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SPEECH IN ALZHEIMER’S DISEASE

admin — Thu, 16 Sep 2010 08:38:07 +0000

Speech is commonly affected in Alzheimer’s disease. Difficulty in finding the correct word to use is experienced early, as is the interpretation of complex conversations or proverbs and metaphors. The understanding of simple speech remains intact at this stage. Later, sentences become difficult to finish and the sufferer wanders off onto another subject and words may get repeated over and over again. Writing and reading are also affected early with word finding or spelling difficulties or a lessening of interest in the task. The taking of messages (especially over the telephone) can prove particularly difficult and may even be the situation that uncovers the early mild dementing illness.

As the disease progresses, the above communication problems steadily worsen. As the word finding deteriorates other words (paraphasias) are added in to fill the gaps so that the true sense of the communication may be lost or the wrong thing asked for. Comprehension similarly gets worse and questions may not get answered or the person may withdraw from talking altogether. Keeping a sentence going often proves too hard for the sufferer and the increasingly frequent change of subject means that the outcome becomes babbling or gibberish.

In advanced disease, communication may prove impossible and the sufferer is often unable to let even their basic needs be known. In a few people there may be an automatic verbal response occasionally, but at this stage the brunt of communicating falls on carers who will need to approach the sufferer with non-verbal means (expression, touch, etc.) Massage and stroking can convey caring probably better than the spoken word.

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LENSES FOR PROTECTION AND CORRECTION OF EYES

admin — Thu, 16 Sep 2010 08:35:35 +0000

Bernice Pherigo of Columbus, Indiana, blind for forty-two years, could see again because of an unusual device like a telescope that passes images through a hole in her eyelid to her retina. The device is a Teflon disc in an optical cylinder – a lens developed in the early 1970s by Hernando Cardona, M.D., an ophthalmologist on the staff of Columbia University.

In the fall of 1977, the patient, who was then sixty-five years old, had the lens implanted into her right eye by Frank Polak, M.D. of the Florida Health Center’s Eye Clinic in Gainesville, Florida. The woman had lost her vision in both eyes when she was in her twenties because of a disease called ocular pemphigus. The disease causes blisters and scars on the outer surface of the eye. In Miss Pherigo’s case, the scar tissue was removed several times in surgery but continued to grow back. Her vision deteriorated to the point where she could only distinguish between light and darkness.

All that is changed today, for the combination of eye surgery and corrective lenses has Miss Pherigo seeing again. Over the past few years the woman has been getting acquainted with a technological phenomenon that passed her by in her forty-year period without sight. Now she’s watching movements on a television screen. There are worlds of small joys such as colors, and the look of furniture in her apartment that she has been experiencing. The vision in Bernice Pherigo’s right eye is about 20-40 now. She can read large-print magazines and newspapers, and eyeglasses have been added to improve her vision of faraway objects.

Working like a fixed-focus camera, the lens in Bernice’s eye receives light and transmits it to the eye’s retina, where the image is recorded. The patient’s upper and lower eyelids have been permanently stitched together and the lens protrudes through a hole in the eyelid. There is no peripheral vision, but Miss Pherigo can move the cylinder with muscles that normally open and close the eyelid.

Cases such as this of Bernice Pherigo are highly dramatic applications of lenses used to restore sight. Those few blind people who have normal retinas and whose corneal damage cannot be repaired by cornea transplant can benefit from a lens implantation. Other people not requiring such dramatic restoration wear ordinary eyeglasses to preserve and enhance the vision that they possess.

