reduced level) episode

Treatment

Dependant on accurate assessment and diagnosis of depression

Psychological

CBT, behavioural activation, interpersonal psychotherapy, problem solving therapy

Social

Identify stressors and work on strategies/signposting to other supporting organisations

Biological – moderate to severe

Antidepressant therapy or antidepressant and antipsychotic combination therapy in psychotic depression

Drug classes

Tricyclic antidepressants (TCAs) e.g., amitriptyline

Selective serotonin reuptake inhibitors (SSRIs) e.g., fluoxetine

Serotonin and NA uptake inhibitors (SNRIs) e.g., venlafaxine

Monoamine oxidase inhibitors (MAOIs)

Irreversible e.g., phenelzine (MAO-A and B)

Reversible e.g., Moclobemide

Atypical antidepressants e.g., Mirtazapine

Noradrenaline reuptake inhibitors (NRIs) e.g., Atomoxetine

TCA - S/E – Short lasting (days) sedation, confusion, and Incoordination in both normal and depressed patients, antimuscarinic effects, dry mouth, blurred vision, decreased mucus production. Dangerous CV effects in OD 

Severe depressive at risk of suicide shouldn’t be given TCA

Interactions – potentiation of the effects of alcohol – alcohol is a depressant and will only compound the depressive effects

SSRI’s - S/E – nausea, anorexia, insomnia, and loss of sexual function

Less anticholinergic side-effects and less dangerous in OD than TCAs. Prolonged QTc – cardiovascular complications risk with citalopram  interactions – NSAIDs, Anticoagulants, triptans

SNRI’s - S/E – significant withdrawal effects – have short half-lives so need to be taken regularly to avoid these effects. Complex nature of TCAs makes them difficult to prescribe to complex patients unlike SNRIs

Interactions – NSAIDs and anticoagulants

MAOIs - S/E – antimuscarinic effects, restlessness as a result of CNS excitation

Interactions – serious food and drug reactions e.g., cheese (tyramine from food such as cheese is broken down by MAO. The lack of breakdown from MAOIs can lead to tyramine actively displacing neurotransmitters such as 5HT, DA, NA – causing hypertensive crisis

VERY IMPORTANT COUNSELLING POINTS

No other drugs or illicit drugs with this

Side effects

Drug and food interactions are unacceptable.

“Cheese reaction”: this occurs when amines that are generated during fermentation, like tyramine, are ingested and absorbed from the gut. (The main danger is ripe cheese, yeast products - Marmite).

Large rise in systemic tyramine indirectly results in a large release

    of catecholamines

Hypertensive crisis characterised by throbbing

            headache, tachycardia & cardiac arrhythmias.

Same can occur with drugs (Pseudoephedrine)

Atypical antidepressants - S/E- sedation, weight gain, increased appetite – good in patients with anorexia or depression causing loss of appetite or weight

Blood disorders – counselling

Withdrawal issues

Can be used with other antidepressants that cause sleep issues

Interactions – alcohol

FDA black box warning – suicide

Treatment

Mild symptoms – psychological therapy

Persistent mild symptoms or moderate to severe symptoms – combination of psychological and drug therapy

1st line treatment usually SSRIs

2nd line switch to alternate SSRI

3rd line switch to different class (normally an SNRI)

Practical issues

Initiating an antidepressant can cause feelings of anxiety consider co-prescribing short course of benzodiazepines to counteract the anxiety

During the first few weeks of antidepressant treatment can have worsening suicidal thoughts with improved motivation so ensure counselling and regular reviews

Consider prescribing limited supply of meds to reduce chance of OD

Side effects often transient and improve with time

Caution when switching antidepressants – table of different half-lives and how to taper them

Treatment approach

If no response to 3 antidepressants, then check concordance, review diagnosis, and consider if social problems are maintaining depression

Consider augmentation – addition of drug to the current therapy

Mirtazapine – sleep

Quetiapine – mood

Aripiprazole

Lithium – mood stabiliser

Lamotrigine – mood stabiliser

Electroconvulsive therapy

Response

2-4 weeks usually for response to be seen (longer in elderly)

Improvement greatest during weeks 1-2

If no response during 2–4-week period, consider first increase in dosage then if again limited efficacy, then switch to alternative

Extended duration if treatment trial will lead to additional benefit in some

Differences between drugs

Mirtazapine, escitalopram, venlafaxine, and sertraline

more efficacious than

duloxetine, fluoxetine, fluvoxamine, paroxetine and reboxetine

Reboxetine less effective overall

Escitalopram and sertraline

better tolerated than

duloxetine, venlafaxine, fluvoxamine, paroxetine and reboxetine

Preventing relapse

Relapse rate 3-6 months post remission is 50% with no drug treatment

A/D treatment reduces absolute risk of relapse by about 50%

After 1st episode continue for 6-9 months

After 2nd episode continue for 12 months

After 3rd episode continue for 2 years

Insomnia – difficulty in getting to sleep or staying asleep long enough to feel refreshed the next morning

Causes

Recreational drugs

caffeine, nicotine, alcohol, cannabis)

Medicinal drugs

anticonvulsants, antipsychotics, b-blockers, SSRIs, MAOIs, steroids, decongestants, Alpha agonists and antagonists, narcotic analgesics

Drug withdrawal

from CNS depressants (eg alcohol, anxiolytics/hypnotics)

Physiological

Diet, late night exercise, shift work (night and evening work)

Environmental

Noise, bright lights, extremes of temperature

Medical conditions

Psychological - anxiety, depression, grief, stress

Non-psychological eg chronic pain, gastric reflux, asthma, sleep apnoea

Types of insomnia

Primary insomnia - insomnia not attributable to a medical psychiatric or environmental cause

Secondary insomnia- insomnia secondary to another condition

Transient (2-3 days) – caused by changes in routine (for eg. change in time zone, alteration of shift work)

Short term (<3 weeks) – may result from temporary environmental stress

Chronic insomnia (>3 weeks) –usually secondary to other conditions

Treatment

FIRST LINE IS ALWAYS NON-DRUG treatments e.g., lifestyle changes and CBT

Drug therapy – Hypnotics

Benzodiazepines

Benzodiazepine-like drugs (Z-class)

melatonin

BEFORE hypnotic is prescribed the cause of insomnia must be established and where possible, underlying factors should be treated

NICE recommends

if hypnotic medicine is the appropriate way to treat one for only short periods of time and strictly according to the licence for the drug. (Usually, 1-2 weeks and max 4 weeks) and should be prescribed on a weekly basis

Benzodiazepines

 Most benzodiazepines

decrease time taken to get to sleep

in individuals who habitually sleep <6hr, the drug increases duration of sleep

Few short-acting BDZs recommended for insomnia (short-term treatment – max 2-4 weeks)

Should only be used when SEVERE, DISABLING or causing EXTREME DISTRESS

Benzodiazepine – like drugs

Z -Hypnotics – Zaleplon, zopiclone, zolpidem (Short acting – t1/2 < 8 hr)

Short term use only (2-4 weeks)

Lack of anxiolytic effects –drowsiness or dizziness - just induce sleep

Melatonin treatment

Prolonged release melatonin available for primary insomnia in over 55yr olds (can be used up to 3 weeks)

Antihistamine gen 1 – can cause drowsiness

Anxiolytics

Kalms, Kalms day, Karma, Karmamood, Potters Newrelax, Relaxherb, Stressless

Hops, valerian, passionflower, passiflora, vervain, St John’s Wort

Sedatives

Kalms night, Kalms sleep, Dormesean, Niteherb, Nytol herbal, Potters Nodoff, sominex herbal

Hops, valerian, vervain, skullcap, wild lettuce, passiflora

Some herbal remedies do contain active ingredients so be careful of interactions

Lifestyle changes – promote sleep hygiene

establishing fixed times for going to bed and waking up

trying to relax before going to bed

maintaining a comfortable sleeping environment avoiding napping during the day

avoiding caffeine, nicotine, and alcohol late at night 

avoiding exercise within four hours of bedtime 

avoiding eating a heavy meal late at night

avoiding watching or checking the clock throughout the night

using the bedroom mainly for sleep if possible

avoid going on phone, looking at screens immediately before bed or whilst in bed

ADHD

Persistent developmentally with inappropriate levels of over reactivity, inattention and/or impulsivity

Diagnosis – based on observation there are no biomed tests

Symptoms – 9 symptoms across 2 domains

Hyperactivity/impulsivity

Inattention

Can be combined type or dominant in one

ADHD – Predominantly inattentive type

Fails to give close attention to details or makes careless mistakes.

Has difficulty sustaining attention.

Does not appear to listen.

ADHD – predominantly Hyperactive/impulsive type

Fidgets with hands or feet or squirms in chair.

Acts as if driven by a motor.

Blurts out answers before questions have been completed.

Difficulty waiting or taking turns.

Interrupts or intrudes upon others.

ADHD – Combined type

Patient meets both sets of inattention and hyperactive/impulsive criteria

ADHD – Differential diagnosis

Sensory impairment – leading to under or over-sensitivity to triggers

Epilepsy and related states – could present as inattention

Effects of head injury

Acute or chronic medical illness

Poor nutrition – linked to poor behavior – not directly linked to ADHD

Sleep disorders – linked to poor behavior – not directly linked to ADHD

Side effects of medication

School or classroom difficulties – bullying or other factors

Large links to exposure to smoking and drinking during pregnancy, childhood illness such as meningitis or other viral infection, low birthweight/prematurity. HIGH heritability

Treatment

Mild-moderate –1st line - parent-training/education programmes with parent and child, group based or individual sessions. Teachers receive ADHD training and offer intervention in schools.

2nd line – CBT or social skills training

3rd line – DRUG THERAPY ONLY FOR SEVERE and should be offered along with psychological, behavioural, and educational interventions

Drug therapy

Methylphenidate – generally first choice

Atomoxetine - if other tics, Tourette's syndrome, anxiety disorder, stimulant misuse or risk of stimulant diversion are present

D-amphetamine – ONLY if other drugs ineffective at raised doses – CD2 high risk in addiction and dependence and misuse so used as last resort

Decide which drug treatment to use based on:

their different adverse effects

potential problems with compliance (for example, if a mid-day dose is needed at school)

potential for drug diversion (taken by others) and misuse

preferences of the child or young person and their parent or carer

When a decision has been made to treat children or young people with ADHD with drugs, healthcare professionals should consider: –

methylphenidate for ADHD without significant comorbidity

methylphenidate for ADHD with comorbid conduct disorder

methylphenidate or atomoxetine when tics, Tourette’s syndrome, anxiety disorder, stimulant misuse or risk of stimulant diversion are present

atomoxetine if methylphenidate has been tried and has been ineffective at the max dose, or the child intolerant to low or moderate doses of methylphenidate.

Atomoxetine

Closely observe children or young people taking atomoxetine for agitation, irritability, suicidal thinking, and self-harming behavior, particularly during the initial months of treatment, or after a dose change.

Liver damage in rare cases (usually presenting as abdominal pain, unexplained nausea, malaise, darkening of the urine or jaundice).

Treatment of adults

In adults, methylphenidate normally first line treatment

Consider atomoxetine or dexamphetamine if symptoms do not respond to methylphenidate or the person is intolerant to it ~6 weeks.

Selection of appropriate medication

Immediate-release preparations if more flexible dosing is required or during initial titration to using methylphenidate, consider determine correct dosing levels

If there is a choice of more than one drug, use the drug of lowest overall cost

modified-release preparations for convenience…

their pharmacokinetic profile,

improving adherence,

reducing stigma (because the drug does not need to be taken at school)

reducing problems of storing and administering controlled drugs in schools

abuse liability

AUTISM

Symptoms

Socialization

Impaired use of non-verbal behaviors to regulate interactions

Delayed peer interactions, few or no friendships, and little interaction

Absence of seeking to share enjoyment and interests

Delayed initiation of interactions

Little or no social reciprocity and absence of social judgment

 Communication

Delay in verbal language without non-verbal compensation (gestures)

Impairment in expressive language and conversation, and disturbance in pragmatic language use

Treatments

NEED early diagnosis and defined biomarkers

Currently intervention is through family and educational support

Only some specific programs have an evidence base

Aim is to ‘improve the functional status…through skill acquisition in core areas’

Eg developing relationships

Achieving social and environmental milestones through play

Positive reinforcement of social communication

Pharmacological treatments for co-morbidities

Developmental

Hyperactivity/impulsivity (see ADHD)

Psychiatric

SSRIs, other antidepressants for depression

atypical antipsychotics for OCD

SSRI or a2 agonists for anxiety

Behavioural

Atypical antipsychotics (irritability, aggression)

Sensory

Neurological

anticonvulsants and fits, a2 agonists for tics

Gastrointestinal

Sleep disruption

melatonin and clonidine

Dementia

Symptoms –

Higher cognitive function affected

Memory, thinking, comprehension, learning capacity, language (speaking and understanding it)

Daily living activities/emotional behaviour (non-cognitive symptoms)

Behavioural and psychological symptoms of dementia (BPSD) – include agitation, apathy, depression, anxiety, delusions, hallucinations, irritability, and wandering

Treatment -

Acetylcholinesterase (AChE) inhibitors (donepezil, galantamine, and rivastigmine) — as monotherapies for managing mild to moderate Alzheimer's disease.

