A feeling of tiredness, drowsiness, or lack of energy.
If the patient with lethargy runs a fever, the di?erential diagnosis is that of a PUO (pyrexia of unknown origin). Many patients with fatigue can establish the onset of the symptom to a febrile illness even though they no longer run a fever. The lethargy that follows some viral infecions, such as HEPATITIS A and glandular fever (see MONONUCLEOSIS) is well recognised; MYALGIC ENCEPHALOMYELITIS (ME) or chronic fatigue syndrome is another disorder associated with lethargy and tiredness. Organic causes of lethargy include ANAEMIA, malnutrition and hypothyroidism (see THYROID GLAND, DISEASES OF). Some of these patients have a true depressive illness and their presentation and response to treatment is little di?erent from that of sufferers of any other depressive illness, URAEMIA, alcoholism and DIABETES MELLITUS.
T.b. gambiense infection, enlarged glands in the neck (Winterbottom’s sign) may be striking. Onset of disease is accompanied by fever, progressive ANAEMIA, and enlarged glands; these signs and symptoms are followed by increasing lethargy, slowing of mentality, and physical weakness, and give way to headache and an increasing tendency to sleep. These symptoms are caused by proliferation of parasites in the patient’s cerebral blood vessels; this is accompanied by in?ammatory changes and disorganisation of nervous tissue. Patients become emaciated and develop bed sores. Death ?nally takes place either as a result of gross emaciation or of an intercurrent infection.
Diagnosis is by detection of trypanosomes in a blood specimen or, alternatively, a sample of cerebrospinal ?uid. Serological tests are of great value in diagnosis.
Treatment is with suramine or pentamidine; when cerebral involvement has ensued, melarsoprol – which penetrates the blood-brain barrier – is of value. In T.b. gambiense infection, e?ornithine has recently given encouraging results; however, this form of CHEMOTHERAPY is not e?ective in a T.b. rhodesiense infection. From the point of view of prevention, control of the tsetse-?y population is crucial; even so, only a very small percentage of these vectors is infected with Trypanosoma spp.... sleeping sickness
The local effects of the tumour commonly cause headache and, less frequently, impairment of vision, particularly of the temporal ?eld of vision, as a result of pressure on the nerves to the eye. The tumour may damage the other pituitary cells giving rise to gonadal, thyroid or adrenocortical insu?ciency. The disease often becomes obvious in persons over about 45 years of age; they may also complain of excessive sweating, joint pains and lethargy. The diagnosis is con?rmed by measuring the level of growth hormone in the serum and by an X-ray of the skull which usually shows enlargement of the pituitary fossa.
Treatment The most e?ective treatment is surgically to remove the pituitary adenoma. This can usually be done through the nose and the sphenoid sinus, but large adenomas may need a full CRANIOTOMY. Surgery cures about 80 per cent of patients with a microadenoma and 40 per cent of those with a large lesion; the rate of recurrence is 5–10 per cent. For recurrences, or for patients un?t for surgery or who refuse it, a combination of irradiation and drugs may be helpful. Deep X-ray therapy to the pituitary fossa is less e?ective than surgery but may also be helpful, and recently more sophisticated X-ray techniques, such as gamma knife irradiation, have shown promise. Drugs – such as BROMOCRIPTINE, capergoline and quiangoline, which are dopamine agonists – lower growth-hormone levels in acromegaly and are particularly useful as an adjunct to radiotherapy. Drugs which inhibit growth-hormone release by competing for its receptors, octeotride and lanreotride, also have a place in treatment.
See www.niddk.nih.gov/health/endo/pubs/ acro/acro.htm
www.umm.edu/endocrin/acromegaly.htm... acromegaly
Not all sufferers from coeliac disease present with gastrointestinal symptoms: doctors, using screening techniques, have increasingly identi?ed large numbers of such people. This is important because researchers have recently discovered that untreated overt and silent coeliac disease increases the risk of sufferers developing osteoporosis (brittle bone disease – see BONE, DISORDERS OF) and cancer. The osteoporosis develops because the bowel fails to absorb the CALCIUM essential for normal bone growth. Because those with coeliac disease lack the enzyme LACTASE, which is essential for digesting milk, they avoid milk – a rich source of calcium.
The key treatment is a strict, lifelong diet free of gluten. As well as returning the bowel lining to normal, this diet results in a return to normal bone density. People with coeliac disease, or parents or guardians of affected children, can obtain help and guidance from the Coeliac Society of the United Kingdom. (See also MALABSORPTION SYNDROME; SPRUE.)... coeliac disease
The dependence that most concerns modern society is one in which individuals become dependent on or addicted to certain substances such as alcohol, drugs, tobacco (nicotine), caffeine and solvents. This is often called substance abuse. Some people become addicted to certain foods or activities: examples of the latter include gambling, computer games and use of the Internet.
The 28th report of the World Health Organisation Expert Committee on Drug Dependence in 1993 de?ned drug dependence as: ‘A cluster of physiological, behavioural and cognitive phenomena of variable intensity, in which the use of a psychoactive drug (or drugs) takes on a high priority. The necessary descriptive characteristics are preoccupation with a desire to obtain and take the drug and persistent drug-seeking behaviour. Psychological dependence occurs when the substance abuser craves the drug’s desirable effects. Physical dependence occurs when the user has to continue taking the drug to avoid distressing withdrawal or abstinence symptoms. Thus, determinants and the problematic consequences of drug dependence may be biological, psychological or social and usually interact.’
Di?erent drugs cause di?erent rates of dependence: TOBACCO is the most common substance of addiction; HEROIN and COCAINE cause high rates of addiction; whereas ALCOHOL is much lower, and CANNABIS lower again. Smoking in the western world reached a peak after World War II with almost 80 per cent of the male population smoking. The reports on the link between smoking and cancer in the early 1960s resulted in a decline that has continued so that only around a quarter of the adult populations of the UK and USA smokes. Globally, tobacco consumption continues to grow, particularly in the developing world with multinational tobacco companies marketing their products aggressively.
Accurate ?gures for illegal drug-taking are hard to obtain, but probably approximately 4 per cent of the population is dependent on alcohol and 2 per cent on other drugs, both legal and illegal, at any one time in western countries.
How does dependence occur? More than 40 distinct theories or models of drug misuse have been put forward. One is that the individual consumes drugs to cope with personal problems or diffculties in relations with others. The other main model emphasises environmental in?uences such as drug availability, environmental pressures to consume drugs, and sociocultural in?uences such as peer pressure.
By contrast to these models of why people misuse drugs, models of compulsive drug use – where individuals have a compulsive addiction
– have been amenable to testing in the laboratory. Studies at cellular and nerve-receptor levels are attempting to identify mechanisms of tolerance and dependence for several substances. Classical behaviour theory is a key model for understanding drug dependence. This and current laboratory studies are being used to explain the reinforcing nature of dependent substances and are helping to provide an explanatory framework for dependence. Drug consumption is a learned form of behaviour. Numerous investigators have used conditioning theories to study why people misuse drugs. Laboratory studies are now locating the ‘reward pathways’ in the brain for opiates and stimulants where positive reinforcing mechanisms involve particular sectors of the brain. There is a consensus among experts in addiction that addictive behaviour is amenable to e?ective treatment, and that the extent to which an addict complies with treatment makes it possible to predict a positive outcome. But there is a long way to go before the mechanisms of drug addiction are properly understood or ways of treating it generally agreed.
