| |
 |
MEMORY LOSS IN ALZHEIMER’S DISEASE
Memory loss occurs in all cases, but it can sometimes be difficult to detect as people cover it up very well. The most recent memories go first and only much later and in severe disease does the past memory get really affected. The things we’ve done in the last few hours, days, weeks and months are placed in our short-term memory. It is this recent storage that seems not to work properly in Alzheimer’s disease. Because memory loss is an important feature of the condition and can be tested for, it forms part of every assessment. One common test is to ask the person a variety of questions covering short- and long-term memory. Ten questions are asked.
• How old are you?
• What is your date of birth?
• What is the day today?
• What month are we in?
• What year is it?
• When was the First World War?
• What is the name of the Prime Minister?
• Where are you now?
• Remember an address, e.g. 24 West Register Street and ask the person to repeat it after 5 minutes.
• Count backwards from 20 to 1.
As long as the person is cooperative (and has been asked in a nice way!) this test is easy to perform. A score out of ten is achieved.
The importance of the test is that it gives a quick guide to the areas where there might be problems. The questions test short-term and long-term memory as well as orientation. A low score by itself never means that the person has dementia. It is only a guide that something is wrong. Someone with mild to moderate dementia will usually get the short-term memory questions wrong and won’t be able to remember the address. They will, however, usually know their birthday (the year might prove hard) and questions about the War. The question about the Prime Minister causes a lot of debate. Mrs. Thatcher was there so long and was so influential on the public in one way or another (and indeed still is) that some assessors feel it is only fair to give a point if her name is given. As a rule a low score that goes up as the weeks go by usually indicates that the initial poor performance was due to an acute confusional state. A persistently low score over many months is much more indicative of a dementia (as long as all the treatable causes of chronic confusion have been ruled out).
Psychologists are experts in the field of memory testing and use much more sophisticated tests than the modified Northwick Park test given above. When testing someone they use a whole range of different types of test so that they get a very accurate picture of where the serious memory losses are occurring. It has been shown that in mild to moderate cases of Alzheimer’s dementia the sufferer can remember something (often a picture) if asked about it immediately. If the person is asked to match one picture with an identical one they can do it if shown them one immediately after the other. Problems begin to occur if a delay is introduced. Indeed after only ten seconds some people cannot match the pictures or remember what they were shown. In other tests where the psychologist tries to get the person to learn something new and then remember it, there is good evidence that a dementia sufferer can do it, can learn something new and remember it, as long as they are given long enough to do it. It seems that they forget things at the same rate as everyone else; their main problem is in learning and retaining. Computers are now being used to help test memory and other aspects that the psychologist is interested in (reaction times – the time taken for the person to press a button when asked to do so or on seeing a certain picture).
In a social setting the loss of short-term memory can be easily missed. Evasive answers to a direct question – ‘It’s slipped my mind’, ‘I’m awful with dates’, ‘It will come to me’, are very common and it’s surprising how you can start a sentence, get stuck, look at someone and they will help finish it for you. However, a stage is reached sooner or later that cannot be concealed from carers. Memory for recent events gradually gets worse and worse, whereas the sufferer can recall childhood situations and young adult life easily. This short-term memory loss can have practical implications in that kettles and ovens can be left on, etc., and people may forget that they have eaten. The sufferer may go out on an errand and a few yards out of the house have forgotten where they were going and occasionally not be able to find their way home again. In the advanced severe stage the person may forget the names of their nearest and dearest, often a very distressing state for the carers. Finally the sufferer may forget their own name.
*28/128/5*
FDA Approved Prescription Drugs.
 General Health
EYE CARE CONTROVERSIES: STRUGGLE AMONG EYE CARE PROFESSIONS
While optometrists are sparring with ophthalmologists on the right to administer dilating drugs, they are also arguing with opticians about the right to fit contact lenses. There is nothing in most state regulations to prevent an optician from fitting contacts. Many state opticians’ licensing examinations include whole sections on contact lenses. Some opticians don’t choose to fit contacts and have asked that the lens part of the test be reserved for those practitioners who choose to go into the field. That way, an optician failing the contact lens portion, but not the eyeglass portion, of the test won’t have been deprived from taking a job or opening in an optical shop where eyeglasses are manufactured and sold.