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CHOOSING NURSING HOME FOR OLDER PEOPLE: DRG SYSTEM AND MORE

admin — Tue, 01 Jun 2010 14:31:35 +0000

Ideally you will have the luxury of making a fully informed choice. In reality your options are likely to be more limited. If your relative is arriving from the community, the best homes tend to have long waiting lists. Priority is given to patients coming from hospitals. Even if your ideal choice has a wait years long, get on the list. Beds do open up.
If your relative is in the hospital, you may not have time to choose at all. Hospitals used to be paid by the day. According to a new reimbursement method called the DRG system, the hospital is now paid a fixed sum before admission according to the person’s “diagnostic related group” -the cost of an estimated “average length of stay” for that condition. This system was devised as an incentive to discourage unnecessarily long hospitalizations. Instead of benefiting economically by keeping patients longer, hospitals now benefit by discharging them sooner, because they collect the same fee regardless of how many days a person stays.
Critics of this system argue that it discriminates against the elderly because, being more frail, they tend to require more time than “average” to recuperate from illness or surgery. Apart from whether this argument has merit, the practical effect of the DRG system is this bottom line: your relative will be pressured to leave the hospital as soon as possible, pushed to accept the first available bed in any area nursing home. But you can forestall this by knowing in advance which homes are acceptable and telling the hospital social worker to call only them. So start your inquiries the minute you think institutional care may be needed -for instance, when your relative enters the hospital.

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GENERAL HEALTH

TAKING CARE OF OLDER PEOPLE: SELECTING NURSING HOME WITH CHECKLIST

admin — Tue, 01 Jun 2010 14:31:04 +0000

The physical plant. Is the home clean, well lit, relatively odor-free, laid out with a disabled person’s needs in mind? Do residents’ rooms contain personal belongings? What is the policy on bringing in such belongings? Is there enough room for privacy and an attractive place to sit outside?
You want a place that looks cheerful and is appropriate for people who have problems in walking or seeing or hearing well, where the environment minimizes excess disabilities. You also want an administration that is sensitive to a crucial human need – not to be parted from all the treasured possessions that are so essential to maintaining our sense of self.
The residents. Are they clean and well groomed? Are they kept occupied, or are most lying in bed or sitting and staring at the wall? Do not expect a camp atmosphere, but expect some residents to be happy and engaged. Approach some of these people, tell them who you are, and ask how they feel about the home. Expect complaints, but also expect to learn a good deal about whether this is a humane place.
The staff. Are they neatly dressed and well groomed? Are they on the floor helping residents? Do they appear to be caring, respectful, and conscientious, answering calls for help without delay? Linger with your eyes and ears open.
The meals and activities. Both are important events in the lives of nursing-home residents. Visit when a meal is being served. Does the food look appetizing, and are there substitutes for the main dish? Do residents who need it get prompt help with eating? Do most eat in the dining room? Visit the activities room. Is it well equipped and staffed? Is a list of activities posted? Do they seem varied, and does the selection include things your loved one would enjoy? Is an effort made to get residents out into the community and bring outsiders in? Is there a volunteer program?
The nursing home should be open to the community, and it should offer residents who are able regular opportunities to leave the grounds. As much as possible, it should also let residents exercise choice, in what they eat, in what they do. The ability to make choices enhances not only our psychological well-being but our physical health too.
The medical care. Are there physicians on the staff? Can residents select among them, or are they assigned a doctor? What hospitals are used if your loved one becomes ill? Is this home equipped to provide any needed specialized medical and rehabilitative care?
Health inspection information. Nursing homes are required by law to post the results of the most recent health inspection. However, since inspections occur infrequently and tend to focus on safety violations and the adequacy of the home’s physical plant, knowing an institution has passed will not tell much about the quality of care it provides. But information about violations and whether they are being corrected should be used along with your observations as a sign the home is good.
Admissions and cost. If the home seems acceptable, visit the admissions office. Is there a waiting list, and if so, how long? What forms are needed to apply, and how long are applications kept on file? If you are paying privately, what services are included in the basic rate, and what costs are extra? What is the refund policy for leaving prematurely? What is the procedure for applying for Medicaid?