Effects of drugs Cannabis, derived from the plant Cannabis sativa, is a widely used recreational drug. Its two main forms are marijuana, which comes from the dried leaves, and hashish which comes from the resin. Cannabis may be used in food and drink but is usually smoked in cigarettes to induce relaxation and a feeling of well-being. Heavy use can cause apathy and vagueness and may even cause psychosis. Whether or not cannabis leads people to using harder drugs is arguable, and a national debate is underway on whether its use should be legalised for medicinal use. Cannabis may alleviate the symptoms of some disorders – for example, MULTIPLE SCLEROSIS (MS) – and there are calls to allow the substance to be classi?ed as a prescribable drug.
About one in ten of Britain’s teenagers misuses volatile substances such as toluene at some time, but only about one in 40 does so regularly. These substances are given o? by certain glues, solvents, varnishes, and liquid fuels, all of which can be bought cheaply in shops, although their sale to children under 16 is illegal. They are often inhaled from plastic bags held over the nose and mouth. Central-nervous-system excitation, with euphoria and disinhibition, is followed by depression and lethargy. Unpleasant effects include facial rash, nausea and vomiting, tremor, dizziness, and clumsiness. Death from COMA and acute cardiac toxicity is a serious risk. Chronic heavy use can cause peripheral neuropathy and irreversible cerebellar damage. (See SOLVENT ABUSE (MISUSE).)
The hallucinogenic or psychedelic drugs include LYSERGIC ACID DIETHYLAMIDE (LSD) or acid, magic mushrooms, ecstasy (MDMA), and phencyclidine (PCP or ‘angel’ dust, mainly used in the USA). These drugs have no medicinal uses. Taken by mouth, they produce vivid ‘trips’, with heightened emotions and perceptions and sometimes with hallucinations. They are not physically addictive but can cause nightmarish bad trips during use and ?ashbacks (vivid reruns of trips) after use, and can probably trigger psychosis and even death, especially if drugs are mixed or taken with alcohol.
Stimulant drugs such as amphetamine and cocaine act like adrenaline and speed up the central nervous system, making the user feel con?dent, energetic, and powerful for several hours. They can also cause severe insomnia, anxiety, paranoia, psychosis, and even sudden death due to convulsions or tachycardia. Depression may occur on withdrawal of these drugs, and in some users this is su?ciently deterrent to cause psychological dependence. Amphetamine (‘speed’) is mainly synthesised illegally and may be eaten, sni?ed, or injected. Related drugs, such as dexamphetamine sulphate (Dexedrine), are prescribed pills that enter the black market. ECSTASY is another amphetamine derivative that has become a popular recreational drug; it may have fatal allergic effects. Cocaine and related drugs are used in medicine as local anaesthetics. Illegal supplies of cocaine (‘snow’ or ‘ice’) and its derivative, ‘crack’, come mainly from South America, where they are made from the plant Erythroxylon coca. Cocaine is usually sni?ed (‘snorted’) or rubbed into the gums; crack is burnt and inhaled.
Opiate drugs are derived from the opium poppy, Papaver somniferum. They are described as narcotic because they induce sleep. Their main medical use is as potent oral or injectable analgesics such as MORPHINE, DIAMORPHINE, PETHIDINE HYDROCHLORIDE, and CODEINE. The commonest illegal opiate is heroin, a powdered form of diamorphine that may be smoked, sni?ed, or injected to induce euphoria and drowsiness. Regular opiate misuse leads to tolerance (the need to take ever larger doses to achieve the same e?ect) and marked dependence. A less addictive oral opiate, METHADONE HYDROCHLORIDE, can be prescribed as a substitute that is easier to withdraw.
Some 75,000–150,000 Britons now misuse opiates and other drugs intravenously, and pose a huge public-health problem because injections with shared dirty needles can carry the blood-borne viruses that cause AIDS/HIV and HEPATITIS B. Many clinics now operate schemes to exchange old needles for clean ones, free of charge. Many addicts are often socially disruptive.
For help and advice see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELF-HELP – National Dugs Helpline.
(See ALCOHOL and TOBACCO for detailed entries on those subjects.)... dependence
Rarely, an enlarged gland may be the result of cancer in the thyroid.
Treatment A symptomless goitre may gradually disappear or be so small as not to merit treatment. If the goitre is large or is causing the patient di?culty in swallowing or breathing, it may need surgical removal by partial or total thyroidectomy. If the patient is de?cient in iodine, ?sh and iodised salt should be included in the diet.
Hyperthyroidism is a common disorder affecting 2–5 per cent of all females at some time in their lives. The most common cause – around 75 per cent of cases – is thyrotoxicosis (see below). An ADENOMA (or multiple adenomas) or nodules in the thyroid also cause hyperthyroidism. There are several other rare causes, including in?ammation caused by a virus, autoimune reactions and cancer. The symptoms of hyperthyroidism affect many of the body’s systems as a consequence of the much-increased metabolic rate.
Thyrotoxicosis is a syndrome consisting of di?use goitre (enlarged thyroid gland), over-activity of the gland and EXOPHTHALMOS (protruding eyes). Patients lose weight and develop an increased appetite, heat intolerance and sweating. They are anxious, irritable, hyperactive, suffer from TACHYCARDIA, breathlessness and muscle weakness and are sometimes depressed. The hyperthyroidism is due to the production of ANTIBODIES to the TSH receptor (see THYROTROPHIN-STIMULATING HORMONE (TSH)) which stimulate the receptor with resultant production of excess thyroid hormones. The goitre is due to antibodies that stimulate the growth of the thyroid gland. The exoph-
thalmos is due to another immunoglobulin called the ophthalmopathic immunoglobulin, which is an antibody to a retro-orbital antigen on the surface of the retro-orbital EYE muscles. This provokes in?ammation in the retro-orbital tissues which is associated with the accumulation of water and mucopolysaccharide which ?lls the orbit and causes the eye to protrude forwards.
Although thyrotoxicosis may affect any age-group, the peak incidence is in the third decade. Females are affected ten times as often as males; the prevalence in females is one in 500. As with many other autoimmune diseases, there is an increased prevalence of autoimmune thyroid disease in the relatives of patients with thyrotoxicosis. Some of these patients may have hypothyroidism (see below) and others, thyrotoxicosis. Patients with thyrotoxicosis may present with a goitre or with the eye signs or, most commonly, with the symptoms of excess thyroid hormone production. Thyroid hormone controls the metabolic rate of the body so that the symptoms of hyperthyroidism are those of excess metabolism.
The diagnosis of thyrotoxicosis is con?rmed by the measurement of the circulating levels of the two thyroid hormones, thyroxine and TRIIODOTHYRONINE.