In contrast, optometrists think that opticians do not have the training to fit hard and soft lenses directly on the eye. They say that all opticians should be prevented from doing the detailed work. They suggest that of the soft contact lenses alone, with more than two dozen manufacturers making them in a dizzying variety of shapes, widths, thicknesses, and materials, more knowledge is needed than available to the less-trained opticians. Some optometrists say, “Opticians don’t know which end is up” about contacts. Dr. Ross said, in referring to opticians fitting contact lenses, “It is a violation of the laws of medicine and optometry?
But opticians who do choose to fit contact lenses point to their success with patients. They question the economic motives of the optometrists’ efforts to restrict opticians’ practices. It’s strictly a matter of greed, they declare. An optician who asked not to be named said, ”A optometrist has a major stake in contacts, but the ophthalmologist can prescribe them too. It hurts the optometrist’s business to have the job handled by the ophthalmologist and the optician. It cuts him out.” In some cases, the ophthalmologist prescribes the correction and the optician manufactures and sells it. The optometrist is like a
barnacle on a boat slowing down the patient’s passage to better sight. Opticians agree among themselves that the optometrist appears to be an unnecessary professional addition.
There is more politics mixed up with money and lenses. Ophthalmologists don’t usually sell eyeglasses and contact lenses, so they declare themselves above the conflict between eye care professionals and obvious economic interests where lenses are sold. Optometrists point out that this attitude smacks of cover-up.
For instance, optometrists claim they do not push unneeded lenses on patients, even though they sell the products. The ophthalmologists doubt this statement, Optometrists, in turn, claim that some ophthalmologists art not above making a profit on lenses, because they do, in fact, have affiliations with lens stores or opticians. Some eye surgeons have lens dispensing sections right in their offices, and they are not entirely truthful about not profiting from the sale of visual aids.
Finally, the opticians routinely complain that some ophthalmologists and optometrists are slow to furnish prescriptions to other specialists when it becomes clear the patient is going to shop around for the eye care products.
This interprofessional infighting goes on among opticians, optometrists, and ophthalmologists in almost every community in the United States. There is little love lost among any of them. Ophthalmologists are concerned about an ongoing power grab at the top rungs of the eye care ladder by optometrists. Optometrists are trying to get maximum mileage out of their training so as to enhance their income by an increased sale of services. With ever-present political resistance from both professions, vision-impaired people become the losers.
*28/127/5*
buy generic viagra
General Health
CHOOSING A NEW DOCTOR TO TAKE HEALTH CARE FOR OLDER PEOPLE: ACCESSIBILITY AND QUALITY OF THE SERVICES
Accessibility
Find out if the office is close by or near public transportation. Will it be easy to get there if your health changes for the worse? Assess how easy it will be to reach the doctor. What are the office hours, and what is the policy if an emergency occurs after hours? Is another doctor on call when yours is unavailable?
If the doctor is part of a group practice, the associates will cover. Doctors in solo practice generally make arrangements with another practitioner to take their calls when they are away. Be as sure as possible that you will be able to get immediate attention when you need it.
Answers to these questions will help narrow your choices. When you visit, look for the following signs.
Quality of the services
Is the doctor prompt, or are you kept waiting for hours? Is the office clean and well equipped? Are you given a thorough examination?
On this first visit, expect the doctor to spend a good deal of time reviewing your medical history. Be prepared to discuss everything important: your major illnesses and operations, the drugs you regularly take, bad reactions to past treatments, any allergies or sensitivities. Get a sense of whether the doctor is questioning you fully and giving you ample time to talk. In the physical examination, the same considerations apply. Is this someone who seems careful and competent? Is this a person you feel comfortable with and can trust?
Look for signs of geriatric sensitivity. Does the doctor dismiss symptoms that bother you as “old age”? Do you get the feeling that what you say is being discounted because you are over seventy-five? Does this person seem to prescribe drugs precipitously? Are you carefully questioned about the medications you are taking now?
If you have a chronic disease, the doctor should be concerned about how your condition is affecting your ability to function and knowledgeable about the total approach to care discussed earlier – rehabilitation, supportive aids and community services. Choose someone who seems interested in more than the strictly physical side of your disease.