Memantine (a N-methyl-D-aspartic acid receptor antagonist):

As monotherapy for managing Alzheimer's disease for people with moderate Alzheimer's disease who are intolerant of, or have a contraindication to, AChE inhibitors, or for people with severe Alzheimer's disease.

In addition to an AChE for people with established moderate or severe Alzheimer's disease who are already taking an AChE

For people with non-Alzheimer's dementia the use of AChE inhibitors or memantine is unlicensed, but they may be prescribed by a specialist for people with:

Mild to moderate dementia with Lewy bodies:

Donepezil or rivastigmine are recommended first line.

Galantamine is an option if donepezil and rivastigmine are not tolerated.

Severe dementia with Lewy bodies:

Donepezil or rivastigmine are recommended.

Vascular dementia:

AChE inhibitors or memantine are options if the person has suspected comorbid Alzheimer's disease, Parkinson's disease dementia, or dementia with Lewy bodies.

Risperidone and haloperidol are the only antipsychotics licensed for treating non-cognitive symptoms of dementia, although other antipsychotics are often prescribed off-label for this purpose.

Acetylcholinesterase inhibitors

NMDA receptor antagonist

Cholinesterase inhibitors for mild to moderate AD (eventually stop working)

NMDA receptor antagonist for severe AD and moderate AD in some cases

Treatment must be started only by a specialist clinician

Rheumatoid arthritis

Inflammatory disease causing persistent symmetric joint synovitis

Presents as pain and joint stiffness with heat and swelling progressing at rest and after periods of inactivity with malaise, fatigue, fever, and weight loss

Risk factors – smoking, eating large amounts of red meat, drinks excessive coffee

Symptoms

Joints

Pain

Swelling

Stiffness

Systemic

Fatigue, depression, irritability

Anaemia

Flu-like symptoms, such as feeling generally ill, hot, and sweating

Pain worse in morning

Treatment

Drugs, mild exercise (enhance flexibility of joint and muscle strength), lifestyle changes (rich antioxidant diet, no smoking)

Main types of RA meds

NSAIDs (short term symptomatic relief) – reduce inflammation. OTC (ibuprofen, naproxen). POM (celecoxib, etoricoxib)

S/E – GI irritation, ulcers (use at lowest dose and take with food, use PPI to lessen effects)

Caution – asthmatics and renal impairment and patients with increased CV risk

Disease-modifying anti-rheumatic drugs (DMARDs) – 1ST LINE for active RA (methotrexate, sulfasalazine)

S/E – Nausea, diarrhoea, oral ulceration, alopecia, cough, SOB, bone marrow suppression – CAN BE REDUCED by co-prescribing FOLIC acid 1mg daily

Biological therapies (type of DMARD) – used when DMARDS don’t control RA

Glucocorticoids – short term treatment when starting new DMARD for rapid symprom control  - also used in flares

Analgesics (painkillers)

Drug Treatment Schedule

Start two DMARD regime once diagnosed, using titration regimens

Use anti-inflammatories (NSAIDs), paracetamol with or without corticosteroids until effective

Review after 6 months: increase dose or switch as clinical condition determines.

Patient counselling in RA

Place of drugs in therapy

Onset of action

Side effects

Immunosuppression

Regular painkillers

Regular monitoring including blood tests

Dexterity aids, prescription services

Osteoarthritis

Predominantly non-inflammatory and caused by cartilage loss from synovial joints and bone remodelling due to excessive and repeated overloading on weight bearing joints or stress of a joint over tome and specific injuries

Risk factors – genetic, age, gender, obesity, damage, occupational, and stress

Symptoms

Pain – tends to be worse when using the joint and at end of the day (Worsens on use, resolves at rest)

Stiffness – feel stiff after rest, usually wears off as you get moving

Grating or grinding sensation (crepitus) – joints creak or crunch as you move

Swelling – may be caused by osteophytes (bone outgrowth) or caused by synovial thickening and extra fluid

Muscles around joint look thin/wasted

Unable to use joint normally – doesn’t move as freely or far as normal

Joints give way – muscles have weakened, and joint is less stable

Management

Provide information on sources of advice and support

Advice on self-care strategies such as;

Weight loss, local muscle strengthening exercises and aerobic fitness training

Appropriate footwear, local heat, or cold packs

Odder psychosocial support – career and occupational health assessments if needed

Advice on simple analgesia

Arranging regular reviews to assess response to treatment

MANAGEMENT GOAL – pain reduction and symptomatic relief

First line:

Paracetamol regularly – 4g daily

Topical NSAIDs

Additional treatment:

Oral NSAIDs– not first line

-Start with ibuprofen

-Monitor for side effects

-Possible place for topical therapy

Topical capsaicin – adjunct and helpful in knee and hand – works by stimulating then decreasing the pain sensation

Corticosteroid injection: â pain and inflammation of flare-up

Role of pharmacist

Counselling:

dosage regimen

side effects

warnings

Monitoring for side effects

Weight loss advice

Physiotherapy advice

Compliance aids & living aids

Gout

Type of inflammatory arthritis – causes severe pain and damage to joints

Caused by abnormal high levels of uric acid in blood which deposits urate crystals in joints and tissue

3 phases

Asymptomatic hyperuricaemia – can remain in this stage for life

Acute attack of gouty arthritis – can vary from months to years before another attack

Final period of chronic tophaceous gout – nodules effecting joints

Treatment

Acute

Ice

Rest affected joint

NSAIDs – short term, 7-14 days, high dose, for pain relief and anti-inflammatory

Colchicine (Dose: 500mcg 2-4 x daily until symptomatic relief or SE (stomach cramps, diarrhoea, vomiting)), steroids (used when NSAID and colchine is contraindicated or not useful)

Choice of drug dependant on comorbidities and renal function (NSAID cause fluid retention whereas colchicine doesn’t)

Colchicine use limited as it can have sudden toxicity at higher conc

Combination treatment can be used as well if monotherapy isn’t controlling the attack

Long term treatment to reduce urate

Lifestyle modifications (reduce dietary intake)

Drug therapy: Allopurinol (1st line – offer to all, 100mg od, increased in 100mg increments every 2-3 weeks) S/E – rashes

Febuxostat (2nd line only use when allopurinol intolerant or contraindicated – 60mg OD dose)

Monitor urate level – aim for < 360 μmol/L or 6 mg/dl (critical level)

Muscoskeletal

Sprain

Commonly ankle, wrist, thumb, knees – pain, swelling, tenderness, bruising, disabled use and no weight

Strain

Common in legs and lower back – pain, swelling, bruising, red, and reduced function

BOTH

Self-limiting gets better in 4-6 weeks and full recovery in 12 weeks

Non-pharma advice

PRICE (Protect, Rest (48-72hrs), Ice immediately after, Compression bandages and Elevate to reduce swelling

Reduce HARM (Heat, alcohol, running and massaging for 72hrs.

Avoid NSAIDs for 72hrs

Exercises for sprains

Gently move joint in all directions to increase and maintain flexibility (lack of movement can delay recovery BUT severe sprains with complete lack of movement rest for 10 days first)

Treatment – topical and oral analgesics

Refer – severe pain, possible break or fracture, no alleviation with OTC meds

Lower back pain

Symptoms – pain, tension, soreness, stiffness without underlying cause

6 weeks usual recovery can be up to 12 weeks

Advice

Back exercises, improve posture, yoga, avoid lying or sitting for too long, remain active.

Sleep in different positions, pillows between legs, under knees, hot baths, hot water bottles, ice packs.

Treatment

OTC – topical analgesics or co-codamol if still painful

Refer

No improvement in 3 days, continues for more than 6 weeks, pain travels higher, pain after injury, younger than 20, older than 50, pain affects sleep, unsteady on feet, unexplained weight loss

EMERGENCY

Pins and needles in back, genital, bum, both legs, lose urine or bowel control

Conjunctivitis

Symptoms

Bacterial

Viral

Allergic

Eyes affected

1 or 2

Both

Both

Discharge

Pussy

Watery

watery

Sensation

Gritty

Gritty

Itchy

Co-presenting symptoms

None

Cough/cold

Rhinitis

If pussy, red or gritty it is contagious – allergic ISNT contagious

Advice

Don’t wear contacts, hold cold flannel on eyes for few mins to cool them, use FBC water to gently wipe lashes and clean off crust and clean with cotton wool pad. Use a different one for each eye

Control spread by – reg wash hands with hot soapy water, cover mouth and nose when sneezing, don’t share towels or pillows and don’t rub eyes

Refer

Baby less than 28 days old with red eyes, allergic reaction, or spots on eyelids. For all – symptoms not resolved after 2 weeks

111 - Severe pain, sensitive to light, sudden changes to vision

Treatment

Viral – self-limiting, use hygiene and non-pharma advice

Allergic – Opticrom eye drops (Adults and child – 1-2 drops in each eye up to 4x daily)

Bacterial – over 2, chloramphenicol drops/ointment (Optrex Bacterial Conjunctivitis 1%w/w Eye Ointment) - apply a small amount of ointment in the affected eye 3-4 times daily for 5 days

Blepharitis

Symptoms

NOT contagious, rims of eyelids are inflamed, burning, soreness or stinging in the eyes, crusty lashes that stick together, itchy eyelids

Advice

Clean eyelids at least 1x daily, clean eyes even if symptoms clear, don’t wear contacts, or eye makeup

Cleaning eyes – soak a clean flannel/cotton wool in warm water and place on eye for 10 mins, gently massage eyelids for 30 secs, clean lids using cotton wool. Baby shampoo at 10:1 ratio good.

Refer

No improvement after 2 weeks of cleaning eyes

Treatment OTC

Brolene eye drops – 1-2 drops in each eye up to 4 x daily. If not better in 2 days refer

Dry eyes

Symptoms

Dry feeling, sensation of something in eye, burning, grittiness, itching, light sensitivity, over-blinking, redness, excess tears (randomly tearing)

Causes – over 50, contacts, digital screens, AC, windy/cold/dry/ dusty environment, smoking, alcohol, meds (antidepressants/BP) medical conditions (blepharitis)

Refer

Treatment failure after 2 weeks, change in eyelid shape

111 – severe pain and red, contact wearer with red eyes (could be an infection)

999 A&E – sudden change in sight, bursts of light sensitivity, severe headache/nausea, dark red eyes, injured/pierced eye, something stuck in eye

Advice

Clean eyes daily, take breaks when using screens, use screens below eye level, use humidifier, wear glasses instead of contacts

Treatment 

Light lubricant – Optrex Double Action Drops for Dry and Tired Eyes - Apply 1-2 drops in each eye.

Hyaluronic Acid - Artelac Rebalance Drops, long lasting relief - Place 1 drop into the conjunctival sac 3-5 times daily or more frequently if required.