Treatment There are several e?ective treatments for thyrotoxicosis. ANTITHYROID DRUGS These drugs inhibit the iodination of tyrosine and hence the formation of the thyroid hormones. The most commonly used drugs are carbimazole and propylthiouricil: these will control the excess production of thyroid hormones in virtually all cases. Once the patient’s thyroid is functioning normally, the dose can be reduced to a maintenance level and is usually continued for two years. The disadvantage of antithyroid drugs is that after two years’ treatment nearly half the patients will relapse and will then require more de?nitive therapy. PARTIAL THYROIDECTOMY Removal of three-quarters of the thyroid gland is e?ective treatment of thyrotoxicosis. It is the treatment of choice in those patients with large goitres. The patient must however be treated with medication so that they are euthyroid (have a normally functioning thyroid) before surgery is undertaken, or thyroid crisis and cardiac arrhythmias may complicate the operation. RADIOACTIVE IODINE THERAPY This has been in use for many years, and is an e?ective means of controlling hyperthyroidism. One of the disadvantages of radioactive iodine is that the incidence of hypothyroidism is much greater than with other forms of treatment. However, the management of hypothyroidism is simple and requires thyroxine tablets and regular monitoring for hypothyroidism. There is no evidence of any increased incidence of cancer of the thyroid or LEUKAEMIA following radio-iodine therapy. It has been the pattern in Britain to reserve radio-iodine treatment to those over the age of 35, or those whose prognosis is unlikely to be more than 30 years as a result of cardiac or respiratory disease. Radioactive iodine treatment should not be given to a seriously thyrotoxic patient. BETA-ADRENOCEPTOR-BLOCKING DRUGS Usually PROPRANOLOL HYDROCHLORIDE: useful for symptomatic treatment during the ?rst 4–8 weeks until the longer-term drugs have reduced thyroid activity.
Hypothyroidism A condition resulting from underactivity of the thyroid gland. One form, in which the skin and subcutaneous tissues thicken and result in a coarse appearance, is called myxoedema. The thyroid gland secretes two hormones – thyroxine and triiodothyronine – and these hormones are responsible for the metabolic activity of the body. Hypothyroidism may result from developmental abnormalities of the gland, or from a de?ciency of the enzymes necessary for the synthesis of the hormones. It may be a feature of endemic goitre and retarded development, but the most common cause of hypothyroidism is the autoimmune destruction of the thyroid known as chronic thyroiditis. It may also occur as a result of radio-iodine treatment of thyroid overactivity (see above) and is occasionally secondary to pituitary disease in which inadequate TSH production occurs. It is a common disorder, occurring in 14 per 1,000 females and one per 1,000 males. Most patients present between the age of 30 and 60 years.
Symptoms As thyroid hormones are responsible for the metabolic rate of the body, hypothyroidism usually presents with a general sluggishness: this affects both physical and mental activities. The intellectual functions become slow, the speech deliberate and the formation of ideas and the answers to questions take longer than in healthy people. Physical energy is reduced and patients frequently complain of lethargy and generalised muscle aches and pains. Patients become intolerant of the cold and the skin becomes dry and swollen. The LARYNX also becomes swollen and gives rise to a hoarseness of the voice. Most patients gain weight and develop constipation. The skin becomes dry and yellow due to the presence of increased carotene. Hair becomes thinned and brittle and even baldness may develop. Swelling of the soft tissues may give rise to a CARPAL TUNNEL SYNDROME and middle-ear deafness. The diagnosis is con?rmed by measuring the levels of thyroid hormones in the blood, which are low, and of the pituitary TSH which is raised in primary hypothyroidism.
Treatment consists of the administration of thyroxine. Although tri-iodothyronine is the metabolically active hormone, thyroxine is converted to tri-iodothyronine by the tissues of the body. Treatment should be started cautiously and slowly increased to 0·2 mg daily – the equivalent of the maximum output of the thyroid gland. If too large a dose is given initially, palpitations and tachycardia are likely to result; in the elderly, heart failure may be precipitated.
Congenital hypothyroidism Babies may be born hypothyroid as a result of having little or no functioning thyroid-gland tissue. In the developed world the condition is diagnosed by screening, all newborn babies having a blood test to analyse TSH levels. Those found positive have a repeat test and, if the diagnosis is con?rmed, start on thyroid replacement therapy within a few weeks of birth. As a result most of the ill-effects of cretinism can be avoided and the children lead normal lives.
Thyroiditis In?ammation of the thyroid gland. The acute form is usually caused by a bacterial infection elsewhere in the body: treatment with antibiotics is needed. Occasionally a virus may be the infectious agent. Hashimoto’s thyroiditis is an autoimmune disorder causing hypothyroidism (reduced activity of the gland). Subacute thyroiditis is in?ammation of unknown cause in which the gland becomes painful and the patient suffers fever, weight loss and malaise. It sometimes lasts for several months but is usually self-limiting.
Thyrotoxic adenoma A variety of thyrotoxicosis (see hyperthyroidism above) in which one of the nodules of a multinodular goitre becomes autonomous and secretes excess thyroid hormone. The symptoms that result are similar to those of thyrotoxicosis, but there are minor di?erences.
Treatment The ?rst line of treatment is to render the patient euthyroid by treatment with antithyroid drugs. Then the nodule should be removed surgically or destroyed using radioactive iodine.
Thyrotoxicosis A disorder of the thyroid gland in which excessive amounts of thyroid hormones are secreted into the bloodstream. Resultant symptoms are tachycardia, tremor, anxiety, sweating, increased appetite, weight loss and dislike of heat. (See hyperthyroidism above.)... goitre
Symptoms: dry throat, eye irritation, headache, fatigue, wheezy chest and flu-like colds may be a product of modern ventilating systems. The headache may come on in the afternoon and improve on leaving work. Humidifier fever. Passive inhalation of cigarette smoke a factor.
Alternatives. Treatment. Ginseng, Iceland Moss, Irish Moss, German Chamomile tea. ... building sickness syndrome
Crohn’s disease is rare in the developing world, but in the western world the incidence is increasing and is now 6–7 per 100,000 population. Around 80,000 people in the UK have the disorder with more than 4,000 new cases occurring annually. Commonly Crohn’s disease starts in young adults, but a second incidence surge occurs in people over 70 years of age. Both genetic and environmental factors are implicated in the disease – for example, if one identical twin develops the disease, the second twin stands a high chance of being affected; and 10 per cent of sufferers have a close relative with in?ammatory bowel disease. Among environmental factors are low-residue, high-re?ned-sugar diets, and smoking.
Symptoms and signs of Crohn’s disease depend on the site affected but include abdominal pain, diarrhoea (sometimes bloody), ANOREXIA, weight loss, lethargy, malaise, ANAEMIA, and sore tongue and lips. An abdominal mass may be present. Complications can be severe, including life-threatening in?ammation of the colon (which may cause TOXAEMIA), perforation of the colon and the development of ?stulae between the bowel and other organs in the abdomen or pelvis. If Crohn’s disease persists for a decade or more there is an increased risk of the victim developing colon cancer. Extensive investigations are usually necessary to diagnose the disease; these include blood tests, bacteriological studies, ENDOSCOPY and biopsy, and barium X-ray examinations.