*141/159/5*
GENERAL HEALTH
General Health
HIGH-QUALITY MEDICAL CARE FOR OLDER PEOPLE: SELECTING A NEW DOCTOR
Changing doctors is an unpleasant task that many older people face, not just the few who awaken to the fact that their trusted family physicians are less than competent. You may have moved after retirement. Or you and your doctor may have grown old together. One year he decides to retire. It is hard to start again from scratch after losing a relationship that may have spanned much of your adult life. You may feel no one will know your body in the same way. Never again will you get the same special attention or care.
These fears are natural. Anyone we have such an intimate relationship with for so long is bound to seem irreplaceable. The truth is that transference is transferable. Provided you make a determined search, you can find a doctor you will eventually feel just as enthusiastic about. But you must choose wisely. Make selecting a replacement a special project. What other investment of time is more important? (Once again, it may be helpful to enlist another person in following the next suggestions, a competent “buddy” who can work with you – or even take over the job – in making this project succeed.)
Develop a list of names. Question friends and relatives, but give most weight to recommendations by doctors or other health-care professionals. They will be better able to evaluate candidates’ skills. You can feel more confident that someone they suggest is competent, not just affable.
Check the credentials of each person on your list. What training and education does the doctor have? Does he or she have an academic appointment at a medical school? What hospital is the physician affiliated with, and what is its reputation? To get these facts, either call the doctor’s office directly or ask your county medical society.
Expense. Find out the doctor’s fees and when payments are due. If your financial situation is tight, would it be possible to arrange a special payment schedule to fit your budget? Find out if the doctor accepts Medicare (or if you are eligible, Medicaid), and if so, for what services. Will the office bill Medicare and your insurance carrier directly?
Medicare will pay only for the services of licensed physicians. Your doctor may bill Medicare directly, or you may pay and then be reimbursed by Medicare. Whatever arrangement you have with your doctor, after you pay the yearly deductible, Medicare pays 80 percent of what it deems the “reasonable charge,” and you pay the other 20 percent. If your doctor charges more than the “reasonable charge,” you are responsible for the additional amount.
If feasible, choose a doctor who takes what is called “Medicare assignment.” This means that even if his normal fee is higher, he agrees not to charge you more than Medicare will cover. Those who accept Medicare assignment also submit claim forms directly to Medicare, which will save you time. Unfortunately, however, it is increasingly hard to find a doctor who does accept assignment. Because of Medicare’s stingy reimbursement rates, nationwide 72 percent do not.
*140/159/5*
General Health
NORMAL SLEEP PATTERNS: NEWBORN
The newborn sleeps for 18 hours a day or more, usually in spells of 2 to 4 hours at a time, and awakes only if he is hungry, cold, or otherwise uncomfortable. For the first few weeks of life, it is very difficult to ‘read’ the baby’s behaviour and sleep patterns. He is making a huge transition to the outside world and will be affected by such factors as his level of maturity (whether the baby is premature), any drugs given to the mother during labour, the delivery itself, and so on. Mothers often find it difficult to interpret signals from a newborn baby, and it takes some time, varying from days to many weeks, to settle into any sort of pattern or rhythm. This period of being unsettled can last considerably longer if the baby was very premature or has medical problems during the newborn period. A newborn baby tends to sleep very soundly and is not easily awakened by loud noises or body movements in the way that an older child is.
*150\90\8*
General Health
FRACTURES – DESCRIPTION
A fracture is a broken bone; it may be complete or incomplete, as in a greenstick fracture in a child. It is recognised by pain, swelling and loss of function but sometimes this last sign is not present. Just because somebody can still move his fingers does not mean that the wrist has NOT been broken.
Fractures may be complicated by causing damage to arteries and nerves, or compound, that is involving lacerations or exposing the bone. With large fractures there is always marked loss of blood internally (so you can’t see it) and the risk of shock is present.
The essence of first aid treatment is to immobilise the fractured bone. Don’t try to straighten a crooked limb — splint it as it is.
Splints are easily improvised. Strap one leg to another or one arm to the side of the body, or put one arm in a sling. A piece of wood, a stick, even a ruler, bandaged against the broken limb will do to immobilise the ends of the broken bone.
All suspected fractures must be seen by a doctor. FINGERS
These may be splinted with bandages, or by strapping to the adjoining fingers. BONES OF THE ARM
May be immobilised in a sling, or strapped to the side.
CLAVICLE (COLLARBONE)
*630/71/1*
General Health
GALLSTONES – TREATMENT
At times, it is necessary to open and explore the common bile duct, as when there is a history of jaundice or if there are indications at operation that a small stone may lie within the duct.