Hypromellose drops – 1-2 drops 3 x daily

Excessive ear wax

Symptoms – hearing loss, earache, noise/ringing, vertigo, dizziness, and nausea

Causes – narrow/damaged canals, hairy canal, skin condition affecting scalp around ear, inflammation of ear canal

Refer – not cleared in 5 days, badly blocked, severe, complete loss of hearing, likely infection

Advice – don’t use fingers or cotton buds to remove wax

Treatment

Olive oil drops – 2-3 drops in affected ear and massage around outside of ear BD x 7 days

Use dropper when lying down with head to one side to allow oil into ear, over 2 weeks then lumps should fall out, but symptoms should be better within 5 days

Otitis externa

Symptoms - pain, discharge, itch, irritation, external ear/canal appears red, swollen, eczema, deafness, skin swells, tender to touch

Refer – ear pain in children, inflamed pinna, unsuccessful treatment (after 4 days), hearing aids, excessive discharge (wax or pus), high fever, vomiting, fatigue, confusion, dizzy, stiff neck, rash, slurred speech, fits, light sensitivity

Advice – avoid under/over dressing feverish child, lower heating, offer regular fluids, avoid dummies when lying flat, give paracetamol/ibuprofen if child is unwell/distressed (not together)

Treatment

Acute localised (furunculosis) – infected hair follicles in outer-ear causing swelling and irritation

Treatment – hot flannel, oral analgesics, antibiotics if severe

Acute diffuse (over 3 months – more widespread inflammation of skin, bacterial/fungal infection or contact dermatitis due to irritant/allergens

Treatment – earwax plus or EarCalm

Otitis media

Symptoms – earache, discharge, hot, irritable, sleeplessness, ear pulling/rubbing, crying, temporary deafness

Refer – recurrent infections, no improvement in 3 days

Treatment

Self-limiting should be better in 3 days, single analgesics for pain

Hyperthyroidism

Too much thyroid hormones produced naturally

Symptoms

Tremor, warm sweaty palms, weigh loss despite increasing appetite, heat intolerance, diffused alopecia, hair thinning, tachycardia, diarrhoea

Advice

Healthy diet with foods rich in antioxidants, green leafy vegetables (broccoli, cabbage etc)

Vitamin D, omega 3 fatty acids and calcium rich foods. Smoking cessation

Treatment

Carbimazole (adjunct B blocker propylthiouracil for adrenergic symptoms) – block and replace regime

Combo of fixed high dose carbimazole and levothyroxine

Radioactive iodine destroys thyroid cells, surgery to remove some thyroid

Hypothyroidism

Thyroid gland doesn’t produce enough hormones caused by immune system attacking thyroid gland and damaging ait or by damage to thyroid that occurs during treatments for a hyperthyroidism or thyroid cancer

Symptoms

Fatigue, muscle pain, weakness, weight gain, sensitive to cold, dry skin, brittle hair, nails, depression, reduced libido

Advice

Eat antioxidant rich food, seeds and nuts, tyrosine (meat, dairy, legumes)

Avoid – soy, iodine rick food, leafy green vegs, caffeine, alcohol – quit smoking, alcohol.

Inform GP if pregnant (needs treatment and monitoring during)

Treatment

Levothyroxine 1st line – dose depends on blood test and progression – take tablet at same time every day (MORNING) If taking too much causes sweating, chest pain, headaches, diarrhoea, vomiting. Supressing thyroid supressing hormone with high doses causes atrial fibrillation, stroke, osteoporosis

Cold sores

Symptoms

Simplex - Pain, burning, itching, tingling before lesions and lasts 6-48 hrs

Crops of vesicles burst and crust over and heal, commonly on lower lip and ends of mouth

Gingivostomatitis – fever, malaise, sore throat, painful nodules in cervix or under jaw, excessive salivation. Painful vesicles on a red swollen base that rupture to form ulcers inside mouth, covered with yellow/grey membranes

Refer – immunocompromised, unable to swallow, risk of dehydration, severe infection, complication, pregnant, recurrent

Treatment

Paracetamol/ ibuprofen for symptoms

Topical acyclovir/penciclovir OTC – use from onset of symptoms before lesions until lesions heal

OTC topical anaesthetic or analgesics, mouthwashes, or lip barriers – topical analgesics aren’t licensed in children

DON’T prescribe oral antiviral for healthy people

Consider prescribing oral antiviral for healthy people with episode of primary oral herpes simplex, recurrent labialis if lesions are severe, frequent, or persistent and recurrent

And for those who are immunocompromised

Should take at onset and until lesions have healed – minimum of 5 days

Choice of aciclovir or valaciclovir based on preference, dose, regimen, and adherence

Advice

Reassure its usually self-limiting and heals without scarring

Adequate fluid intake

Offer leaflets or websites for more info

Avoid kissing, oral until lesions fully healed, don’t share pillows, makeup, or lip balms. Don’t touch lesions other than when applying treatment – dab instead of rubbing. Wash hands after touching.

Athletes foot

Interdigital — most common; affects the lateral toe web spaces first; usually caused by Trichophyton rubrum.

Moccasin or dry — diffuse chronic scaling and hyperkeratosis affecting the sole and lateral foot; usually caused by Trichophyton rubrum.

Vesicobullous — least common; multiple small vesicles and blisters mainly on the arches and soles of the feet; usually caused by Trichophyton interdigital.

Risk – hot, humid, occlusive footwear excessive sweating, contaminated surfaces, immunocompromised

Advice

Wear well fitting, open footwear that keep feet cool and dry, replace old shoes that may be contaminated. Maintain good foot hygiene – wear different pair of shoes every 2-3 days. Wear cotton, absorbent socks, don’t scratch skin, after washing feet dry then well and between toes, don’t share towels and wash towel freq.

Treatment

Topical antifungal cream in mild, non-extensive disease

Terbinafine 1% cream (12 and over – apply thinly to affected area 1 or 2 daily for 7 days) or clotrimazole 1% cream (2-3 times daily and continue for 4 weeks minimum) okay for kids – OTC for some ages

Additional mild topical corticosteroid if there’s inflammation

Hydrocortisone 1% cream (OD for max 7 days)

Adult severe or extensive – oral antifungal with confirmed fungal infection

1st choice – terbinafine (250 mg once daily for 2–6 weeks, depending on the severity of infection)

2nd – itraconazole, Griseofulvin if not tolerated or contraindicated

Refer

Treatment failure, severe pain, got, painful and red (indicative of serious infection), infection spreads, diabetic patient, immunocompromised

Warts and verrucae

Warts – small, rough growths caused by infection of skin with HPV, form anywhere on skin most commonly on hand and feet

Verruca – (plantar wart) wart on sold of feet

Spread by direct contact, occur and clear spontaneously at any time or may take years

Common warts are firm and raised with a rough surface that resembles a cauliflower (common on knuckles, knees, and fingers).

Periungual warts are common warts around the nails that can be painful and disturb nail growth — nail biting is a risk factor.

Plane warts are usually round, flat-topped, and skin coloured or greyish yellow (common on the backs of hands).

Filiform warts have a finger-like appearance and may have a stalk (more common on the face and neck).

Palmar and plantar warts grow on the palms and the soles of the feet (verrucae). They often have central dark dots (thrombosed capillaries) and may be painful.

Mosaic warts occur when palmar or plantar warts coalesce into larger plaques on the hands and feet.

Not harmful and don’t come with symptoms and resolve with treatment

Advice

Reducing transmission and limit spread, keep feet dry, wear slippers or waterproof plaster in shower and communal areas. don’t share towels, socks, shoes. Don’t scratch lesions, bite nails or suck fingers with warts

Refer

Painful, facial, uncertain diagnosis, immunocompromised, extensively infected

Treatment

Only treated if painful, cosmetically unsightly, or patient request and persistent as the treatment is long and can have side effects.

Topical salicylic acid – up to 12 weeks

Duofilm® (salicylic acid 16.7% plus lactic acid 16.7%) — licensed for plantar and mosaic warts.

Bazuka® extra strength gel (salicylic acid 26%) — licensed for warts and verrucae.

Occlusal® (salicylic acid 26%) — licensed for common and plantar warts.

Salactol® (salicylic acid 16.7% plus lactic acid 16.7%) — licensed for warts, plantar warts, and verrucae.

Apply OD at night, file and soften area by soaking in warm water for 5-10 mins, peel of remaining film before administering next dose, don’t apply on healthy skin

Cryotherapy – every 2 weeks for max 6 treatments

Liquid nitrogen – only for older children and adults

Corns and calluses

Hard or thick areas of skin that can be painful

Corns – lumps of hard skin on knuckles and joints of toes

Callouses – larger patches of rough, thick skin

Both can be tender and painful

Refer

Diabetic, heart disease, circulation issues. Bleeding or puss, treatment failure after 3 weeks, severe pain

Advice

Wear thick, cushioned socks, wear wide, comfortable shoes with low heel and soft sole, use insoles or heel pads, soak corns and calluses in warm water to soften them, use pumice stone regularly or foot file to remove hard skin. Moisturise.

Don’t try to cut them, walk, or stand for long period, wear high heels or tight pointy shoes, go barefoot

Treatment

Heel pads and insoles, OTC products, pain relief

Carnation brand caps for both – adhesive dressing

Fungal nail infection

Caused by dermatophyte and non-dermatophyte moulds and yeasts

Symptoms

Discoloured, abnormal, small flaky white patches and pits on top of nail and becomes rough and eroded. Nail lifted, wite or yellow opaque streaks on one side of nail, scaling, thickening

Refer

Diabetic, severe, treatment failure, spread to other nails

Advice

Keep nails trimmed short and filed, don’t share clippers and files. Well-fitting shoes, cotton socks, maintain good foot hygiene, weak shoes in communal places, avoid nail trauma

Treatment

Not needed if patient not troubled by appearance and infection is asymptomatic

Advise antifungal treatment if – walking uncomfortable, distress, cosmetic, co-morbid complication, or complication

If dermatophyte or candida infection conformed – topical antifungal treatment 0f 50% of nail involved, 2 nails infected, contraindication to oral antifungal

Topical – amorolfine 5% mail lacquer – OTC apply 1 or 2 weekly to affected nail after gentle nail filing – 6 months minimum for fingernails, 12 months for toenails

If dermatophyte nail infection is confirmed:

Prescribe oral terbinafine first-line.

250 mg once a day for between 6 weeks and 3 months for fingernails, and for 3–6 months for toenails

Oral itraconazole if an alternative drug is indicated.

Prescribe as pulsed therapy 200 mg twice a day for 1 week, with subsequent courses repeated after a further 21 days.

If Candida or non-dermatophyte nail infection is confirmed:

Prescribe oral itraconazole first-line.

Prescribe as pulsed therapy 200 mg twice a day for 1 week, with subsequent courses repeated after a further 21 days.

Prescribe oral terbinafine if an alternative drug is indicated.

Prescribe 250 mg once a day for between 6 weeks and 3 months for fingernails, and for 3–6 months for toenails.

[alusa12]

Massage for Sciatica Relief: Soothing Nerve Pain with Therapeutic Touch

Introduction:

Sciatica, characterized by pain that radiates along the path of the sciatic nerve, can be a debilitating condition that affects daily activities and quality of life. While conventional treatments such as medication and physical therapy are commonly recommended for managing sciatica, massage therapy offers a natural and effective approach to relieving nerve pain, reducing muscle tension, and promoting healing. In this article, we'll explore the benefits of massage for sciatica relief, delve into the mechanisms by which it alleviates symptoms, and provide practical tips for incorporating massage into your sciatica management plan.출장안마

Understanding Sciatica:

Sciatica refers to pain that radiates along the sciatic nerve, which runs from the lower back down through the hips, buttocks, and legs. This pain typically originates from compression or irritation of the sciatic nerve roots in the lumbar spine, often caused by conditions such as herniated discs, spinal stenosis, or piriformis syndrome.

Common symptoms of sciatica include:

Sharp or shooting pain that radiates from the lower back or buttocks down one or both legs.

Numbness, tingling, or weakness in the affected leg or foot.

Difficulty standing, walking, or sitting for prolonged periods.

Worsening of symptoms with movement, coughing, or sneezing.

Sciatica can significantly impact mobility, comfort, and overall quality of life, making it essential to find effective treatments for managing symptoms and promoting healing.출장마사지

The Role of Massage Therapy in Sciatica Management:

Massage therapy offers a gentle and non-invasive approach to relieving sciatic nerve pain, reducing muscle tension, and promoting relaxation in individuals with sciatica. By targeting the muscles, connective tissues, and nerve pathways involved in sciatica, massage therapy can help alleviate pain, improve mobility, and support the body's natural healing processes.

Here's how massage therapy can benefit individuals with sciatica:

Muscle Relaxation: Massage therapy helps relax tight muscles and reduce tension in the lower back, hips, and buttocks, which can contribute to sciatic nerve compression. By releasing muscle tension and promoting flexibility, massage therapy can help alleviate pain and improve range of motion.

Pain Relief: Massage therapy can provide natural pain relief by stimulating the release of endorphins, the body's natural pain-relieving hormones. By targeting trigger points and areas of tension along the sciatic nerve pathway, massage therapy can help reduce pain intensity and frequency.

Improved Circulation: Massage therapy promotes blood flow to the affected area, delivering oxygen and nutrients to injured tissues and promoting healing. Increased circulation can help reduce inflammation, alleviate swelling, and support the body's natural recovery process.

Nerve Mobilization: Massage techniques such as nerve gliding or mobilization can help gently stretch and mobilize the sciatic nerve, reducing compression and promoting neural mobility. By improving nerve function and reducing irritation, massage therapy can help alleviate symptoms of numbness, tingling, and weakness.