Treatment As with ulcerative colitis, treatment is aimed primarily at controlling symptoms. Physicians, surgeons, radiologists and dietitians usually adopt a team approach, while counsellors and patient support groups are valuable adjuncts in a disease that is typically lifelong. Drug treatment is aimed at settling the acute phase and preventing relapses. CORTICOSTEROIDS, given locally to the affected gut or orally, are used initially and the effects must be carefully monitored. If steroids do not work, the immunosuppressant agent AZATHIOPRINE should be considered. Antidiarrhoeal drugs may occasionally be helpful but should not be taken during an acute phase. The anti-in?ammatory drug SULFASALAZINE can be bene?cial in mild colitis. A new generation of genetically engineered anti-in?ammatory drugs is now available, and these selective immunosuppressants may prove of value in the treatment of Crohn’s disease.
Diet is important and professional guidance is advisable. Some patients respond to milk- or wheat-free diets, but the best course for most patients is to eat a well-balanced diet, avoiding items that the sufferer knows from experience are poorly tolerated. Of those patients with extensive disease, as many as 80 per cent may require surgery to alleviate symptoms: a section of affected gut may be removed or, as a lifesaving measure, a bowel perforation dealt with.
(See APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELFHELP – Colitis; Crohn’s disease.)... crohn’s disease
Di?erent tumours seem to be particularly sensitive to radiation; radiotherapy plays an important role in the management of germ-cell tumours (SEMINOMA; TERATOMA) and lymphomas (see LYMPHOMA). Many head and neck tumours, gynaecological cancers, and localised prostate and bladder cancers are curable with radiotherapy. It may be used to reduce the pain
– for example, from bone metastases.
Unwanted effects Generalised: lethargy, loss of appetite. Skin: ERYTHEMA, dry desquamation with itching, moist desquamation. Patients should keep the treated area(s) dry and clean and avoid soap, antiseptic mouthwashes, smoking and spicy food if possible. (See ISOTOPE; RADIATION SICKNESS; RADIOTHERAPY).... irradiation
Side effects include lethargy, loss of appetite, leg cramps, dizziness, rash, and impotence.... cyclopenthiazide
Haloperidol is also given to control symptoms of Gilles de la Tourette’s syndrome and, in small doses, to sedate people who are aggressive as a result of dementia.
Side effects include drowsiness, lethargy, weight gain, dizziness, and parkinsonism.... haloperidol
In?ammation of the liver, or HEPATITIS, may occur as part of a generalised infection or may be a localised condition. Infectious hepatitis, which is the result of infection with a virus, is one of the most common forms. Many di?erent viruses can cause hepatitis, including that responsible for glandular fever (see MONONUCLEOSIS). Certain spirochaetes may also be the cause, particularly that responsible for LEPTOSPIROSIS, as can many drugs. Hepatitis may also occur if there is obstruction of the BILE DUCT, as by a gall-stone.
Cirrhosis of the liver A disorder caused by chronic damage to liver cells. The liver develops areas of ?brosis or scarring; in response, the remaining normal liver cells increase and form regeneration nodules. Those islands of normality, however, suffer from inadequate blood supply, thus adversely affecting liver function. Alcohol is the most common cause of cirrhosis in the United Kingdom and the USA, and the incidence of the disorder among women in the UK has recently risen sharply as a consequence of greater consumption of alcohol by young women in the latter decades of the 20th century. In Africa and many parts of Asia, infection with hepatitis B virus is a common cause. Certain drugs – for example, PARACETAMOL – may damage the liver if taken in excess. Unusual causes of cirrhosis include defects of the bile ducts, HAEMOCHROMATOSIS (raised iron absorption from the gut), CYSTIC FIBROSIS, cardiac cirrhosis (the result of heart failure causing circulatory congestion in the liver), and WILSON’S DISEASE (raised copper absorption).
Symptoms Some people with cirrhosis have no signs or symptoms and the disease may be diagnosed at a routine medical examination. Others may develop jaundice, OEDEMA (including ascites – ?uid in the abdomen), fever, confusion, HAEMATEMESIS (vomiting blood), loss of appetite and lethargy. On examination, cirrhotic patients often have an enlarged liver and/ or SPLEEN, and HYPERTENSION. Liver function tests, cholangiography (X-ray examination of the bile ducts) and biopsy of liver tissue will help to reach a diagnosis.
Treatment Nothing can be done to repair a cirrhosed organ, but the cause, if known, must be removed and further advance of the process thus prevented. In the case of the liver, a high-protein, high-carbohydrate, low-fat diet is given, supplemented by liver extract and vitamins B and K. The consumption of alcohol should be banned. In patients with liver failure and a poor prognosis, liver TRANSPLANTATION is worthwhile but only after careful consideration.
Abscess of the liver When an ABSCESS develops in the liver, it is usually a result of amoebic DYSENTERY, appearing sometimes late in the disease – even after the diarrhoea is cured (see below). It may also follow upon in?ammation of the liver due to other causes. In the case of an amoebic abscess, treatment consists of oral metronidazole.
Acute hepatic necrosis is a destructive and often fatal disease of the liver which is very rare. It may be due to chemical poisons, such as carbontetrachloride, chloroform, phosphorus and industrial solvents derived from benzene. It may also be the cause of death in cases of poisoning with fungi. Very occasionally, it may be a complication of acute infectious hepatitis.
Cancer of the liver is not uncommon, although it is rare for the disease to begin in the liver – the involvement of this organ being usually secondary to disease situated somewhere in the stomach or bowels. Cancer originating in the liver is more common in Asia and Africa. It usually arises in a ?brotic (or cirrhotic) liver and in carriers of the hepatitis B virus. There is great emaciation, which increases as the disease progresses. The liver is much enlarged, and its margin and surface are rough, being studded with hard cancer masses of varying size, which can often be felt through the abdominal wall. Pain may be present. Jaundice and oedema often appear.... liver, diseases of
Habitat: Native to Eurasia; found as winter weed and cultivated for fodder in parts of Punjab, Haryana and Uttar Pradesh.
English: Sweet Clover, Annual Yellow Sweet Clover, Small-flowered Melilot.Ayurvedic: Vana-methikaa.Unani: Ilkil-ul-Malik (yellow- flowered var.).Folk: Ban-Methi, Senji.Action: Plant—astringent, dis- cutient, emollient. Used as poultice or plaster for swellings. The plant gave coumarins—fraxidin, herniarin, umbelliferone and scopoletin.
When fed alone as a green fodder, it exhibits narcotic properties; causes lethargy, tympanitis and is reported to taint the milk of dairy cattle. It may cause even paralysis. The plant contains 3-methoxyflavone, meliter- natin which experimentally inhibited cell growth, induced granularity, retraction and then lysis of cells.... melilotus indicaIt is also used in small doses as an antiemetic drug.
It may cause involuntary movements of the face and limbs, lethargy, dry mouth, blurred vision, and dizziness.... prochlorperazine
Possible adverse effects include abnormal movements of the face and limbs, drowsiness, lethargy, dry mouth, constipation, and blurred vision.
Long-term treatment may cause parkinsonism.... promazine
Surgery may be most common, and is often the only treatment, for some gastrointestinal tumours, soft-tissue tumours, gynaecological tumours and advanced cancers of the head and neck.