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GENERAL HEALTH

SLEEP PROBLEMS AT DIFFERENT AGES: TODDLERS

admin — Thu, 21 May 2009 06:59:30 +0000

Parents have a variety of complaints about their toddlers. Many toddlers refuse to go to bed at night. They will invent an extraordinary variety of reasons why they should stay up a little longer, and some parents dread the approach of bedtime as they know that they will inevitably get involved in a drawn-out struggle with the child.

Some toddlers are happy enough to go to bed but then refuse to sleep. Again, reasons, all of which, of course, are designed to involve the parents. They may be hungry, thirsty, need to go to the toilet (having just been), are afraid of the dark, or the dog, or something else, or just want to say one last thing to mummy or daddy, or are just not tired, and so on. All parents will be able to add to this list. The one thing that all of these excuses have in common is that they all are intended to involve the parents in giving a response. Indeed, as we shall discuss shortly, it is precisely because the parents respond that these behaviours continue. They are dependent on a response from the parents — once this is not forthcoming, they very quickly stop.

Other toddlers wake during the night, and either call out to their parents or else come out of bed to be with the parents wherever they are, including the parents’ bed. Again the continuation of this behaviour depends on the parents reinforcing it.

Some children have got so used to having a parent present when they go off to sleep that it may be impossible for them to go to sleep alone. The usual scenario is for the child to go to sleep in the parent’s arms, or at the breast, or with the parent lying alongside the child until he falls asleep. While in some families this is the norm, and without saying necessarily that it is wrong or leads to any long-term harm, it does mean that the parents should be resigned to having to be involved with the child falling asleep for a long, long time.

During the toddler period other sleep problems begin to emerge, such as nightmares, night terrors, sleepwalking and sleeptalking, as well as fears and phobias that may affect a child’s sleep patterns.

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RESUSCITATION – GENERAL INFORMATION

admin — Mon, 18 May 2009 06:28:08 +0000

You should learn how to do mouth-to-mouth resuscitation and teach it to your older children.

If breathing has stopped, place the patient on his back. Check to see whether his heart is beating. The pulse can be felt at the wrist or at the neck, or you can place your hand over his heart and feel his heart beat, or you can listen with your ear placed on his chest.

If the heart has stopped, the pupils of the eyes dilate and they do not respond to light. If the heart has stopped, you must begin external cardiac massage.

If the heart is still beating, but the breathing has stopped, the patient will show signs of cyanosis. This is the blue discoloration of the skin, more noticeable on the lips and other mucous membranes in a dark-skinned person. It is due to a build-up of carbon dioxide in the blood.

Check the mouth and remove any foreign body, such as seaweed, blood or vomit. In an adult you may have to remove false teeth. Do this quickly.

If possible place a small pillow or a folded towel or a coat under the shoulder blades. Kneel beside the head of the patient. Lift the lower jaw forward and keep this up all the time, otherwise the tongue will fall back and obstruct breathing.

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GLAUCOMA – DESCRIPTION

admin — Fri, 15 May 2009 09:07:09 +0000

The defect in vision usually affects the inner or nasal side and this loss is often not noticed because it falls into the binocular area covered by both eyes.

Later it may involve the outer area and so lead to “tunnel vision”, where it appears the vision is reduced to seeing straight ahead as if one were looking through a tunnel.

The visual loss may not involve the central area and so the person may still appear to have good vision with or without correcting glasses. Being unaware of the progressive loss, the sufferer may see no need to have his eyesight checked.

As in acute glaucoma, haloes may be seen on looking at bright lights. This phenomenon can occur in any condition which gives rise to oedema of the cornea. Once diagnosed, chronic glaucoma can usually be brought under control.

Pilocarpine has been the mainstay of treatment. It is instilled into the affected eye several times a day, constricts the pupil and so prevents the bunching up of the colored iris into the corner of the eye where the duct to drain away the fluid from the chamber behind the cornea is.

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HOME BIRTHS

admin — Fri, 15 May 2009 07:07:34 +0000

A generation has grown up not knowing that the large obstetric hospitals developed because of unsatisfactory results in home deliveries of babies.