Stress Reduction: Chronic stress and tension can exacerbate symptoms of sciatica by increasing muscle tightness and reducing blood flow to the affected area. Massage therapy promotes relaxation, reduces stress hormones, and induces a state of calm, which can help alleviate symptoms and improve overall wellbeing.

Postural Alignment: Massage therapy can help improve postural alignment and biomechanics, reducing strain on the spine and supporting optimal spinal health. By addressing imbalances and compensatory patterns, massage therapy can help prevent future episodes of sciatica and promote long-term relief.

Practical Tips for Incorporating Massage into Sciatica Management:

If you're considering trying massage therapy for sciatica relief, here are some practical tips to help you get started:

Find a Qualified Massage Therapist: Look for a licensed massage therapist with experience working with clients with sciatica or lower back pain. Seek recommendations from healthcare providers, friends, or family members, and inquire about the therapist's training and approach to treating sciatica.

Communicate Your Symptoms: Before your massage session, communicate your symptoms, concerns, and treatment goals with your therapist. Be specific about the location and severity of your pain, any limitations or restrictions you're experiencing, and your preferences for pressure and technique.

Focus on Problem Areas: During your massage session, your therapist will focus on areas of tension, discomfort, and pain associated with sciatica. This may include the lower back, hips, buttocks, and legs, as well as specific trigger points along the sciatic nerve pathway.

Experiment with Different Techniques: There are various massage techniques that may be beneficial for sciatica relief, including Swedish massage, deep tissue massage, myofascial release, and trigger point therapy. Experiment with different techniques to see what feels most comfortable and effective for you.

Be Consistent: To experience the full benefits of massage therapy for sciatica, consider scheduling regular sessions with your therapist. Consistency is key to achieving lasting relief from pain and promoting healing in the affected area.

Practice Self-Care Between Sessions: In addition to receiving massage therapy, incorporate self-care practices into your daily routine to support your sciatica management plan. This may include gentle stretching exercises, heat or ice therapy, ergonomic modifications to your workstation, and taking regular breaks to rest and stretch your back and legs.

[healthkenya7]

UNDERSTANDING RELAPSES AND REMISSION IN MULTIPLE SCLEROSIS

Multiple Sclerosis (MS): MS is a chronic autoimmune disorder that affects the central nervous system (CNS), which includes the brain and spinal cord. In MS, the immune system mistakenly attacks the protective covering of nerve fibers called myelin. This leads to inflammation, demyelination (loss of myelin), and damage to nerve fibers, causing a wide range of neurological symptoms.

Relapses (Exacerbations or Flare-ups):

Relapses, also known as exacerbations or flare-ups, are sudden episodes of new or worsening neurological symptoms that last for at least 24 hours and are separated by a period of relative stability. These symptoms can vary widely depending on the location of the affected nerve fibers in the CNS and may include vision problems, numbness or tingling, muscle weakness, coordination difficulties, and fatigue. Relapses occur due to new areas of inflammation and demyelination.

Causes of Relapses:

Inflammatory Response: Immune cells attack myelin, leading to inflammation and damage in specific areas of the CNS.

Blood-Brain Barrier Dysfunction: The blood-brain barrier, which usually restricts immune cells' access to the CNS, can become compromised, allowing immune cells to infiltrate and cause inflammation.

Viral Infections: Certain viral infections can trigger an immune response that exacerbates MS symptoms.

Remission: Remission in MS refers to a period of time when there is a reduction or absence of relapses and the associated neurological symptoms. It's important to note that remission does not mean a complete absence of the disease; rather, it indicates a decrease in disease activity and symptom severity.

Types of Remission:

Complete Remission: No evidence of disease activity (NEDA) is observed. This means no relapses, no new MRI lesions, and no worsening of disability over a specific period.

Partial Remission: Some disease activity may persist, but the frequency and severity of relapses are significantly reduced.

Pharmacological Remission: Achieved through disease-modifying therapies (DMTs) that can reduce the frequency and severity of relapses, slowing down the progression of the disease.

Factors Affecting Relapses and Remission:

Treatment: Effective use of disease-modifying therapies can reduce relapse frequency and promote remission.

Individual Variability: MS is highly variable, and some individuals may experience more relapses or have longer periods of remission than others.

Environmental Factors: Stress, infections, and other external factors can trigger or exacerbate relapses.

Age and Gender: MS often presents in early adulthood, and women are more susceptible. Age and gender can influence disease activity.

Monitoring and Management: Regular neurological examinations, MRI scans, and communication with healthcare providers are essential for monitoring disease activity, detecting relapses, and evaluating remission status. Treatment strategies, including DMTs, symptomatic management, and lifestyle adjustments, aim to manage relapses, slow disease progression, and maximize periods of remission.

Mr. Jayesh Saini says, “Understanding relapses and remission in multiple sclerosis involves understanding the underlying immune-mediated processes, the fluctuating nature of symptoms, and the various factors that influence disease activity. Advances in treatment options and personalized care have improved the quality of life for many individuals living with MS.”

#jayeshsaini #healthcare #LifeCareHospitals #Kenya #NHIF #NPS #TSC

[healthwisekenya]

UNDERSTANDING RELAPSES AND REMISSION IN MULTIPLE SCLEROSIS

Multiple Sclerosis (MS): MS is a chronic autoimmune disorder that affects the central nervous

system (CNS), which includes the brain and spinal cord. In MS, the immune system mistakenly

attacks the protective covering of nerve fibers called myelin. This leads to inflammation,

demyelination (loss of myelin), and damage to nerve fibers, causing a wide range of neurological

symptoms.

Relapses (Exacerbations or Flare-ups):

Relapses, also known as exacerbations or flare-ups, are sudden episodes of new or worsening

neurological symptoms that last for at least 24 hours and are separated by a period of relative

stability. These symptoms can vary widely depending on the location of the affected nerve fibers

in the CNS and may include vision problems, numbness or tingling, muscle weakness,

coordination difficulties, and fatigue. Relapses occur due to new areas of inflammation and

demyelination.

Causes of Relapses:

❖ Inflammatory Response: Immune cells attack myelin, leading to inflammation and

damage in specific areas of the CNS.

❖ Blood-Brain Barrier Dysfunction: The blood-brain barrier, which usually restricts immune

cells' access to the CNS, can become compromised, allowing immune cells to infiltrate

and cause inflammation.

❖ Viral Infections: Certain viral infections can trigger an immune response that exacerbates

MS symptoms.

Remission: Remission in MS refers to a period of time when there is a reduction or absence of

relapses and the associated neurological symptoms. It's important to note that remission does

not mean a complete absence of the disease; rather, it indicates a decrease in disease activity

and symptom severity.

Types of Remission:

a) Complete Remission: No evidence of disease activity (NEDA) is observed. This means no

relapses, no new MRI lesions, and no worsening of disability over a specific period.

b) Partial Remission: Some disease activity may persist, but the frequency and severity of

relapses are significantly reduced.

c) Pharmacological Remission: Achieved through disease-modifying therapies (DMTs) that

can reduce the frequency and severity of relapses, slowing down the progression of the

disease.

Factors Affecting Relapses and Remission:

1. Treatment: Effective use of disease-modifying therapies can reduce relapse frequency

and promote remission.

2. Individual Variability: MS is highly variable, and some individuals may experience more

relapses or have longer periods of remission than others.

3. Environmental Factors: Stress, infections, and other external factors can trigger or

exacerbate relapses.

4. Age and Gender: MS often presents in early adulthood, and women are more susceptible.

Age and gender can influence disease activity.

Monitoring and Management: Regular neurological examinations, MRI scans, and

communication with healthcare providers are essential for monitoring disease activity, detecting

relapses, and evaluating remission status. Treatment strategies, including DMTs, symptomatic

management, and lifestyle adjustments, aim to manage relapses, slow disease progression, and

maximize periods of remission.

Mr. Jayesh Saini says, “Understanding relapses and remission in multiple sclerosis involves

understanding the underlying immune-mediated processes, the fluctuating nature of symptoms,

and the various factors that influence disease activity. Advances in treatment options and

personalized care have improved the quality of life for many individuals living with MS.”

[jayeshsini]

ALZHEIMER'S DISEASE AND SLEEP DISORDERS

Alzheimer's Disease: Alzheimer's disease is a progressive and irreversible neurological disorder that affects the brain, leading to a gradual decline in memory, cognitive function, and the ability to carry out daily activities. It is the most common cause of dementia, a term used to describe a range of symptoms related to cognitive decline and memory loss.

Causes and Risk Factors: The exact cause of Alzheimer's disease is not fully understood, but it is believed to result from a combination of genetic, environmental, and lifestyle factors. Some of the known risk factors include age (most cases occur in individuals over 65), a family history of Alzheimer's, certain genes like the APOE ε4 allele, cardiovascular risk factors (e.g., high blood pressure, diabetes, and high cholesterol), and a history of head injuries.

Pathological Changes: In Alzheimer's disease, there are two hallmark brain abnormalities: amyloid plaques and neurofibrillary tangles. Amyloid plaques are formed by the accumulation of a protein called beta-amyloid outside nerve cells, while neurofibrillary tangles result from the abnormal accumulation of a protein called tau inside nerve cells. These abnormalities disrupt the communication between nerve cells, leading to their degeneration and eventual cell death.

Stages of Alzheimer's Disease: Alzheimer's disease typically progresses through several stages:

• Preclinical stage: Changes in the brain occur but there are no noticeable symptoms.

• Mild cognitive impairment (MCI): Memory problems become evident but do not interfere significantly with daily functioning.

• Mild Alzheimer's disease: Memory loss and cognitive impairments become more noticeable and may interfere with daily tasks.

• Moderate Alzheimer's disease: Memory loss and cognitive decline worsen, affecting communication, behavior, and orientation.

• Severe Alzheimer's disease: Patients lose the ability to communicate, become dependent on others for care, and may experience difficulty swallowing and walking.

Symptoms: Early symptoms of Alzheimer's disease often include forgetfulness, difficulty finding words, getting lost in familiar places, and difficulty with problem-solving. As the disease progresses, individuals may experience confusion, personality changes, mood swings, agitation, and difficulty with self-care.

Diagnosis: There is no definitive test for Alzheimer's disease during life. Diagnosis is usually based on medical history, neurological exams, cognitive assessments, and ruling out other potential causes of cognitive decline. Brain imaging and biomarker tests may aid in supporting the diagnosis.

Treatment: Currently, there is no cure for Alzheimer's disease, and available treatments aim to manage symptoms and slow down its progression. Cholinesterase inhibitors and memantine are commonly prescribed medications to help improve cognitive function and manage behavioral symptoms.

Sleep Disorders: Sleep disorders encompass a wide range of conditions that interfere with the normal pattern of sleep. They can affect sleep quality, duration, and timing, leading to various adverse effects on physical and mental health.

Types of Sleep Disorders: There are numerous sleep disorders, but some of the most common ones include:

 Insomnia: Difficulty falling asleep or staying asleep, leading to inadequate sleep duration and poor sleep quality.

 Sleep Apnea: Breathing interruptions during sleep due to the partial or complete collapse of the upper airway, leading to oxygen deprivation and disrupted sleep.

 Narcolepsy: A neurological disorder characterized by excessive daytime sleepiness and sudden episodes of muscle weakness or paralysis triggered by strong emotions (cataplexy).

 Restless Legs Syndrome (RLS): An irresistible urge to move the legs, often accompanied by uncomfortable sensations, which worsen during periods of rest or inactivity, leading to sleep disturbances.

 Sleepwalking and Sleep Talking: Parasomnias that involve performing complex behaviors or talking during sleep.

 REM Sleep Behavior Disorder (RBD): A parasomnia where the normal paralysis during REM (Rapid Eye Movement) sleep is absent, leading to physical movements and acting out dreams during sleep.

Causes and Risk Factors: Sleep disorders can be caused by a variety of factors, including:

 Medical conditions: Such as sleep apnea being linked to obesity, heart conditions, and hormonal imbalances.

 Neurological disorders: For example, narcolepsy is caused by a lack of a brain chemical called hypocretin.

 Psychological factors: Anxiety, depression, and stress can contribute to insomnia.

 Lifestyle and environmental factors: Poor sleep habits, excessive caffeine or alcohol intake, and irregular sleep schedules can disrupt sleep.

Effects and Consequences: Sleep disorders can have significant effects on physical and mental health. Chronic sleep deprivation can impair cognitive function, memory, and decision-making. It can also contribute to mood disorders, compromised immune function, cardiovascular issues, and an increased risk of accidents.

