Description and Possible Medical Problems
If you suddenly become short of breath and simultaneously begin to cough up a pinkish sputum, you need to call 911 for immediate medical attention. You may also be sweating, pale, and wheezing.
These are all signs of acute pulmonary edema, in which the lungs begin to fill with water. Acute pulmonary edema can be caused by a dietary change, a sudden change in or cessation of a medication, a reaction from mixing two or more kinds of medication, or a heart attack or change in heart rhythm. If you have phlebitis, acute pulmonary edema can also be the result of a clot that travels from the veins of the legs into the lung, a condition known as pulmonary embolus.
Treatment
Acute pulmonary edema is a life-and-death situation, and immediate medical attention is necessary. While waiting for medical help, the most important thing to do is to keep a sitting position. If you have any diuretics or water pills at home, there is no harm in taking two of these pills immediately.
Regardless of the cause of acute pulmonary edema, once professional help is on the scene, the treatment for acute pulmonary edema includes the injection of a diuretic, such as Lasix, which will remove excess fluid from your body, meaning the heart has to work less, and nitrates, which reduce the amount of effort the heart has to make. In severe cases, it will be necessary to put you on ventilator support.
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Description and Possible Medical Problems
Like gray hair, wrinkles are a normal part of aging. However, wrinkles tend to appear earlier than gray hair in most people and so are fought more rabidly and for a longer period of time.
One factor we can’t control when it comes to wrinkles is the fact that skin becomes thinner as it ages, which hastens the appearance of wrinkles. Certain factors can speed up the initial appearance of wrinkles and make them worse once they do appear. Cigarette smoking and sun exposure ate often cited as the two best friends a wrinkle can have. Failing to drink enough water every day is also a significant factor, since adequately hydrated skin tends to wrinkle later and less often.
Most of the expensive skin creams that supposedly “turn back the clock” on wrinkles help keep the skin moist—if you apply the cream to damp skin—but the most important thing you can do is to hydrate your skin from within by drinking 8 to 10 glasses of water a day. It’s never too late to start. You should also stop smoking cigarettes and restrict your exposure to the sun.
Treatment
Wrinkles, of course, are irreversible, unless you decide to opt for cosmetic surgery.
Getting a face-lift has been a popular choice for both women and men for years, but the major drawback, besides the fact that any surgical procedure is dangerous, is the fact that it isn’t permanent, which necessitates a repeat performance in a number of years—and at regular intervals afterward. For some people, however, a face-lift is definitely worth it.
Dermatologists have prescribed the use of certain preparations for years, though the side effects can sometimes be harsh.
Again, more and more people today are deciding to let nature take its course and to age with grace—which includes getting wrinkles.
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We all get hoarse from time to time. Sometimes it’s due to over-enthusiastic cheering at a sporting event; at others it’s due to talking too much. Hoarseness can also result from a cold, perhaps accompanied by a sore throat. Whatever the cause, hoarseness occurs when the larynx— which contains the vocal cords—becomes irritated and inflamed, a condition that is known as laryngitis.
Whenever I hear hoarseness in a patient’s voice, I’ll immediately suspect he or she is a smoker. I always ask, “How many cigarettes do you smoke?” It always amazes my patients that I know they smoke. In turn, I’m surprised that they’re not aware of their smoker’s voice. From then on, at every checkup I’ll know to look for the possibility of polyps— abnormal growths that are common in smokers—on their larynxes.
For people who do not smoke but are frequently hoarse nonetheless, the cause is usually raising the voice or talking loudly. Like smokers, people who talk loudly or who frequently shout or scream are prone to developing polyps on the larynx.
While some folks may joke that the periodic bouts of laryngitis some people have finally allow others to get a word in edgewise, the fact is that persistent hoarseness and/or laryngitis may in fact be an indication of a more serious disease, such as polyps or a tumor on the larynx or in the lung.
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However, discussion of sexual matters in the seminar can make the subject more comfortable. Doctors attending seminars have said that it is a safe place in which to practice the discussion of sexual details, and they gain greater confidence to listen to, or to broach sexual topics with their patients.
Setting clear training boundaries that exclude personal sexual revelations and that tie all discussion to a specific case, allows for a study of those difficult moments in the consultation when a feeling of sexiness develops in the room. For the woman doctor faced with a man who produces an erection, the embarrassment can be great for both parties. It may be possible to see such moments as uncon-sicous defences on the part of the patient (Skrine, 1987). Certainly the doctor is usually de-skilled and has to retreat to the safety of the prescription pad, the ordering of tests or a referral to another doctor. During training the doctor can learn to cope with such moments with some degree of equanimity.
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Although doctor had a special interest in psychosexual therapy and some skill in this field, his personal feelings made therapy with this woman, or her husband, a potential minefield. The professional pride of this doctor nearly led him to embark on a dangerous offer of therapy. He could recognize that, because of his training, he had been able to stick with the real problem – that the woman wanted to change her method of contraception without the existence of a logical acceptable reason. He knew from his previous experience with similar encounters that an emotional reason was likely. He had several bright ideas: she might feel she was too old to be continuing on the combined oral contraceptive, or that she might want a less reliable method in order to risk pregnancy without taking a definite decision to start a family. The failure of these ideas to strike a chord with the patient reminded the doctor that each patient is unique and that experience gained from other patients is of no help in understanding what is happening with this particular patient. Only when he waited, in ignorance, for her to tell him what the problem was for her, did he discover the underlying difficulty. He knew, too, that if the husband had come to him with the problem of premature ejaculation, he might have been able to help him discover why it happened. Perhaps his first wife had taken too much from him and he wanted subconsciously to retain the sexual pleasure for himself; perhaps he had always had this pattern and could not see any difficulty, or any of the myriad other reasons why it occurs. Then he could perhaps help him to make the necessary changes to ovecome the precipitate ejaculation. The doctor’s difficulty was his nonprofessional partisan feelings, which made referral elsewhere a preferable option. He would have to propose this to Mrs S. without making her feel rejected.