Radiotherapy uses ionising radiation to kill tumour cells. Radiation is by naturally occurring isotopes (see ISOTOPE) or arti?cially produced X-RAYS. Germ-cell tumours (see SEMINOMA; TERATOMA) and malignant lymphomas (see LYMPHOMA) appear to be particularly sensitive to irradiation, and many head and neck tumours, gynaecological cancers, and localised cancers of the PROSTATE GLAND and URINARY BLADDER are curable with radiotherapy. It is also a valuable means of reducing pain from bone metastases (see METASTASIS). Unpleasant side-effects are common: chie?y lethargy, loss of appetite and dry, itchy skin symptoms.
Chemotherapy is also an important treatment in germ-cell tumours (see above); in some forms of LEUKAEMIA and lymphoma; in ovarian cancer (following surgery – see OVARIES, DISEASES OF); and in small-cell lung cancer (although most patients die within 18 months – see LUNGS, DISEASES OF). It is also used in some breast cancers (see BREASTS, DISEASES OF); advanced myeloma (see MYELOMATOSIS); sarcomas (see under CANCER); and some childhood cancers (such as WILMS’ TUMOUR).
More than 20 substances are in common use, the major classes being ALKYLATING AGENTS (e.g. cyclophosphamide, chlorambucil, busul fan); ANTIMETABOLITES (e.g. methotrexate); VINCA ALKALOIDS (e.g. vincristine, vinblastine); and antitumour ANTIBIOTICS (e.g. actinomycin D). Choice of agent and the appropriate regimen requires expert guidance. Common side-effects include nausea and vomiting, bone-marrow suppression and ALOPECIA, with each substance having its own spectrum of unwanted effects.
Good doctor-patient communication, with the sharing of information and bringing the patient into the decision-making process, is vital even if time-consuming and exhausting.
Equally imortant treatment is PALLIATIVE, for example to ensure e?ective pain or nausea control. Common sources of pain in cancer may involve bone, nerve compression, soft tissue, visceral, myofascial, constipation, muscle spasm, low-back pain, joint pain (e.g. capsulitis) and chronic post-operative pain. Patients may be suffering from more than one pain, all of which should be identi?ed. The aim should be to eliminate pain.
There are three rungs of the analgesic ladder; if one rung fails, the next one should be tried:
(1) non-opioid drugs – for example, aspirin, PARACETAMOL, NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS); (2) weak opioids – for example, CODEINE, DIHYDROCODEINE, dextropropoxyphene; (3) strong opioids
– for example, MORPHINE, DIAMORPHINE, buprenorphine. Oral treatment is always preferable, unless prevented by severe vomiting. (See also CANCER; ONCOLOGIST; PAIN; PALLIATIVE CARE.)... oncology
Beams of radiation may be directed at the tumour from a distance, or radioactive material
– in the form of needles, wires or pellets – may be implanted in the body. Sometimes germ-cell tumours (see SEMINOMA; TERATOMA) and lymphomas (see LYMPHOMA) are particularly sensitive to irradiation which therefore forms a major part of management, particularly for localised disease. Many head and neck tumours, gynaecological cancers, and localised prostate and bladder cancers are curable with radiotherapy. Radiotherapy is also valuable in PALLIATIVE CARE, chie?y the reduction of pain from bone metastases (see METASTASIS). Side-effects are potentially hazardous and these have to be balanced against the substantial potential bene?ts. Depending upon the type of therapy and doses used, generalised effects include lethargy and loss of appetite, while localised effects – depending on the area treated – include dry, itchy skin; oral infection (e.g. thrush – see CANDIDA); bowel problems; and DYSURIA.... radiotherapy
It is used to prevent and treat peptic ulcers and to treat oesophagitis.
Side effects may include headache, skin rash, nausea, constipation, and lethargy.... ranitidine
Spironolactone may cause numbness, weakness, and nausea.
Less common side effects include diarrhoea, lethargy, impotence, rash, and irregular menstruation.
High doses may cause abnormal breast enlargement in men.... spironolactone
Evidence suggests that tonics mainly have a placebo effect.
The term tonic is also used adjectivally to relate to muscle tone (see tone, muscle), as in the tonic neck reflex, one of the primitive reflexes found in newborn infants.... tonic
Causes There is an inherited element: parents, children or siblings of schizophrenic sufferers have a one in ten chance of developing the disorder; a twin has a 50 per cent chance if the other twin has schizophrenia. Some BRAIN disorders such as temporal lobe EPILEPSY, tumours and ENCEPHALITIS seem to be linked with schizophrenia. Certain drugs – for example, AMPHETAMINES – can precipitate schizophrenia and DOPAMINE-blocking drugs often relieve schizophrenic symptoms. Stress may worsen schizophrenia and recreational drugs may trigger an attack.
Symptoms These usually develop gradually until the individual’s behaviour becomes so distrubing or debilitating that work, relationships and basic activities such as eating and sleeping are interrupted. The patient may have disturbed perception with auditory HALLUCINATIONS, illogical thought-processes and DELUSIONS; low-key emotions (‘?at affect’); a sense of being invaded or controlled by outside forces; a lack of INSIGHT and inability to acknowledge reality; lethargy and/or agitation; a disrespect for personal appearance and hygiene; and a tendency to act strangely. Violence is rare although some sufferers commit violent acts which they believe their ‘inner voices’ have commanded.
Relatives and friends may try to cope with the affected person at home, but as severe episodes may last several months and require regular administration of powerful drugs – patients are not always good at taking their medication
– hospital admission may be necessary.
Treatment So far there is no cure for schizophrenia. Since the 1950s, however, a group of drugs called antipsychotics – also described as NEUROLEPTICS or major tranquillisers – have relieved ?orid symptoms such as thought disorder, hallucinations and delusions as well as preventing relapses, thus allowing many people to leave psychiatric hospitals and live more independently outside. Only some of these drugs have a tranquillising e?ect, but their sedative properties can calm patients with an acute attack. CHLORPROMAZINE is one such drug and is commonly used when treatment starts or to deal with an emergency. Halperidol, tri?uoperazine and pimozide are other drugs in the group; these have less sedative effects so are useful in treating those whose prominent symptoms are apathy and lethargy.
The antipsychotics’ mode of action is by blocking the activity of DOPAMINE, the chemical messenger in the brain that is faulty in schizophrenia. The drugs quicken the onset and prolong the remission of the disorder, and it is very important that patients take them inde?nitely. This is easier to ensure when a patient is in hospital or in a stable domestic environment.
CLOZAPINE – a newer, atypical antipsychotic drug – is used for treating schizophrenic patients unresponsive to, or intolerant of, conventional antipsychotics. It may cause AGRANULOCYTOSIS and use is con?ned to patients registered with the Clorazil (the drug’s registered name) Patient Monitoring Service. Amisulpride, olanzapine, quetiapine, risperidone, sertindole and zotepine are other antipsychotic drugs described as ‘atypical’ by the British National Formulary; they may be better tolerated than other antipsychotics, and their varying properties mean that they can be targeted at patients with a particular grouping of symptoms. They should, however, be used with caution.