Diagnosis and Treatment: Diagnosing sleep disorders typically involves a detailed medical history, sleep diary, and sometimes overnight sleep studies (polysomnography) conducted in a sleep lab. Treatment options vary depending on the specific disorder but may include lifestyle changes, medication, and behavioral therapies.

Mr. Jayesh Saini says, “Alzheimer's disease is a progressive neurological disorder characterized by cognitive decline and memory loss, while sleep disorders encompass a range of conditions that disrupt normal sleep patterns and can have significant health consequences.”

Mr. Jayesh Saini further notes that “Early recognition and appropriate management of both conditions are crucial for maintaining the quality of life and overall well-being of affected individuals. If you or someone you know is experiencing symptoms related to Alzheimer's disease or a sleep disorder, it's essential to seek medical evaluation and professional advice.”

[crossroadwellness123]

Now No More to be Depressed, Drug Rehabilitation Centres Are Here

Written By - Crossroadwellness

Are you feeling down, hopeless, and overwhelmed? Do you find yourself losing interest in activities that once brought you joy? You may be experiencing depression. Depression is a common mental health condition that affects millions of people around the world. But the good news is, there are drug rehabilitation centres that can help individuals struggling with this condition. In this blog post, we will discuss what depression is and its causes, as well as how drug rehabilitation centres can provide support and treatment to those who need it most. So read on to learn more about how these centres can change your life for the better Drug rehabs centre in pune!

What is depression?

Depression is a mental health condition that affects a person's mood, thoughts and behaviour. It can manifest in different ways for different people, but the most common symptoms include feelings of sadness or hopelessness, loss of interest in activities once enjoyed, changes in appetite or sleep patterns, fatigue and difficulty concentrating. Depression is not just feeling sad or down occasionally - it's an ongoing feeling that interferes with your daily life. Sometimes depression can be triggered by specific events like trauma, the loss of a loved one or major life changes. However sometimes there may be no obvious cause at all. It's important to note that depression is not a sign of weakness and seeking help does not mean you are weak. It takes strength to acknowledge when something isn't right and take steps towards improving your mental health. If you think you might be experiencing depression it's important to speak to someone about how you're feeling. A healthcare professional will be able to provide support and guidance on treatment options such as therapy or medication which could help improve your symptoms over time.

Symptoms of depression

Depression is a mental disorder that can affect anyone at any age. It is characterized by feelings of sadness, hopelessness, and loss of interest in activities once enjoyed. The symptoms of depression are varied and can range from mild to severe. One common symptom of depression is persistent sadness or feeling down for an extended period. This can be accompanied by feelings of emptiness or worthlessness. People with depression may also experience fatigue, insomnia, or oversleeping. Additionally, depression may cause physical symptoms such as headaches, stomach problems or muscle pain without any apparent medical reason. Depression often causes difficulty in concentration which might lead to poor performance at work or studies. Changes in appetite and weight gain/loss are other signs indicating the onset of depressive episodes; this could be due to changes in eating habits caused by emotional stress brought on by the disorder. It's important to recognize these symptoms early on so that you can seek help promptly if needed.

Causes of depression

Depression is a serious mental health condition that affects people of all ages and backgrounds. Although its causes vary from person to person, there are some common factors that contribute to this illness. One of the most significant causes of depression is genetics. Studies have shown that individuals with a family history of depression may be more prone to developing the condition themselves. However, it doesn't necessarily mean that someone will develop depression just because their parents did. Another factor that can cause depression is traumatic life events such as the loss of a loved one, divorce, financial problems or any other stressful experiences in life. These events can trigger chemical imbalances in the brain which lead to depressive symptoms. Additionally, environmental factors like social isolation or lack of support from friends and family members can also contribute towards feelings of sadness and hopelessness. Certain medications such as contraceptive pills or steroids used for medical conditions could potentially cause depressive side effects among some individuals who take them regularly. It's important to remember though that these are only possible contributors and not everyone faces them universally. Depression remains complex hence professional help should always be sought if experiencing any sort of symptomatology related to it.

Drug rehabilitation centres

Drug rehabilitation centres are specialized facilities that offer drug addiction treatment and support to individuals struggling with substance abuse. These centres provide a range of services, including detoxification programs, counselling sessions, group therapy and aftercare support. The aim of these programs is to help patients overcome their addictions and achieve long-term recovery. The treatment provided in drug rehabilitation centres is tailored to meet the unique needs of each individual patient. This means that patients receive personalized care based on factors such as their medical history, level of addiction, mental health issues and other personal considerations. One key benefit of attending a drug rehabilitation centre is the supportive environment it provides. Patients have access to round-the-clock care from trained professionals who understand what they are going through. Additionally, most rehab centers offer a sense of community for those undergoing treatment by providing opportunities for social interaction with others who share similar experiences. At drug rehabilitation centres, patients learn coping mechanisms and strategies designed to help them maintain sobriety once they leave the facility. Rehab centers also educate family members on how best to support recovering addicts during this difficult time. Drug rehabilitation centres play an important role in helping individuals overcome substance abuse disorders and rebuild their lives in positive ways. By offering comprehensive treatments that address both physical dependence on drugs as well as psychological issues associated with addiction, these facilities can be instrumental in empowering people towards successful recoveries.

How do drug rehabilitation centres help?

Drug rehabilitation centres help individuals struggling with addiction in various ways. One of the primary benefits of attending such a centre is that it provides a safe and supportive environment, where one can receive professional treatment while surrounded by others who understand their struggles. The programmes offered at rehabilitation centres are tailored to meet individual needs, incorporating both medical and psychological therapies to ensure that patients recover fully. These may include detoxification, counselling sessions, group therapy or family support services. In addition to these therapies, drug rehabilitation centres also provide aftercare services to help recovering addicts avoid relapse once they leave the facility. This may involve ongoing counselling sessions or participation in community-based support groups. During their stay at a rehab centre, individuals learn valuable life skills and coping mechanisms which enable them to better deal with stress and other triggers that might lead to substance abuse. The goal is not only for patients to overcome addiction but also reintegrate into society as productive members of their communities. Drug rehabilitation centres offer hope for those battling addiction by providing a structured approach towards recovery while ensuring personalised care from start till end.

Conclusion

Depression is a serious mental health condition that affects millions of people worldwide. It can lead to feelings of hopelessness, worthlessness, and even suicidal thoughts. However, with the help of drug rehabilitation centres, those who are struggling with addiction and co-occurring disorders like depression can find a way out. Drug rehabilitation centres offer comprehensive treatment programs that address both addiction and mental health issues. They provide individuals with the tools they need to manage their symptoms and build a fulfilling life in recovery. If you or someone you know is struggling with substance abuse and depression, don't hesitate to reach out for help. Drug rehabilitation centres are here to support you on your journey towards healing and recovery. Remember that it's never too late to make positive changes in your life!

Google Map - https://goo.gl/maps/iQLFrCpSoi4yu1xw6

[neoorthopaedics]

Disc Herniation

What is

Disc herniation occurs when an intervertebral disc degenerates and deteriorates, causing the inner nucleus to leak into a weakened area on the outside of the disc.

The weak point in the outer nucleus of the intervertebral disc is directly below the spinal nerve root, so a herniation in this area can put direct pressure on nearby nerves or the spinal cord.

Therefore, herniated discs are sometimes a cause of radiculopathy, which encompasses any disease that affects the nerve roots of the spine.

Dr Ashu Consul, best orthopaedic in Dwarka, consultant at Venkateshwara Hospital, adds that, initially, herniated discs can be confused with the following pathologies: “piriformis syndrome, facet arthropathies, deep gluteal syndrome, peripheral neuropathies, muscle trigger points and, in more severe cases, tumors”.

Causes

The vertebrae of the spine are separated by discs that cushion movement and leave space between the vertebrae. In the same way, they allow their movement, which makes it possible to bend down or stretch out.

In addition, the vertebrae of the spine protect the spinal cord that comes from the brain and runs down the back to the lower back. The discs fulfill a very important function of cushioning and distribution of loads and any damage to them can be serious if not treated quickly.

The disc can move out of place, that is, herniate, or rupture due to injury or stress. This can cause excess pressure on the spinal nerves resulting in pain, numbness or weakness in the patient.

Normally, herniated discs are located in the lumbar region, with the second most affected area being the cervical discs (the neck).

Symptoms

A cervical disc herniation can cause pain in the neck, which in turn can radiate to the arm, shoulder, or can cause numbness or tingling in the arm or hand. Sometimes the pain can be dull, constant, and difficult to locate.

In addition to this pain, the symptoms of herniated discs are the following:

The first sign that the patient has a herniated disc is pain in the arms     and neck. If numbness or tingling occurs it may indicate that the     problem is more serious.

Typically, the patient complains of sharp, cutting pain, and in some cases, there may be a prior history of episodes of localized pain, present in the back and radiating down the leg.

The episode of pain may come on suddenly or be heralded by a tearing or snapping sensation in the spine.

When the pain starts slowly, it can worsen after the patient spends a long time sitting, standing, at night, when sneezing, coughing or laughing.

Weakness is also a common symptom that affects the leg or arm and may require excessive effort to move them.

Usually, the numbness or weakness goes away over a period of several weeks or months. 

Prevention

According to Orthopaedic in Dwarka, “exercising regularly and appropriately is important. Also avoiding leading a sedentary lifestyle, being overweight and smoking helps prevent this type of back pathology. Finally, avoid unnecessary risks such as lifting heavy objects, improperly bending or twisting the lower back, or sitting or standing in the same position for many hours and in an unergonomic way.

Types

There are three degrees:

Disc protrusion: when the nucleus pulposus has not yet come out of the annulus fibrosus, it is therefore weaker and gives way in its structure. This is the first stage of a herniated disc.

Disc herniation: the material of the nucleus pulposus is ejected from the limits of the annulus fibrosus.

Disc extrusion: the exit of the disc material is violent and breaks the posterior common vertebral ligament, leaving free fragments in the vertebral canal. 

Diagnosis

To diagnose a herniated disc, the orthopaedic doctor in Delhi will carry out a medical examination of the spine, arms and lower extremities. Depending on the region where the patient's symptoms are located, the orthopaedic in Delhi will look for possible numbness or loss of sensitivity.

In addition, he will test your muscle reflexes, which may have been affected and slowed down or even disappeared. He will also study the patient's muscle strength and the shape of the curvature of the spine. 

On the other hand, the patient may also be asked to sit, stand or walk, bend forward, backward or sideways and move the neck, shoulders or hands.

Diagnostic tests that can verify the existence of a herniated disc are:

An electromyography that will determine which nerve root is affected and where it is compressed.

A myelography to specify the size and location of the hernia.

An MRI that will show if there is pressure on the spinal cord.

Finally, an X- ray of the spine may also be performed to rule out other injuries that cause cervical or back pain.

Treatments

The first treatment given to patients with this condition is short rest and pain medication, followed by a period of physiotherapy session with physiotherapist in Dwarka. In most cases, almost immediate recovery occurs, but in other cases medication or injections may be required.

In the case of corticosteroids, they are usually administered, above all, non-steroidal anti -inflammatory drugs to control pain and also muscle relaxants. 

Injections into the area of ​​your back where the herniated disc is located can help control pain for a few months. In addition, these injections greatly reduce the swelling of the disc.

The last option is microdiscectomy, considered as the surgery that is used to relieve pressure on the nerve root and allow the nerve to recover more effectively. This type of intervention does not entail great difficulty, since it is usually enough with a small incision and one night of admission. 

Regarding the therapeutic approach to herniated discs, Orthopaedic in West Delhi states that "one of the most important advances has occurred in the increased precision of diagnostic tools, which has made treatment much more effective and specific, both in management conservative as in the surgical. From the surgical point of view, the trend is towards minimally invasive, what we commonly know as microsurgery, so that the tissues suffer the least negative impact after the surgical intervention”.

At what age do herniated discs usually appear?

“Disc herniation can appear at any age, since its causes are multifactorial. Although, it begins to be more frequent in the range of 30 to 50 years of age. And they are more prevalent after the age of 50, where it is estimated that more than 80% of the population begins to show disc degeneration”, says orthopedic in Delhi.