When the duct is explored, it usually extends the stay in hospital to 10 to 14 days.
In the past, quacks often gained a reputation for themselves by claiming to cure gallstones. Their potions usually consisted of one part of oil and another of alkali. These reacted in the bowel to form a soap which collected as one or more pellets.
When these were passed in the motion, the quack claimed he had rid the person of their stones.
While researchers have long sought to dissolve stones, rather than operate, it is only recently that this has become possible.
Chenodeoxycholic acid (CDC) is a naturally occurring bile acid which can be given by mouth in large quantities and can both prevent and dissolve the cholesterol stones.
It only works for these rather than the pigment or mixed stones and, even then, is only effective in about 20 per cent of cases, although up to half the stones may be reduced in size.
*374/71/1*
General Health
EXCESSIVE BODY HAIR – GENERAL INFORMATION
Shaving is probably the most used method and can be done by a blade or an electric shaver. While most women seem happy to shave their legs and under their arms, they have a reluctance to shave their faces, perhaps because it seems unfeminine.
Many still believe shaving tends to increase hair growth and to make it coarser. Tests have shown that hairs cut across by shaving have a stubbly appearance and feel, but do not become thicker or harder.
Chemical means of removing hairs are available and effective. They may irritate sensitive skins and have little benefit over shaving, except that the regrowth does not feel as rough as after shaving.
Plucking the hairs is the most popular means of reducing the number in the eyebrows and is effective elsewhere. It is painful and may lead to irritation of the follicles.
Waxing, using either hot or cold wax, has the same effect as plucking — it pulls the hairs out from the follicle and the hair may take from two to six weeks to regrow.
Electrolysis or burning out the hair follicle by an electric current is a popular method of treatment. If the hair follicle is destroyed, there should be no regrowth and permanent cure results, but this is not easy to achieve.
Repeated treatments are usually necessary and some hairs in their “resting” stage may not be destroyed. This method may lead to inflammation and even to scarring or an increase in pigmentation.
So there is no one satisfactory method of clearing those unwanted and unsightly hairs.
*123/71/1*
General Health
BABY AND CHILDHOOD INFECTIOUS DISEASES: POLIOMYELITIS
The prevention of poliomyelitis, commonly known as polio, is the conquest of the current quarter of a century. Once a disastrous and diabolical disease with a high mortality rate, and an even higher harbinger of partially paralysed bodies, it is now seldom seen in the acute stage. Until the mid-1950s it regularly left a trail of wreckage and havoc on the Australian population, and in fact in all Western countries, to say nothing of the appalling disasters it wrought in the developing lands.
But in the mid-1950s, all that changed. The sudden development of a suitable and highly effective vaccine by Dr Salk, and mass immunization campaigns, brought the disease to a sudden halt. Since then, Salk injections have been largely replaced by Sabin oral vaccine, and this is currently recommended for all babies from the age of two months. The death rate from polio plummeted, and the figure has been zero for several years now.
But it will remain this way only as long as parents are vigilant and continue to have their infants immunized along the recommended lines. Polio is still as rampant as ever in the Third World, which is not very far from Australia’s shores. If our national immunization rates fall, then polio could rapidly make a come back in Australia. It is perfectly feasible that it could even return to the pre-vaccination days and again become a major killer and paralyser. It is unlikely that, if the present trend for vaccination against polio continues, many doctors (or anybody for that matter) will witness a case of polio during their lifetime. However, it is worth knowing the symptoms, if only to alert parents to the horrid consequences if they happen to become careless in not arranging for a child to receive the proper course of immunization.
Early symptoms are often vague. They may simulate an oncoming bout of the flu, and the patient may seem to recover temporarily. But a recurrence of fever, backache, neck stiffness, nausea and vomiting may supervene. This may ‘smoulder’ for several days, perhaps up to a week.
Then suddenly the major symptom occurs: paralysis. It may accompany the fever. It is often very variable, ranging from minor weakness of a single muscle group, to severe debilitating loss of function of any section of the body. The most important is the respiratory system; if this is affected, death may be imminent unless immediate emergency facilities are available. These entail the use of an artificial respirator, and its use for an ongoing period of time may be essential to maintain life.