The welcome long-term shift of mentally ill patients from large hospitals to community care (often in small units) has, because of a lack of resources, led to some schizophrenic patients not being properly supervised with the result that they fail to take their medication regularly. This leads to a recurrence of symptoms and there have been occasional episodes of such patients in community care becoming a danger to themselves and to the public.
The antipsychotic drugs are powerful agents and have a range of potentially troubling side-effects. These include blurred vision, constipation, dizziness, dry mouth, limb restlessness, shaking, sti?ness, weight gain, and in the long term, TARDIVE DYSKINESIA (abnormal movements and walking) which affects about 20 per cent of those under treatment. Some drugs can be given by long-term depot injection: these include compounds of ?upenthixol, zuclopenthixol and haloperidol.
Prognosis About 25 per cent of sufferers recover fully from their ?rst attack. Another 25 per cent are disabled by chronic schizophrenia, never recover and are unable to live independently. The remainder are between these extremes. There is a high risk of suicide.... schizophrenia
u... tyrosinosis
Causes. Diet too rich in fats, inability to digest fats. May be associated with diabetes, starvation wasting diseases and liverish attacks; when followed by coma, situation is serious.
Symptoms. Physical weakness, pallor, lethargy, acid stools, constant yawning, constipation, diarrhoea – in severe cases, jaundice. A liver tonic would be an ingredient of a prescription (Barberry, Balmony, Dandelion, Mulberry, Wahoo).
A reduced alkalinity of the blood allows acidosis to take over. Symptoms of diabetic coma when due to salt deficiency profoundly affects the chemistry of the blood.
Alternatives. Teas: Agrimony, Balm (lemon), Bogbean, Boldo, Centuary, Chamomile, Cleavers, Dandelion, Fumitory, Hyssop, Meadowsweet, Motherwort, Wormwood.
Tea. Formula: equal parts, Balm, Chamomile and Dandelion. 1 heaped teaspoon to each cup boiling water, infuse 10 minutes; dose – 1 cup thrice daily.
Tablets/capsules. Seaweed and Sarsaparilla, Blue Flag, Goldenseal, Wild Yam, Yellow Dock.
Potter’s Acidosis tablets: Anise oil, Caraway oil, Cinnamon, Meadowsweet, Rhubarb, Medicinal Charcoal.
Formula. Equal parts: Dandelion, Blue Flag, Meadowsweet. Mix. Dose: Powders: 500mg; Liquid extracts: 30-60 drops; Tinctures: 1-2 teaspoons thrice daily.
Goldenseal tincture: 1-2ml thrice daily.
Diet. Vigorous cutback in food-fats, especially dairy products. Readily assimilable form of carbohydrate (honey), replenishing stores in the liver without working that organ too hard. Restore body chemistry. Kelp instead of salt. Powdered skimmed milk, yoghurt, plantmilk made from Soya bean. Pectin foods: raw apples help solidify the stool. Bananas, carrots, carob flour products. Vitamin B complex, B6, Folic ac., Niacin, Pantothenic acid. See: CAROB BEAN. ... acidosis
Main causes of a raised pressure include increase in blood thickness, kidney disorder or loss of elasticity in the arteries by hardening or calcification.
Well defined physical problems account for 10 per cent of high blood pressure cases. By the age of 60, a third of the peoples of the West are hypertensive. Other causes: genetic pre-disposition, endocrine disorders such as hyperactive thyroid and adrenal glands, lead and other chemical poisoning, brain tumour, heart disorder, anxiety, stress and emotional instability.
Other causes may be food allergies. By taking one’s pulse after eating a certain food one can see if the food raises the pulse. If so, that food should be avoided. Most cases of high blood pressure are related to lifestyle – how people think, act and care for themselves. When a person is under constant stress blood pressure goes up. It temporarily increases on drinking the stimulants: alcohol, strong tea, coffee, cola and caffeine drinks generally.
Symptoms. Morning headache (back of the head), possible palpitation, visual disturbances, dizziness, angina-like pains, inability to concentrate, nose-bleeds, ringing in the ears, fatigue, breathlessness (left ventricular failure).
Dr Wm Castelli, Director of the Framlingham Heart Study in Massachusetts, U.S.A., records: “The greatest risk is for coronary heart disease (CHD). Hypertensives have more than double the risk of people with normal blood pressure and seven times the risk of strokes.”
In countries where salt intake is restricted, a rise in blood pressure with age is not seen.
Simple hypotensive herbs may achieve effective control without the side-effects of sleep disturbance, adverse metabolic effects, lethargy and impaired peripheral circulation.
Essential hypertension is where high blood pressure is not associated with any disease elsewhere; it accounts for 90 per cent cases. Most of the remainder have kidney disease except for a few other abnormalities.
Alternatives. Balm, Black Haw, Black Cohosh (blood pressure of the menopause), Cactus, Cramp bark, Chamomile (German). Garlic, Buckwheat, Lily of the Valley, Balm, Mistletoe, Motherwort. Passion flower, Nettles, Lime flowers, Wood Betony, Yarrow, Rosemary, Hawthorn flowers, Olive leaves, Dandelion. Where there is nerve excitability: Valerian.
Tea No 1. Equal parts: Hawthorn leaves and flowers, Mistletoe, Lime flowers. Mix. 2 teaspoons to each cup boiling water; infuse 5-10 minutes. 1 cup 2-3 times daily. Alternative:–
Tea No 2. Equal parts: Nettles, Lime flowers, Yarrow, Passion flower. Mix. 2 teaspoons to each cup boiling water; infuse 5-10 minutes. 1 cup 2-3 times daily.
Nettles. Nettle tea is capable of removing cholesterol deposits (“fur”) from artery walls, increasing their elasticity. Like so many herbs they are rich in chlorophyll. The tea may be made as strong as desired. Mistletoe. 2-3 teaspoons cut herb (fresh or dried) to cup cold water. Allow to infuse overnight (at least 8 hours). 1 cup morning and evening.
Garlic. Juice from one Garlic corm expressed through a juicer taken morning and evening. Garlic dilates blood vessels. Alternative: 2-3 Garlic capsules at night.
Blood pressure of pregnancy: See – PREGNANCY.
Tablets/capsules: Cramp bark, Mistletoe, Motherwort, Rutin, Garlic.
Powders. Formula. Buckwheat (rutin) 1; Motherwort 1; Mistletoe half; Valerian quarter. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.
Liquid extracts, tinctures. Formula. Equal parts: Cactus, Mistletoe, Valerian. Dose: liquid extracts, one 5ml teaspoon; tinctures, two 5ml teaspoons; thrice daily.
Practitioner Formula. Tinctures: equal parts: Lily of the Valley, Mistletoe, Valerian. Dose: 30-60 drops thrice daily.
Where high blood pressure is due to faulty kidney function diuretics such as Dandelion or Bearberry will be added according to individual requirements. Dandelion root is one of the most widely-used potassium-conserving agents for increasing flow of urine, as well as being a mild beta-blocker to reduce myocardial infarction. Broom (Sarothamnus scoparius) (diuretic) is not used in cases of high blood pressure. It is good practice to assess kidney function in all new cases of hypertension for renal artery stenosis.