[furiousgoldfish]

Trauma symptoms caused by childhood abuse

Early symptoms (childhood and teenage years):

Inability to show pain and vulnerability to others

deep belief that you ‘have to be tough’, secretly fearing that you’re weak and pathetic if you ever shed any tears or break down in pain

personality changes from outgoing and social, to isolated and quiet, trying not to be noticed

feeling like there’s something deeply wrong with you, deep belief that you’re some kind of monster who deserves to be punished

fear that if someone finds out about whats happening to you, they will blame you and hurt you worse

anxiety around adults, always being scared you’ll annoy someone and be hurt for it

very low attention to your needs and wants, feeling pride in neglecting your own well being, even neglecting your pain

belief that your value is tied to how much pain and mistreatment you can endure

urge to self harm, or outright hurting yourself

feeling like you want to disappear, or not be born at all, contemplating suicide

self hatred, feeling extremely negative about yourself and feeling like things would be better if you didn’t exist

spending phases of time being emotionless, feeling like a zombie and not caring about anything

foreshortened sense of future (belief that you wont live for much longer, inability to see your future or plan for it)

not feeling the consequences of events in the real time, or not at all; for instance, being completely unphased by a violent outburst or screaming, not feeling pain when you’re hurt, or not feeling the exhaustion when you’re clearly overworked

strong urge to not think about certain topics or events, or inability to do so

fear that your body is wrong and disgusting, anxiety about anyone seeing it but desperate need for validation that you’re normal

deep sense of shame in yourself, your actions and your appearance

strong investment in finding excuses for people who do bad things, always trying to see things from their angle and to forgive them

feeling like the blame for any bad thing in the world can be put on you

not feeling like a human being, belief that you’re less than human

feeling like your home is not here and you do not belong on this planet

feeling uncomfortable being touched and wanting people to back off

uncontrolled ourbursts of rage

looking for anything to soothe your pain or distract you, indulging with obsessions or drugs

early development of anxiety disorder, depression, insomnia, ocd

trying to regress your age and force yourself to stay younger than you are, because you feel like your value is dropping with age and nobody will care for you anymore

trying to desperately take control over some aspects of your life, which can result in overdoing or completely neglecting school, losing yourself in virtual life, eating disorders, self harm or magic thinking that enables you to believe you can control your circumstances

in case of a sexual trauma, innapropriate sexual behaviour, deep shame tied to your body, indulging in sexual interactions even before puberty, feeling like you’re meant to be used, violent or forceful sexual fantasies accompanied with shame, fear of touch, fear of anyone finding out, reaching out for pornographic material to put your experience into perspective

feeling desperate to appear normal and clinging very strongly to the perception that your childhood is normal

Later symtoms, can develop anytime after puberty, can be in 20s or 30s or even 50s:

Emotional

Flashbacks, nightmares, panic attacks, freezing up in terror, beyond average amounts of fear and dread

Trust issues, either trusting without suspicion even when you shouldn’t or trusting nobody and feeling completely alone in the world

Episodes of re-living traumatic events from childhood or later in life; emotional meltdowns

Being unable to leave the past and feeling frozen in the moments of trauma

Emotional flashbacks, feeling the events from past as if they’re happening now, except this time you feel it thousand times stronger and completely fall apart from the horror of it

Feeling unstable, ashamed for not being able to control your emotions, fear of being judged, mocked or humiliated for it, trying desperately to not feel it, using distractions or drugs

Self doubt, struggling to know what is real and what isn’t, doubting your memories and emotions, trying to only feel what you believe is obliged from you

Questioning the past over and over again, trying to find sense and who to blame

Trying desperately to put your relationship with your abuser(s) into perspective, feeling both guilt and obligation towards them, but also rage and desire to take over control from them

Self harm, self-destructive behaviour, suicidal behaviour, wanting to die to end the pain

Deep and overwhelming grief over loss of childhood and loss of trust in people you believed wouldn’t hurt you, or believed they were doing it for your good, which now proved not to be true

Depression, loss of joy in anything you used to like doing, loss of optimism in life

Losing the courage to try anything, regardless of how much it would benefit you, if there’s even a slight chance of getting hurt in a way you find impossible to endure, living passively

Feeling irreparably damaged and ruined

Getting lost in maladaptive daydreaming, fiction, or the virtual world, feeling unable to face reality, falling to obsessions or addictions to endure the pain

Feeling other people’s feelings as if they’re your own, especially feelings of pain, anxiety, fear, nervousness, anger or grief; trying to soothe them and especially having strong reactions to anger

Feeling overwhelmed whenever around people, feeling the urge to self-isolate and to be completely alone

Being hit with extreme amounts of rage and struggling to process it; worrying about misdirecting the rage or acting on it, violent fantasies

Getting stuck in a mindset of a child and barely able, or unable to do any grown-up tasks

Struggling to achieve even minimum function, or not functioning at all

Losing the will or the energy to participate in any activities you used to enjoy

Fighting or indulging the urge to normalize what happened or make it ‘not that bad’, trying to re-live it in a way that wouldn’t be traumatic, especally with sexual trauma, needing to perceive it as if it would be normal only if it was ‘consensual’ or more controlled and trying to find a way to frame it as ‘not that big of a deal’ and denying it’s hurting you

Beating yourself up horribly for still being upset and traumatized by events that happened long ago

Inability to have friends or form connections with others, high alert for betrayal and manipulation

Avoding places and people connected to the trauma, getting easily triggered and forced to re-live something that needs recovery time of days or weeks

Losing your sense of reality; not being sure where you are or what year is it for some periods of time, feeling like you’re going crazy

Only being able to focus on surviving a short amount of time (just trying to get thru the day or week)

Physical

Extreme anxety; trembling, spending prolonged amount of time tense and expecting danger and pain at every second, inability to calm down, limbs not working properly, fainting out of fear

Continually activated “fight or flight” response, always feeling endangered, trouble digesting food because your body shuts down your digestion in order for you to be able to escape faster, vomiting, stomach pains after eating

Hyperventilation, problems with breathing, feeling there’s “no air” in small or crowded spaces

Chronic exhaustion, feeling heavy weight over your body, having difficulty moving at all

Chronic pain, tension in your body never leaving, physical pain appearing when you’re experiencing emotional pain, chest pain, heart palpitations

Problems with blood pressure, fainting easily

Dissociation (feeling detached from your emotions and/or body, feeling numb and unreal, your body not feeling yours, feeling outside your body or like you’re stuck in someone else’s body)

Memory issues, not being able to remember whole parts of your life, weak short term memory, not being able to look back on your life in linear way or put the events in they order they happened in, mixing several events into one, remembering feelings but not events

Increased sensitivity to noise, getting very upset at any non recognizable sound, reacting with irritability or rage to background noises, or with terror at loud noises; needing complete silence, or constant soothing background noise

Extreme sensitivity to stress, having to block out stressful things from memory, having physical reactions to stress, like shaking, your hair falling out, feeling incapable of dealing with even minimally stressful tasks

Dry mouth in the night, overheating during the nightmares, getting so distressed after sleep you can’t move from the bed for hours, not calming down for days

Not being able to control your body, falling down and shaking uncontrollably, even trashing around as your body processes violence done to it

Not being able to relax or calm down without experiencing physical pain, feeling addicted to abuse and indulging in self harm, or letting someone else hurt you so that you might gain a moment of not feeling tense, stressed and scared

Feeling sensations of pain or discomfort on your body even when nothing is happening to it, especially the body parts that have been violated in some way; in case of sexual trauma it would mean private parts, in case of overworking yourself or break yourself with effort, pain in all muscles and joints

In case of sexual trauma, reoccurring memories of it, trouble figuring out your sexuality, wanting to escape your body or perceiving it in a distorted way, urge to repeat the trauma to get desensitized to it, hypersexual behaviour or complete lack of interest in sexuality

Weight gain or loss, hatred of your body and desire to change or hurt it, or complete neglect over body, lack of any self care of even acknowledging you need it

Difficulty sleeping or being awake, feeling too high alert to fall asleep or dropping out of consciousness from overexhaustion

Inability to focus or finish tasks, procrastinating or feeling sick just knowing there is a task you have to do.

 If you struggle(d) with 5 or more of early ones, or 5 or more of later ones, you’ve been dealing with trauma.

[itsdoctorhouse]

Paternity

CC: Diplopia, night terrors ongoing 3 weeks, and a myoclonic jerk

Dx: Subacute sclerosing panencephalitis (SSPE)

Diplopia:

aka double vision: the perception of two images instead of a single object

Common causes usually stem from issues with the eyes, muscles and nerves controlling the eyes, and the brain.

Night terrors:

As mentioned in the episode, there are two leading causes for onset teenage night terrors: PTSD and sexual abuse.

Personally I think there isn’t much reason for the patient to have experienced night terrors beyond the initial stages of SSPE causing changes in emotional behavior and personality.

Myoclonic jerk:

Brief, involuntary twitching of some muscles; generally in healthy persons it can be seen right before falling asleep (aka a hypnic jerk).

The patient presents it even though he’s not asleep or tired.

Multiple sclerosis (MS):

In the episode:

After testing some CSF, because of a buildup and blockage, they find high levels of IgG and assume multiple sclerosis, but find no evidence of lesions. A good assumption because over 80% of patients with MS show oligoclonal bands with high IgG.

Since the patients symptoms have only begun 3 weeks previously they determine it’s rapidly progressive MS.

They can’t definitively diagnose MS, because there are no specific tests for it. Generally doctors have to rule out every other possibility before they can confirm. What’s mentioned in the episode is waiting 6 months to confirm, most likely to see progression of symptoms as well as ruling out differentials.

More on Marburg MS s7e08 “Small Sacrifices”

MS is a chronic central nervous system disease in which the myelin sheath and nerve axons in the brain are destroyed. It’s referred to as a demyelinating disease. The damage disrupts the ability to transmit signals which can result in a slew of signs and symptoms.

The three main characteristics are the formation of lesions/plaques in the CNS, inflammation and the destruction of myelin sheaths of neurons

Other specific symptoms usually include diplopia, blindness in one eye, muscle weakness, and trouble with sensation or coordination.

Some pathognomonic signs include:

Internuclear ophthalmoplegia (INO): an impairment in the lateral conjugate gaze, meaning that when both eyes are looking toward one side the affected eye cannot properly adduct (move toward the center). Caused bye a lesion in the medial longitudinal fasciculus (part in the brainstem).

To put it simply, if the right eye is affected, the patient should be able to look to the right, and cross their eyes, but upon looking to the left, the right eye won’t be able to move to the midline.

Positive Romberg’s sign: when the patient sways or falls with their eyes closed. It demonstrates a loss of postural control and proprioception (perception and awareness of one’s body) in the absence of visual input.

Positive Lhermitte’s sign: paresthesia/an electrical shock that passes down the back of the neck and spine, usually brought upon by bending the head forwards towards the chest.

Progression usually occurs as episodes of worsening lasting days to months, followed by improvement (relapsing episodes).

Subacute sclerosing panencephalitis (SSPE):

Early in the episode Cameron admits to not having taken a full history or family history which really would have solved the case a hell of a lot sooner, given his birth mother was the cause of the patients issues.

tbf, it was the whole point of the episode to focus on determining paternity, which, given all the daddy issues on the show is a good setup.

Then again, the patient is a 16 year old lacrosse player, and he figured out he was adopted at a much younger age, 10 if I remember right, just from having a cleft chin. Talk about selective blindness on the team.

aka Dawson disease

SSPE is a super rare complication from measles wherein there is chronic progressive brain inflammation caused by the mutated virus.

Patients generally have history of a primary measles infection in infancy (where the birth mother was not vaccinated and thus could not pass along the proper antibodies to protect the infant for up to 6 months), followed by an asymptomatic period that can last up to 27 years. Afterwards neurological deterioration ensues with behavioral changes, myoclonic seizures, visual disturbances, ataxia, and ultimately death.

Anti-measles IgG appears to increase as the disease progresses

There is no definitive cure, but if it is diagnosed in the first stage of the disease oral isoprinosine and intraventricular interferon alfa could help, it varies patient to patient. And the only accepted treatment are purely supportive: anticonvulsants.

Should not be confused with acute disseminated encephalomyelitis (ADEM), which can also be caused by the measles virus.

Another demyelinating disease, it is a rare autoimmune disease with acute inflammation of the brain and spinal cord.

Often triggered by a viral infection or specific non-routine vaccinations.

Very closely resembles symptoms of MS except for usually occurring in children and marked with rapid fever.

[vcrtigoes-a]

a revised & more comprehensive list of chronic pain hc’s stemming from the lightning strike.

- there are five ways lightning can strike a person. as a child, mike experienced what is called a ‘direct strike’, which is, as can probably be expected, when the person becomes part of the lightning’s full discharge, and tends to be the most deadly form. it put him in a coma for two days, while his body was stabilized, and heart restarted several times.

- when finally discharged, it was with the assurance that there were no lasting effects. they were right only in some respects; he had regained motor functions, his hearing was recovering, he had full range of motion, and some of his memories of the afternoon. it said nothing, of course, of the trauma, but also the long-term nerve damage. 