Confinements are normal and mother and baby do well in 70 per cent of cases with no complications so for the majority it really doesn’t matter where the mother has the baby.

But what of the others?

Good obstetric care has meant a great drop in the maternal mortality. In NSW, in 1936, the maternal mortality was 6.3 per thousand live births and in 1977 0.13 per thousand live births. Babies have also benefited from this care.

Criticism of obstetric intervention is now com-monNand doctors are believed to resort too quickly to induction of births and caesarian section.

The Medical Journal of Australia, in talking about recent research in this area, says “… even if labor does not progress in a normal manner and manipulative interference is required, the outlook for the baby is not prejudiced.

“With the advent of ante-natal care, availability of blood transfusion and increased use of caesarian section, women began to expect a live baby from each pregnancy. As is shown from this research, modern obstetrics is ensuring the baby is not only alive, but well. We must avoid turning back the clock half a century because someone thinks that darkness is beneficial or the home environment is best for mother and baby.”

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BABY AND CHILDHOOD DIGESTIVE SYSTEM DISORDERS: TEETHING

admin — Fri, 08 May 2009 08:32:33 +0000

Acquiring the teeth is a perfectly normal process. It is certainly not a disorder, nor a disease, nor anything sinister. But it is included in this section because many infants experience difficulty when teething.

A large number of disorders have been blamed on the teething process. Diarrhoea, convulsions, coughs and cold and general respiratory illnesses and skin rashes have all been attributed to the teething mechanism. Many parents know that teething time can be the time of an unhappy, distressed baby. Inside the baby’s mouth will often be gums that are red, inflamed and swollen; for sure, this must cause discomfort and pain and make the infant crochety and irritable. The baby may cry, go off food, and in turn predispose to a lot of other symptoms.

During teething time, I believe that a baby’s general body resistance tends to fall temporarily. Therefore the child is more susceptible than usual to respiratory and bowel viruses that are always ready to pounce. Resistance factors in the blood are less, and the child is more susceptible to skin irritations and allergies. So rashes may appear.

All of these should be treated along the appropriate lines. Most respond well to simple measures. If they do not, visit the doctor. Have the baby thoroughly examined to make certain that more sinister disorders are not present. Go along with any further treatment the doctor advises.

A word must be said here about teeth staining. Many older children today have teeth that are irregularly stained an unattractive yellowish colour. In many cases, this was caused by the antibiotic tetracycline being given early in life to treat various infections. Tetracycline has the propensity for collecting in the teeth and causing the discoloration. Today, doctors do not prescribe it for babies and children, but occasionally mothers may have it prescribed, and if they are breast-feeding it may reach their babies via their milk. Ideally, mothers and babies today are not given the tetracycline family of antibiotics.

Some infants and children show evidence of early tooth decay, now referred to as caries. Normally, the teeth have a strong outer coating that resists penetration by germs; however, the free use of sugars appears to contribute to the destruction of this natural barrier. So, the less sugar the diet contains, the better for the infant. Not only in respect of teeth, but for general health as well.

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BREAST FEEDING: BONDING

admin — Fri, 08 May 2009 08:26:08 +0000

‘There is no doubt that the psychological value is enormous,’ I agreed. ‘Doctors refer to it as bonding—a link or interaction between mother and baby, which is important. The earlier breast feeding begins, the more intense and successful bonding will be.’

‘Then why is it some mothers have difficulty?’ Karen asked.

‘Some are simply not interested or may have a mental block. The more you talk in positive terms before the baby is born, the more successful you will be. Mental preparation is an excellent idea, and these mothers seem to be the ones chalking up the best success records.

‘A peaceful atmosphere is important. Peace and calm, and freedom from tensions and anxieties, will let the milk flow be even, regular and plentiful in most cases. Ideally, the baby should go to the breast soon after birth, and thereafter “on demand”, as they say.