Evidence from two major studies confirms that diuretics rather than beta-blockers should be the treatment of choice for most elderly hypertensives. The addition of a diuretic (Yarrow, etc) to prescriptions for the elderly is commended.
Prevention. Chances of developing high blood pressure are said to be reduced by a daily dose of Cod
Liver oil. Results from studies at the University of Munich, Germany, show that when an ounce of Cod Liver oil was added to the typical Western diet, better pressure readings and lower cholesterol levels followed. When the flavour renders it objectionable to the palate, taste may be masked by stirring briskly into fruit juice.
General. Stop smoking. Watch weight. Moderate exercise. Avoidance of stress by relaxation, yoga, music, etc. These relieve constriction of peripheral blood vessels. Curb temper
Diet. Avoid processed and fast foods high in fat and salt, and empty calories. Cheese and meat sparingly. Eat plenty of natural foods. Positively reject coffee, strong tea and alcohol. “There is a significant drop in plasma Cortisol with a fall in blood pressure after stopping alcohol.” (Dr J.F. Potter, University of Birmingham, England) It is well-documented that a vegetarian diet is associated with a lower blood pressure.
Salt. The association of salt with blood pressure is larger than generally appreciated and increases with age and initial blood pressure. Even a small reduction in salt (3g) may reduce a systolic and diastolic pressure by 5mmHg and 2.5mmHg respectively. All processed foods containing salt should be avoided. Supplementation. Inositol, zinc, Vitamin C, Vitamin B6. (Dr C. Pfeiffer) Vitamin E to improve circulation. Check with practitioner pressure level before starting 200iu increasing to 400iu daily. Magnesium: 300mg daily. Choline.
See: BLOOD PRESSURE. ... hypertension
Symptoms: Always tired. Lethargy. Irregular heart-beats from heart-muscle irritability. Possible cardiac arrest. Breathlessness.
Alternatives. Teas. Plantain, Chamomile, Mullein, Coltsfoot. Mistletoe. Nettles, Gotu Kola, or Yarrow. Decoction. Irish Moss, Agar-Agar, Kelp, Dandelion root.
Powders. Formula. Dandelion, Hawthorn, Liquorice. Equal parts. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.
Tinctures. Formula. Equal parts: Hawthorn, Dandelion, Liquorice. Dose: 1-2 teaspoons, thrice daily. Diet. Bananas: (fruit with highest potassium). Dates, Raisins. Oily fish. Figs. Prunes, Carrot leaves, Cider vinegar (impressive record), Black Molasses. ... hypokalaemia
Symptoms: lethargy, disorientation, clinical depression and tiredness associated with long-haul flights. Treatment. Herbs for pushing forward (or back) the internal clock so that biological time accords with chronological time: Ginseng, Garlic, Gotu Kola, Kola, Capsicum. These may be supported by a good multivitamin capsule. Ginseng is a melatonin stimulant. Treat transient hypothyroidism.
Topical. Inhalant: aromatherapy oil – Rosemary.
Diet. Day before ‘take-off’ should be a ‘feast’ day, but the day of departure should be a ‘fast’ day. Coffee, tea and other caffeine-containing beverages should be taken only in the evenings of ‘fast’ days when going east, and in the mornings going west. Circadian disturbance is more easily adjusted on ‘fast’ days. This regime assists the production of melatonin, a natural hormone of the pineal gland which manipulates the body’s response to the light/dark cycle. Avoid alcohol.
Supplements. Daily. Vitamin B6 10mg; Vitamin C 2g; Vitamin E 400iu. Magnesium, Selenium, Zinc.
Note: On day of departure change watch to the time at your destination. During the flight eat only if it is daytime there. Take plenty of fluids. On arrival the body clock is already adjusted to local time – go to bed. ... jet lag
Causes: damage from gall-stones, aftermath of infections, drugs; the commonest is alcohol. Usually made up of three factors: toxaemia (self-poisoning), poor nutrition, infective bacteria or virus.
Symptoms. Loss of appetite, dyspepsia, low grade fever, nosebleeds, lethargy, spidery blood vessels on face, muscular weakness, jaundice, loss of sex urge, redness of palms of hands, unable to lie on left side. Mechanical pressure may cause dropsy and ascites. Alcohol-induced cirrhosis correlates with low phospholipid levels.
Treatment. Bitter herbs are a daily necessity to keep the bile fluid and flowing. Among other agents, peripheral vaso-dilators are indicated. Regulate bowels.
Teas. Balmony, Milk Thistle, Boldo, Bogbean. Dandelion coffee. Barberry tea (cold water). Tablets/capsules. Calamus, Blue Flag, Wild Yam.
Formula. Wahoo 2; Wild Yam 1; Blue Flag root 1. Dose: Liquid Extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.
Milk Thistle (Silybum marianum). Based on its silymarin contents: 70-210mg, thrice daily.
Practitioner. For pain. Tincture Gelsemium: 5-10 drops in water when necessary.
Enema. Constipation may be severe for which warm water injection should be medicated with few drops Tincture Myrrh.
Diet. High protein, high starch, low fat. Reject alcohol. Accept: Dandelion coffee, artichokes, raw onion juice, turmeric as a table spice.
Lecithin. Soy-derived lecithin to antidote alcohol-induced cirrhosis. (Study: Bronx Veterans Affairs Medical Center & Mount Sinai Hospital School of Medicine, New York City)
Supplements. B-complex, B12, C (1g), K, Magnesium, Zinc.
Treatment by or in liaison with a general medical practitioner or gastro-enterologist. ... liver – cirrhosis
Symptoms: headache, vomiting of bile, depression, furred tongue, poor appetite, lethargy, sometimes diarrhoea. Upper right abdomen tender to touch due to enlargement, pale complexion.
BHP (1983) recommends: Fringe Tree, Wahoo, Goldenseal, Blue Flag, Butternut bark, Boldo, Black root. Treatment. Treat the underlying cause, i.e. heart or chest troubles. Bitter herbs.
Alternatives:– Teas. Balmony, Bogbean, Centuary. 1 heaped teaspoon to each cup boiling water infused 15 minutes. Half-1 cup 3 or more times daily.
Decoction. Dandelion and Burdock roots. Mix. One teaspoon to large cup water simmered gently 20 minutes. Cup 2-3 times daily.
Tablets/capsules. Blue Flag, Goldenseal, Wild Yam.
Formula. Dandelion 2; Wahoo 1; Meadowsweet 1; Cinnamon 1. Dose: Liquid Extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon) thrice daily.
Alfred Vogel recommends: Barberry bark, Centuary, Boldo, St John’s Wort, St Mary’s Thistle, Sarsaparilla.
Epsom salt baths (hot) to promote elimination of impurities through the skin.
Diet. Fat-free. Dandelion coffee. Artichokes. Lecithin. ... liver – congestion
Anaemia is not a disease but a feature of many different disorders. There are various types, which can be classified into those due to decreased or defective red-cell production by bone marrow (see anaemia, aplastic; anaemia, megaloblastic; anaemia, iron-deficiency) and those due to decreased survival of the red cells in the blood (see anaemia, haemolytic).