- even after becoming an avatar, mike continues to endure occasional episodes of intense burning pain throughout the length of his scars similar to an after-echo of the initial strike. these are psychosomatic, at least according to professionals, as if anything he has less nerve functionality than most in that area, but it doesn’t lessen the severity of the symptoms.

- most commonly persists as a pins-and-needles sort of tingling graduating to an intense burning sensation, coupled with generalized muscle weakness, fatigue, tremors, difficulty concentrating, and reduced coordination. these episodes may last anywhere from a few hours to a few days at their worst. 

- obviously inclement weather can be its own pavlovian trigger, but it is not necessary. some days are simply bad ones.

- he owns a cane but really only uses it when he has to be mobile in these periods. for the most part, he finds it more hassle than it’s worth, if only because it’s never where he actually needs it when he needs it (and he has a high chance of simply forgetting it somewhere).

- if possible under his own power, he likes to numb the afflicted areas himself through extremely cold showers or the rare freezing drift through sea or space, if only to take some of the edge off the burning. 

[alusa12]

Massage for Sciatica Relief: Soothing Nerve Pain with Therapeutic Touch

Introduction:

Sciatica, characterized by pain that radiates along the path of the sciatic nerve, can be a debilitating condition that affects daily activities and quality of life. While conventional treatments such as medication and physical therapy are commonly recommended for managing sciatica, massage therapy offers a natural and effective approach to relieving nerve pain, reducing muscle tension, and promoting healing. In this article, we'll explore the benefits of massage for sciatica relief, delve into the mechanisms by which it alleviates symptoms, and provide practical tips for incorporating massage into your sciatica management plan.출장안마

Understanding Sciatica:

Sciatica refers to pain that radiates along the sciatic nerve, which runs from the lower back down through the hips, buttocks, and legs. This pain typically originates from compression or irritation of the sciatic nerve roots in the lumbar spine, often caused by conditions such as herniated discs, spinal stenosis, or piriformis syndrome.

Common symptoms of sciatica include:

Sharp or shooting pain that radiates from the lower back or buttocks down one or both legs.

Numbness, tingling, or weakness in the affected leg or foot.

Difficulty standing, walking, or sitting for prolonged periods.

Worsening of symptoms with movement, coughing, or sneezing.

Sciatica can significantly impact mobility, comfort, and overall quality of life, making it essential to find effective treatments for managing symptoms and promoting healing.출장마사지

The Role of Massage Therapy in Sciatica Management:

Massage therapy offers a gentle and non-invasive approach to relieving sciatic nerve pain, reducing muscle tension, and promoting relaxation in individuals with sciatica. By targeting the muscles, connective tissues, and nerve pathways involved in sciatica, massage therapy can help alleviate pain, improve mobility, and support the body's natural healing processes.

Here's how massage therapy can benefit individuals with sciatica:

Muscle Relaxation: Massage therapy helps relax tight muscles and reduce tension in the lower back, hips, and buttocks, which can contribute to sciatic nerve compression. By releasing muscle tension and promoting flexibility, massage therapy can help alleviate pain and improve range of motion.

Pain Relief: Massage therapy can provide natural pain relief by stimulating the release of endorphins, the body's natural pain-relieving hormones. By targeting trigger points and areas of tension along the sciatic nerve pathway, massage therapy can help reduce pain intensity and frequency.

Improved Circulation: Massage therapy promotes blood flow to the affected area, delivering oxygen and nutrients to injured tissues and promoting healing. Increased circulation can help reduce inflammation, alleviate swelling, and support the body's natural recovery process.

Nerve Mobilization: Massage techniques such as nerve gliding or mobilization can help gently stretch and mobilize the sciatic nerve, reducing compression and promoting neural mobility. By improving nerve function and reducing irritation, massage therapy can help alleviate symptoms of numbness, tingling, and weakness.

Stress Reduction: Chronic stress and tension can exacerbate symptoms of sciatica by increasing muscle tightness and reducing blood flow to the affected area. Massage therapy promotes relaxation, reduces stress hormones, and induces a state of calm, which can help alleviate symptoms and improve overall wellbeing.

Postural Alignment: Massage therapy can help improve postural alignment and biomechanics, reducing strain on the spine and supporting optimal spinal health. By addressing imbalances and compensatory patterns, massage therapy can help prevent future episodes of sciatica and promote long-term relief.

Practical Tips for Incorporating Massage into Sciatica Management:

If you're considering trying massage therapy for sciatica relief, here are some practical tips to help you get started:

Find a Qualified Massage Therapist: Look for a licensed massage therapist with experience working with clients with sciatica or lower back pain. Seek recommendations from healthcare providers, friends, or family members, and inquire about the therapist's training and approach to treating sciatica.

Communicate Your Symptoms: Before your massage session, communicate your symptoms, concerns, and treatment goals with your therapist. Be specific about the location and severity of your pain, any limitations or restrictions you're experiencing, and your preferences for pressure and technique.

Focus on Problem Areas: During your massage session, your therapist will focus on areas of tension, discomfort, and pain associated with sciatica. This may include the lower back, hips, buttocks, and legs, as well as specific trigger points along the sciatic nerve pathway.

Experiment with Different Techniques: There are various massage techniques that may be beneficial for sciatica relief, including Swedish massage, deep tissue massage, myofascial release, and trigger point therapy. Experiment with different techniques to see what feels most comfortable and effective for you.

Be Consistent: To experience the full benefits of massage therapy for sciatica, consider scheduling regular sessions with your therapist. Consistency is key to achieving lasting relief from pain and promoting healing in the affected area.

Practice Self-Care Between Sessions: In addition to receiving massage therapy, incorporate self-care practices into your daily routine to support your sciatica management plan. This may include gentle stretching exercises, heat or ice therapy, ergonomic modifications to your workstation, and taking regular breaks to rest and stretch your back and legs.

[buzzworddotie]

A little (not quite) Anxiety Ramble

Do something! Do SOMETHING! Don’t stop doing something!

Welcome to 2020.

It won’t stop, my brain will not shut off. We’ve been in lockdown for… to be honest off the top of my head I can’t even get dates right but I’ve been in isolation mode, working from home for about 4 weeks now maybe?

On week 2, I became more lethargic than I ever have in my life, I withdrew from any contact with other people, my brain was in a fog, I couldn’t focus. My muscles were tired and refusing to function and my energy was entirely zapped.

I managed to pull myself out of that by attempting to not guilt myself for eating that bowl of carb loaded cereal or allowing myself to rationalise that it’s OK to just watch a movie.

But here I find myself in that cloudy little place again. My anxiety is in such a way that my brain refuses to shut down and my motivation is becoming a precious commodity that I’m unsure of how exactly to keep it in a steady flow.

When the anxiety kicks in like this for me, I stress and worry about every and any thing. Things entirely out of my control, other people, how I am perceived, why I am not now or have ever been good enough for anything or anyone. 

My rational brain packs its bags and heads for the door as I stare in the mirror and hate everything I see looking back. My doubts, my insecurities, my shame - every dark little voice that can be mustered up gets louder and louder.

And so I overthink every action I make, I try too hard to impress a version of myself on people. I try too hard to force anyone who might give a shit that I am in fact OK! And you know there’s nothing saner than someone screaming “I’M OK!!” directly into another person's face manically.

Sleeping is the worst, or in my case not sleeping. It doesn’t matter how tired I may or may not be, I can be assured that as soon as I lay my head down that anxiety demon comes alive.

I cannot remember the last time I slept for a solid 7 - 8 hours. I can recall what it feels like to be at complete odds and ends at 4am because it’s happening every goddamn night!

Is this a symptom of what is happening in the world right now or is it just an exemplification of how screwed up I might actually be? These are the beautiful thoughts which haunt my brain in between scrolling through Twitter or Reddit, telling myself to not scroll through Twitter or Reddit and then, you know, casually reminding myself that I will never be good enough for whatever the fuck I think I should be good enough for!

I’ve always been a bit of an introverted extrovert, or am I an extroverted introvert? I’m not sure, the point is I’ve never had a problem being a bit “isolated”. I’m quite happy in my own company and just pondering about, in my own little world doing whatever silly things I decide to do with myself. However, that world of mine was always interrupted with everyday interactions - people I work with, the ability to visit someone and general activities which we just take for granted.

I’m starting to even question if I am as introverted as I liked to think I was at all! I told myself that being locked down wasn’t a big deal for me, not a massive shift in my life. I’m single, I live alone… Just a real wholesome and healthy picture there! “I’m OK!!!”

First World Problems.

One thing about me I’ve known since childhood is that I love my independence. I was told by my parents growing up I was the most independent of all my siblings. There is a sense of freedom that comes with independence and I think losing that is throwing me for a bit of a loop.

The freedom and independence to just make a decision to do something in the moment and being able to just do it. Even the smallest, stupidest of things like going for a browse in a shop. Such a boring and mundane activity but an activity that clearly ticked some kind of box for my mind.

Of course, I am wary of banging on about this word “freedom” but allow me to state, I do not mean freedom with the gusto of some hardcore, right wing, gun toting Murican (Or the Irish lady, she whom shall not be named… We all know).

No, I’m not trying to suggest my first world concept of freedom is being threatened on some conspiracy level, I accept the merit in the fact that for a period of time we have to do what’s best for the greater good. But jaysus, it’s not easy at times is it?

Without the fundamental freedoms which I take for granted as everyday life it’s as if my brain is being withheld vital nutrients for it to operate full steam ahead. Don’t get me wrong, this anxiety trip isn’t a new phenomenon for me, I know the bitch well, but I had such a great grip on things and I think the hardest part for a minute there was trying to figure out how I was allowing it all to spiral so ferociously when I know I have the tools to not do that.

It also bothers me because I am, by nature, incredibly laid back and positive. I flip between Energizer Bunny, Everything is Awesome and easily passing for a hippie stoner on my good days. So seeing myself behave erratically at times now makes me not recognise or like the person I am having to live with during this lockdown! Her neediness and desire to please is very, very off putting to me.

But maybe I just need to let her be a little bit, maybe I just need to let her know that it is fine. It is fine if a momentary lapse in the mind causes a mini freak out which embodies itself as wanting to just shut down, it is fine if she does just go a bit OTT at times with people to overly compensate for how weak and low she is feeling. It’s fine.

It is fine. Once you recognise that that’s all it is, it does not lessen your worth to behave in a way you might later regret and it does not lessen your value if you allow your insecurities or vulnerabilities to sneak through every now and then. You just have to hope that whoever is lucky enough to get the brunt of your vulnerability can appreciate the value in getting a taste of it at all. Because that right there, that vulnerability, that is a precious thing which is not afforded to many, if any at all. 

It is the most beautiful aspect of humanity, to be vulnerable. And it is really fucking hard to let go of. Vulnerability takes an incredible amount of strength, it’s a feather that keeps on floating through regardless of how much dirt and debris gets attached to weigh it down. It is delicate and strong all at the same time. 

And for me, it is terrifying to let that wall down. It feels frightening to think for a moment I let someone see weakness or gave a hint that I, with all my positivity and strength and being there for other people, could have a moment of weakness. It cracks the veneer of who I want to pretend I am.

Meet my friend, Anxiety.

Anxiety has been an under current which has existed within me since my childhood but something I only recognised as I began to get older and, yes, get help. Speaking to a professional allowed me the opportunity to begin to understand myself and learn about myself, gain self awareness.

Where I am now compared to where I was back then are completely opposed. At its worst, I was consumed by my anxiety and all the other little niggly things which tortured my brain. It all manifested in self-hate usually, maybe hate is a strong word but certainly a really strong dislike of myself! I would allow that to spin in circles in my mind until I was lost in it and trying to fix a million and one things about myself and others which really, was all very surface or non-existent.

The difference today is that I can, at last, recognise it. I can see the signs, at times I am deep within them and it takes a step back to shake it off and see it but at least I can find it within myself to rationalise and take that step back.

It doesn’t make it easy, there is nothing easy about managing mental health in the same sense there is nothing easy about managing physical health. If I want that toned stomach I will have to feel the burn and it has to work the same for mental health too!

Jesus, it is not easy at times. I will always remember an episode of RuPaul’s Drag Race in which the contestant Katya suffered severely from debilitating anxiety. During a walk through Ru asked the Queen if she was, in fact, addicted to the anxiety. This registered with Katya and as time has gone by and that interaction replays in my own mind, I realise it often registers for me too.

When it is all you know, you can easily become all consumed by the anxiety, the worry, the stress and you can get sucked right down into it. And you can find a level of comfort within that discomfort, it’s recognisable and it can feel easier to submit yourself to it than seek out the light and pull yourself back from it.