This will in most instances soon establish a plentiful milk supply. If there are early difficulties (and this is not uncommon), the aid of a sympathetic person experienced in baby care will often help considerably.’

‘Is it best to feed the baby while lying down or while sitting up,’ Karen asked. ‘I’ve tried both. Which is the ideal?’

‘The ideal is what suits you both best. Sometimes, with the milk running downhill, baby receives too much too quickly; so she coughs and splutters and has difficulty, and this may frighten her in the early stages. Try lying down, with baby on top, so she has to suck “uphill”. This makes it a bit more difficult and reduces the rate of flow, but makes the experience more satisfactory for both.

‘Some babies are vigorous suckers; others are slower, take their time and may even go to sleep. Don’t forget that the baby is a personality in her own right and will tend to do things the way she likes it best.’

‘It’s interesting to see that she certainly knows where the food supply is,’ Karen said.

‘They have an inbuilt intuition,’ I commented. ‘All babies can sense food, and when anywhere near it will automatically seek the correct connection. Another automatic reflex starts as soon as she gets the nipple in her mouth. She commences sucking. It is an inbuilt and automatic reflex.’

‘It seems to me that some mothers simply give up the idea of breast feeding after a week or two, claiming it is impossible. Is this really true?’ Karen asked.

‘Sometimes it takes time for the milk pattern to become established. Also, in the days following birth, some women become morose and depressed and wonder what everything is all about. They tend to give up in despair and become discouraged easily. Some suffer from cracked nipples, which may be very painful, so do not persist. After a few weeks of feeding, most mothers sense a feeling of the milk coming into the breasts at feeding time. Even thinking about feeding their babies or hearing them cry can initiate this interesting automatic reflex.’

‘When I go home, how often do I feed Joanna?’ was Karen’s next query.

‘Most doctors today suggest that you feed “on demand”. It doesn’t take the baby long to fall into a regular feeding pattern. At first she may want ten or twelve feeds a day, but this quickly reduces until most babies are content with four or five a day in each 24 hours.

‘In the first few days, a very rich, creamy kind of milk called colostrum is produced. This is believed to contain special antibodies aimed at giving the baby protection during the first few days of life. This persists for several days after birth, and then normal lactation takes place.

‘The baby is often hungry at each feed. Commence with one side for five to ten minutes, then switch to the opposite side. Let her suckle for as long as she desires, possibly up to 20 minutes. Next feed, commence with the opposite breast.’

‘One of my girl friends said that her milk supply seemed to diminish quickly after she left hospital and returned home,’ Karen said. ‘Is this common?’

‘It is not uncommon, for the new mother is back in the world of normal activity, with its inherent stresses and strains, and these may play a part in the milk supply,’ I answered. ‘But if she persists with breast feeding, the milk supply will soon return to normal. Ideally, she will benefit if she can gain some rest during the early days.

‘More fluids are essential for her also. Usually she should be able to supply all of the baby’s needs, although many mothers like to give their babies extra fluids, especially if the weather is hot. Boiled water or diluted fruit juice (orange) with vitamin C are suitable. Fluoride, should be given in the appropriate doses to babies fed entirely on breast milk, before they are drinking water. This assists in preventing later dental caries, tooth decay; for both breast milk and cow’s milk, the dentists say, have insufficient amounts of this.’

‘But why do some women refuse to breast feed if the advantages are so obvious?’ Karen asked.

‘Sometimes it is impossible,’ I answered. ‘If the baby is weak, ill or premature, or if there is some structural deformity such as a cleft palate or lip, it may be difficult to breast feed. Then ideally breast milk is used but given via a bottle. On the other hand, some mothers are simply unable to produce adequate amounts of milk, so formula or artificial feeding may be recommended. In today’s affluent society, many women simply opt for bottle feeding, although in recent times, wherever possible, more and more are happily returning to nature’s way.’

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