Treatment
Symptoms such as those mentioned above, occurring in an unvaccinated child, require the urgent attention of the doctor. Prompt treatment may be essential to preserve life, especially if the breathing mechanism is affected. Treatment must be carried out in hospitals where the attention of experts is available and full facilities aimed at preserving life are available. This is no game for amateurs or do-it-yourself methods at home.
Younger generations of parents have only heard about polio. With the passage of time and the paucity of cases heard about, stories of the disastrous consequences of yesteryear often fall on deaf ears. And as the likelihood of contracting polio seems minimal there is a general tendency for young people to be complacent. ‘It can’t happen to me or to my child. It’s history … old hat… something in granny’s day.’ All too often apathy can set in. Do not be lulled into a false sense of security and neglect to have your babies immunized against this potential killer. It is simply not worth the risk.
*47\87\2*
General Health
THE FIRST MONTH
Activity
Baby actively thrusts arms and legs about willy nilly in a playful attitude. Movements of the arms, hands and legs are largely reflex actions. For example, when you rub your finger gently over the baby’s palm you will notice how the baby will automatically, reflexively grasp it with curled fingers. If the baby’s head is unsupported, it will flop backwards and forwards loosely. If left lying on the abdomen, the baby will try to lift the head or turn it to one side so that breathing is not obstructed. Supported in a sitting position, the baby may try to hold the head in line with the body for brief periods of time. Fingers are quite often kept clenched. If an effort is made to keep them open, the baby will automatically tend to close them. The baby may hold an object for a short time but generally drops it after a few seconds. There is a tendency to stare at things, but no effort made to reach out and grab them. The two eyes tend to be co-ordinated in their movements.
Talk
The baby tends to cry a good deal, this being a method of gaining attention as well as filling the lungs with oxygen. The baby also makes little noises in the throat. If spoken to, he or she tends to respond.
Mind
The 1-month-old baby prefers to sleep most of the time, being attentive for only about ten per cent of the time. There is little facial expression, and the baby tends to give a vague stare during waking hours. He or she seems to prefer patterns to look at, rather than be attracted by colour or brightness or size of objects; familiar objects, such as parents, tend to give a little excitement. However, at this age the baby cannot concentrate on any single object for long, tending only to pick it up automatically if it comes into the range of vision but readily letting it. slip out of view without making an effort to retain it—when a person walks past, for example. The baby tends to look up and down at objects, or from one side towards the centre of the line of vision. If objects reappear within a few seconds the baby may remember them.
He or she is quite aware of the desire for food and tends to expect it at regular time intervals and may object if it is not forthcoming.
The baby becomes alert to the value of crying for attention, likes receiving attention, and will tend to stop crying if held and cuddled, or if seeing familiar faces, such as mother’s. Reflexes tend to become more efficient and effective.
Relationships
The baby dislikes pain and will let you know about it by crying. He also responds to comforting, and ceasing crying quickly indicates the desire to be comforted when in distress. Occasionally the baby will react to a smiling face, and may return the smile; a familiar voice may also bring a response. The baby will tend to look at mother’s face, looking intently into her eyes, and if obviously distressed may quieten down. The response to changing a wet nappy is often remarkable.
Baby tends to adjust to the person holding him or her, to mould to the body for a more comfortable union; the little one may pluck at the person, curling fingers reflexively around parts of their body such as their fingers. During feeding the baby may suckle noisily, grasping at the breast and nipple actively.
There may be obvious recognition of parents’ voices, but for the most part there is a vagueness about the baby’s stares. He or she may lie impassively for many hours, and when awake tend to stare into space without obviously concentrating on anything. The baby tends to sleep, wake up, cry, make little noises and eat, in a very disorganized manner.
At this age, the baby likes to have two feeds at night and five or six during the day. There are two to four bowel actions each day.
*2\87\2*
General Health
Related Posts:
|
 |
|
|
Search
Calendar:
May 2012
| M |
T |
W |
T |
F |
S |
S |
| « Jun |
|
|
| | 1 | 2 | 3 | 4 | 5 | 6 |
| 7 | 8 | 9 | 10 | 11 | 12 | 13 |
| 14 | 15 | 16 | 17 | 18 | 19 | 20 |
| 21 | 22 | 23 | 24 | 25 | 26 | 27 |
| 28 | 29 | 30 | 31 |
|
Pharmacy Link
Categories
RSS
97 posts |
|