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Sometimes any contact with a familiar doctor may be perceived as too threatening. A young girl may be unwilling to reveal her sexual needs to a doctor whom she regards as an extension of her parents, particularly her father, and therefore (she feels) bound to disapprove. The occasional publicity about parents being told about their daughter’s sexual activity by a doctor, or even the presence of a rumour about lack of confidentiality, will further discourage the timid or unsure. This part of the growing up process which has to be kept hidden from parental supervision and knowledge, the secret inner world, this search for the separate individual self which is the adult into which the adolescent is developing, prevents the not-yet-quite-adult from consulting those he or she views as being in the parental role. Doctors, teachers, school nurses, as well as parents, all recognize the difficulties of reaching past the defences of the often sullen and rebellious teenager or young adult. Particularly if there are difficulties – the unsuitable boyfriend, a fear of infection or abnormality, failure of erection, pain or dissatisfaction with intercourse – a stranger may need to be sought out. A clinic or doctor unknown previously, perhaps recommended by a friend as sympathetic, is consulted instead of the familiar family doctor.
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In the next two case examples, not only were the patients young at the time of their vasectomy, but there is the additional factor that with both men the procedure was undertaken for the sake of their partner.
A couple came for advice about their infertility. They were in their early 40s, the man dressed in a neat business suit, and his wife also formally dressed. She was so distressed that the overwhelming impression was of a woman with a mass of wild auburn hair and barely restrained emotion. They had married at 18 and had three adult children. After the birth of the third child, the husband, aged 22, had undergone a vasectomy in the puerperium. There appeared to have been no encouragement for him to discuss his decision with his wife. Initially the situation seemed acceptable, but as the years went on and the children grew up, the couple became increasingly distraught. They found adoption was impossible and fostering did not meet their emotional needs. They both regretted the operation and reversal was undertaken but pregnancy did not follow.
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Her situation was discussed and the importance of failure rates examined. Ann said that in the event of failure of the method she would find termination of pregnancy very difficult to even consider, as she felt it would indicate that she had no value. It was agreed that the injectable contraceptive would give her secure contraception and be the safest option in view of her total immobility. This method protected her against pregnancy and induced amenorrhoea which she found a blessing. Many times over the years the couple and their doctor have discussed the prospect of children. Ann and John have now decided that the risk to her health and life is too great. Ann has needed to feel that she had the choice and that she had the capacity to conceive like everyone else. Now, after discussion with her husband, she has made her own choice rather than having a decision thrust upon her by a well-meaning professional.
After some years on injectable progestogens she dreads the thought of periods again and she is currently discussing the possibility of sterilization and endometrial ablation. Further long-term use of the injections has to be considered carefully in view of the possible risk of osteoporosis, which is already a risk factor for her due to her immobility. It is important that Ann and John feel comfortable with the decision made.
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If you think you have temporal arteritis, you should see your doctor immediately, especially if you have experienced sudden blindness. He will conduct a blood test that includes a test for the erythrocyte sedimentation rate, or ESR, which will check how quickly red blood cells settle in the bottom of a test tube. A high ESR is an indication of an inflamed artery, as in temporal arteritis. Your doctor may also perform a biopsy of the temporal artery in order to make a positive diagnosis.
If you do have temporal arteritis, you will need to treat it with a regimen of corticosteroid medication such as prednisone on a long-term basis, possibly for months. This will help reduce the swollen artery to its normal size. In order to prevent future problems, however, you will need to continue taking the medication for a year or more; regular blood tests that monitor the ESR in addition to your symptoms will help your doctor to guide your treatment.
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Description and Possible Medical Problems
A sudden sharp, stabbing pain in your face that begins at your temple and radiates to your cheek or jaw can be frightening. But when the pain arrives for no apparent reason, occurs intermittently for up to several weeks, and then disappears completely for anywhere from a day to several months before striking again, you probably have a condition called trigeminal neuralgia.
Trigeminal neuralgia is characterized by its unpredictability and its sharp, sometimes brief ashes of pain. Men and women over the age of 50 tend to have the condition, and the frequency of attacks increases significantly over the age of 70.
The cause of trigeminal neuralgia is unknown. Though some studies point to a brain tumor or a blood vessel pressing on the nerve as the culprit, the exact cause cannot be determined.
Treatment
If the pain recurs with regularity and makes it difficult for you to functior your doctor may recommend you take phenytoin or carba-mazepine, anticonvulsant medications that may help reduce the number of attacks. You may need to take the medication for a number of weeks after the initial attack.
For severe cases of trigeminal neuralgia that don’t respond to anticonvulsants, your doctor may suggest you undergo an operation that either destroys the trigeminal nerve or reduces its sensitivity, though the final outcome of the operation is difficult to predict and may lead to permanent paralysis of one side of your face. However, in the entire time I’ve spent working as a physician, I have never seen this surgery performed. In addition to the anticonvulsant medications I’ve mentioned, some people with trigeminal neuralgia can also take the antidepressant Elavil to control their pain.
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