When I break it down I can see the various triggers for my anxiety:

Opening up and being vulnerable = Opening myself up for rejection.

Feeling like I cannot help = Opening myself up for failure.

Failure, rejection = Not good enough. 

Attempting to improve and increase my self worth is really something that I never understood was such an issue for me, mostly because the concept of “self worth” was never something that even showed up on my radar. But guess what? It’s a thing! 

Self love is not about having an over inflated and delirious ego, it is about recognising that you do have worth as a human being. Recognise yourself as a human being.

Oh god, she’s going to talk about her childhood...

So, why is it that I may not have always recognised myself as a human being, worthy of care and love? Well, I will refrain from the details that will cause my very being to quiver but I was raised in a home in which I received a lot of love, but it was unstable. Arguments, raised voices, depression and a lack of seeing love between my parents. A tumultuous family backstory which, while I was not in existence for much of it, carried a heavy cloud over all proceedings. I was in existence for difficult times with siblings and parents who butted heads constantly. 

I was a witness, I was shielded from being on the receiving end for the most part but I still stayed awake at night waiting for things to take a turn for the worse. I jumped at nothing and everything, like a scared little mouse. I was reserved and private with friends, I held the problems into myself and did not expose anyone to it. 

As well as this, I faced a level of mental, physical and, like so many other girls and women out there, sexual abuse. I won’t delve into all the details but it seems like some sick, twisted joke that once you are forced to be subjected to this as a child, you do not recognise the issue with it which leaves you vulnerable for it again as you mature into an adult and set off on your own.

This is because your self worth has been destroyed. So when you see ladies coming to the fore as part of #MeToo or another movement, or no movement at all, don’t be so quick to judge. These ladies have likely held their tongue because their self worth has been so low that until they became exposed to others discussing it they didn’t even realise what had happened to them.

I won’t dwell too long on that, I could spend a long time dissecting it but it isn’t for now.

I will note, neither of my parents were responsible for that abuse. However, what my beautiful, kind and lovely parents were responsible for was me and as much as it absolutely kills me to have to admit, there were failings. Aside from generally being exposed to an unhappy home, as a child I was used to bridge the gap. Something which ran into my adulthood.

If my father was angry, upset or, as I now reflect and realise, in a spiral of depression it was my responsibility to pick him out of it. From a young age, I was the fixer - a tool to try to make things better. 

Until I actually discussed this with a professional I never saw the problem here, everything was normalised to me, but apparently not great! It’s a lot of pressure to put on a child!

Add into that a complex / chip on my shoulder of never being as good as an older sibling, whom I perceived as the ‘golden child’, feeling like I had to keep things hurting me hidden for fear of disrupting an already disruptive home for which I felt responsible for keeping the peace or holding together and well, you get yourself a nice little stew that is a recipe for absolute fucked up adulthood!

Honest Reflection.

How could I ever expect to grow into a well developed individual? The balance of genuine love I did receive from my parents is what I believe kept me from falling down an even more desperate track, a track which I pondered along on many occasions. A dark road with flickering lights where the allure of escape was often far too real.

However, my internal commentary of having to be responsible for others actually kept me from ending it on many occasions as I could not release the feeling of not wanting to let anyone down.

Jesus, unpack this shit and it’s an absolute shit show! But I don’t claim to be special or unique, the sad reality is how many people went through a similar journey or worse and are now in their early to mid adulthood and attempting to get to grips with it all. And that’s only if they managed to find the tools and resources to recognise it in the first place.

Recognise that 1. You are not mental and 2. You are not a terrible human being. 

I can’t speak to anyone else but clearly I have lacked the tools to manage or cope with my emotions. Anything outside of my control freaks me out and I lose the absolute run of myself! I panic, I seek out approval and validation and often in unhealthy ways. I have had eating disorders which I have been in denial about, I have drank too much, gone off the rails and slept with far too many people! 

What now? What triggered my writing, which has evidently turned into an unintentional essay about myself (fair play if you’ve made it this far, you’re a better person than me).

I recognised irrational behaviour and a deep dip in my mood as well as an increase of self critical behaviours. That was when I began writing, this is now the future, or present, or wait, is this inception? I’ve incepted myself, just know as you read now a couple of days have passed.

And it took those couple of days for the lightbulb to click on but better late than never! 

Let there be Light!

I began writing this aimlessly as a means to just put my thoughts down and that was a step in the direction of realising I had to do something. I am now slowly picking myself back up from it all.

First step, I went to the chemist and I just asked what can you give me for anxiety, I am not sleeping, I have not had a proper night sleep in close to two weeks or more - I asked for…… Help!

Gulp, scary, try it sometime.

The Pharmacist gave me a product called “Avena Sativa” (check it out). I added 20-30 drops to a little bit of water and it immediately relaxed and eased my mind. I took more before bed and baby, when I say I slept! Pure, deep, joyful sleep - all the z’s.

But wait, there’s more! Thinking I might as well hit this from all angles, I also grabbed some Vitamin D supplements and began retaking my B-12. I don’t know if one or all of these things did the trick but I can certainly feel the easing effects.

So that’s the taking stuff, but that isn’t all I did - Oh no, that would be too short for me!

I knew I really needed to hit this hard if I wanted to pull myself out of the hole I could eventually be down deep within. I’m a fan of meditation, I get that some skeptical people might huff it off as new age hippie nonsense or whatever, but it can work. Youtube has a host of wonderful meditation videos and for me, switching off from the world and onto one of those helps me massively. 

Additionally, I stopped hanging out of my phone, for the best part at least. I have a bit of anxiety with my phone (of course I do). I went through a period of time where my phone was a bearer of bad news, any phone call could have been bad news and eventually, it was. I realised I find it hard to let go of that, the idea that if I do not have my phone on me and with sound on 24/7 I risk not getting an important piece of news, I risk letting someone down or not being there as I should be.

Should = dangerous word. Don’t let ‘should’ govern your life or mind. Every ‘should’ is an expectation and additional level of stress you are putting on yourself. Best advice I received was to replace ‘I should’ with ‘I want to’ and see what the end result becomes.

Let’s wrap this up.

All in all, this is a time that can lead those susceptible to anxiety, and even those who are not typically, to find themselves in the mental trenches. It’s imperative to look at yourself from the outside and attempt to recognise what might be the deep rooted cause of what is effing you up. Do you really hate your body right now or is your self worth a bit low because of some other reason that deserves to be addressed?

Maybe consider going a bit easy on yourself? Don’t beat yourself up over that response or message that you regret. Don’t assume you can control others, just be yourself. Speak your truth at any given time and allow yourself that beautiful release of scary, scary vulnerability. 

Don’t run from it or beat yourself up over every and any little interaction or negative thought, give yourself a break and pull yourself out of the addiction of dark thoughts. Seek out help, ask for help - even if you are just asking yourself. Make healthy choices that will have a knock on effect of making you feel good about yourself or happy in your decision.

It is far from easy, but again, nothing worth having in this life is ever easy. But then the end result, when you push through and put in that effort - it is so, so very worth it to be able to have that moment of that day when you actually don’t doubt yourself or hate yourself.

I will keep motoring along with my own work and efforts and I ask that you do the same, if you find yourself in that dark place. Push through and don’t give up on yourself, you’re all you’ve got and that’s a pretty amazing thing to have.

[healthkenya7]

ALZHEIMER'S DISEASE AND SLEEP DISORDERS

Alzheimer's Disease: Alzheimer's disease is a progressive and irreversible neurological disorder that affects the brain, leading to a gradual decline in memory, cognitive function, and the ability to carry out daily activities. It is the most common cause of dementia, a term used to describe a range of symptoms related to cognitive decline and memory loss.

Causes and Risk Factors: The exact cause of Alzheimer's disease is not fully understood, but it is believed to result from a combination of genetic, environmental, and lifestyle factors. Some of the known risk factors include age (most cases occur in individuals over 65), a family history of Alzheimer's, certain genes like the APOE ε4 allele, cardiovascular risk factors (e.g., high blood pressure, diabetes, and high cholesterol), and a history of head injuries.

Pathological Changes: In Alzheimer's disease, there are two hallmark brain abnormalities: amyloid plaques and neurofibrillary tangles. Amyloid plaques are formed by the accumulation of a protein called beta-amyloid outside nerve cells, while neurofibrillary tangles result from the abnormal accumulation of a protein called tau inside nerve cells. These abnormalities disrupt the communication between nerve cells, leading to their degeneration and eventual cell death.

Stages of Alzheimer's Disease: Alzheimer's disease typically progresses through several stages:

Preclinical stage: Changes in the brain occur but there are no noticeable symptoms.

Mild cognitive impairment (MCI): Memory problems become evident but do not interfere significantly with daily functioning.

Mild Alzheimer's disease: Memory loss and cognitive impairments become more noticeable and may interfere with daily tasks.

Moderate Alzheimer's disease: Memory loss and cognitive decline worsen, affecting communication, behavior, and orientation.

Severe Alzheimer's disease: Patients lose the ability to communicate, become dependent on others for care, and may experience difficulty swallowing and walking.

Symptoms: Early symptoms of Alzheimer's disease often include forgetfulness, difficulty finding words, getting lost in familiar places, and difficulty with problem-solving. As the disease progresses, individuals may experience confusion, personality changes, mood swings, agitation, and difficulty with self-care.

Diagnosis: There is no definitive test for Alzheimer's disease during life. Diagnosis is usually based on medical history, neurological exams, cognitive assessments, and ruling out other potential causes of cognitive decline. Brain imaging and biomarker tests may aid in supporting the diagnosis.

Treatment: Currently, there is no cure for Alzheimer's disease, and available treatments aim to manage symptoms and slow down its progression. Cholinesterase inhibitors and memantine are commonly prescribed medications to help improve cognitive function and manage behavioral symptoms.

Sleep Disorders: Sleep disorders encompass a wide range of conditions that interfere with the normal pattern of sleep. They can affect sleep quality, duration, and timing, leading to various adverse effects on physical and mental health.

Types of Sleep Disorders: There are numerous sleep disorders, but some of the most common ones include:

Insomnia: Difficulty falling asleep or staying asleep, leading to inadequate sleep duration and poor sleep quality.

Sleep Apnea: Breathing interruptions during sleep due to the partial or complete collapse of the upper airway, leading to oxygen deprivation and disrupted sleep.

Narcolepsy: A neurological disorder characterized by excessive daytime sleepiness and sudden episodes of muscle weakness or paralysis triggered by strong emotions (cataplexy).

Restless Legs Syndrome (RLS): An irresistible urge to move the legs, often accompanied by uncomfortable sensations, which worsen during periods of rest or inactivity, leading to sleep disturbances.

Sleepwalking and Sleep Talking: Parasomnias that involve performing complex behaviors or talking during sleep.

REM Sleep Behavior Disorder (RBD): A parasomnia where the normal paralysis during REM (Rapid Eye Movement) sleep is absent, leading to physical movements and acting out dreams during sleep.

Causes and Risk Factors: Sleep disorders can be caused by a variety of factors, including:

Medical conditions: Such as sleep apnea being linked to obesity, heart conditions, and hormonal imbalances.

Neurological disorders: For example, narcolepsy is caused by a lack of a brain chemical called hypocretin.

Psychological factors: Anxiety, depression, and stress can contribute to insomnia.

Lifestyle and environmental factors: Poor sleep habits, excessive caffeine or alcohol intake, and irregular sleep schedules can disrupt sleep.

Effects and Consequences: Sleep disorders can have significant effects on physical and mental health. Chronic sleep deprivation can impair cognitive function, memory, and decision-making. It can also contribute to mood disorders, compromised immune function, cardiovascular issues, and an increased risk of accidents.

Diagnosis and Treatment: Diagnosing sleep disorders typically involves a detailed medical history, sleep diary, and sometimes overnight sleep studies (polysomnography) conducted in a sleep lab. Treatment options vary depending on the specific disorder but may include lifestyle changes, medication, and behavioral therapies.

Mr. Jayesh Saini says, “Alzheimer's disease is a progressive neurological disorder characterized by cognitive decline and memory loss, while sleep disorders encompass a range of conditions that disrupt normal sleep patterns and can have significant health consequences.”

Mr. Jayesh Saini further notes that “Early recognition and appropriate management of both conditions are crucial for maintaining the quality of life and overall well-being of affected individuals. If you or someone you know is experiencing symptoms related to Alzheimer's disease or a sleep disorder, it's essential to seek medical evaluation and professional advice.”

#jayeshsaini #healthcare #LifeCareHospitals #Kenya #NHIF #NPS #TSC