The severity of symptoms depends on how low the haemoglobin concentration has become. Slightly reduced levels can cause headaches, tiredness, and lethargy. Severely reduced levels can cause breathing difficulty on exercise, dizziness, angina, and palpitations. General signs include pallor, particularly of the skin creases, the lining of the mouth, and the inside of the eyelids.
Anaemia is diagnosed from the symptoms and by blood tests (see blood count; blood film). A bone marrow biopsy may be needed if the problem is with red blood cell production.... anaemia
Antipsychotics can cause drowsiness, lethargy, dyskinesia, and parkinsonism.
Other possible side effects include dry mouth, blurred vision, and difficulty in passing urine. However, newer drugs may have fewer side effects when used in the long term.... antipsychotic drugs
Insomnia, malaise, agitation, and tearfulness are also common. Gradually, but usually within 2 years, the bereaved person adjusts to the loss.
Family and friends can often provide support. Outside help may be required and may be given by a social worker, health visitor, member of the clergy, or self-help group. For some people, when depression, apathy, and lethargy impede any chance of recovery, specialized counselling or psychotherapy is necessary. (See also stillbirth.)... bereavement
Dehydration occurs due to inadequate intake of fluids or excessive fluid loss. The latter may occur with severe or prolonged vomiting or diarrhoea or with uncontrolled diabetes mellitus, diabetes insipidus, and some types of kidney failure. Children are especially susceptible to dehydration by diarrhoea.
Severe dehydration causes extreme thirst, dry lips and tongue, an increase in heart rate and breathing rate, dizziness, confusion, lethargy, and eventual coma. The skin looks dry and loses its elasticity. Any urine passed is small in quantity and dark-coloured. If there is also salt depletion, there may also be headaches, cramps, and pallor.
Bottled mineral water can help maintain the intake of salts. For vomiting and diarrhoea, rehydration therapy is needed; salt and glucose rehydration mixtures are available from chemists.
In severe cases of dehydration, fluids are given intravenously.
The water/salt balance is carefully monitored by blood tests and adjusted if necessary.... dehydration
With congenital hydrocephalus, the main feature is an enlarged head that continues to grow rapidly. Other features include rigidity of the legs, vomiting, epilepsy, irritability, lethargy, and the absence of normal reflex actions. If it is not treated, hydrocephalus progresses to severe brain damage, which may result in death within weeks. When the condition occurs later in life, symptoms include headache, vomiting, loss of coordination, and the deterioration of mental function.
In most cases, treatment of hydrocephalus is by draining the fluid from the brain to another part of the body, such as the abdominal cavity, where it can be absorbed.... hydrocephalus
Hypercalcaemia causes nausea, vomiting, lethargy, depression, thirst, and passing urine excessively.
Higher blood levels of calcium produce confusion, extreme fatigue, and muscle weakness.
Without treatment, the condition can result in cardiac arrhythmias, kidney failure, coma, and even death.
Long-standing hypercalcaemia may cause nephrocalcinosis or kidney stones (see calculus, urinary tract).
Diagnosis is by blood tests.
Treatment is of the underlying cause.... hypercalcaemia
Symptoms include tiredness and lethargy. There may also be muscle weakness, cramps, a slow heart-rate, dry skin, hair loss, a deep and husky voice, and weight gain. A syndrome called myxoedema, in which the skin and other tissues thicken, may develop. Enlargement of the thyroid gland may also occur (see goitre). If the condition occurs in childhood, it may retard growth and normal development.
The disorder is diagnosed by measuring the level of thyroid hormones in the blood.
Treatment consists of replacement therapy with the thyroid hormone thyroxine; usually for life.... hypothyroidism
The later stages of the disease are marked by jaundice and ascites (excess fluid in the abdomen).
Tumours are often detected by ultrasound scanning, and diagnosis may be confirmed by liver biopsy.
A hepatoma can sometimes be cured by complete removal.
In other cases, anticancer drugs can help to slow the progress of the disease.
It is usually not possible to cure secondary liver cancer, but anticancer drugs or, in some cases, removal of a solitary metastasis may be advised.... liver cancer
The main symptom is swelling of the legs and face due to oedema. Also, fluid may collect in the chest cavity, resulting in pleural effusion, or in the abdomen, causing ascites. Diarrhoea, lethargy, and anorexia may occur.
Treatment is of the underlying condition.
A low-sodium diet may be recommended, and diuretic drugs may be given to reduce oedema.
If the concentration of protein in the blood is very low, protein may need to be given intravenously.... nephrotic syndrome
as areas of India, where people subsist on maize. Most of the niacin in maize is unabsorbable unless the maize is treated with an alkali such as limewater. Disorders such as carcinoid syndrome and inflammatory bowel disease may also be a cause of pellagra.
The 1st symptoms are weakness, weight loss, lethargy, depression, irritability, and inflammation and itching of skin exposed to sunlight.
In acute attacks, weeping blisters may develop on the affected skin, and the tongue becomes swollen and painful.
Diagnosis is made from the patient’s condition and dietary history.
Daily intake of niacin and a varied diet usually bring about a cure.... pellagra
A diagnosis is made by finding antibodies against CHLAMYDIA PSITTACI in the blood. Treatment is with tetracycline antibiotic drugs. With no treatment, death may result.... psittacosis
The disorder starts as the child recovers from the infection. Symptoms include uncontrollable vomiting, lethargy, memory loss, and disorientation. Swelling of the brain may cause seizures, disturbances in heart rhythm, coma, and cessation of breathing.
Brain swelling may be controlled by corticosteroid drugs and by intravenous infusions of mannitol. Dialysis or blood transfusions may be needed. If breathing stops, a ventilator is used.
The death rate is around 10 per cent, and higher for those who have seizures, lapse into deep coma, and stop breathing.
Permanent brain damage may occur.... reye’s syndrome
Alcohol withdrawal symptoms start 6–8 hours after cessation of intake and may last up to 7 days. They include trembling of the hands, nausea, vomiting, sweating, cramps, anxiety, and, sometimes, seizures. (See also confusion, delirium tremens, and hallucinations.)
Opioid withdrawal symptoms start after 8–12 hours and may last for 7–10 days. Symptoms include restlessness, sweating, runny eyes and nose, yawning, diarrhoea, vomiting, abdominal cramps, dilated pupils, loss of appetite, irritability, weakness, tremor, and depression.
Withdrawal symptoms from barbiturate drugs and meprobamate start after 12–24 hours, beginning with tremor, anxiety, restlessness, and weakness, sometimes followed by delirium, hallucinations, and, occasionally, seizures. A period of prolonged sleep occurs 3–8 days after onset. Withdrawal from benzodiazepine drugs may begin much more slowly and can be life-threatening.
Withdrawal symptoms from nicotine develop gradually over 24–48 hours and include irritability, concentration problems, frustration, headaches, and anxiety. Discontinuation of cocaine or amfetamines results in extreme tiredness, lethargy, and dizziness. Cocaine withdrawal may also lead to tremor, severe depression, and sweating.
Withdrawal symptoms from marijuana include tremor, nausea, vomiting, diarrhoea, sweating, irritability, and sleep problems. Caffeine withdrawal may lead to tiredness, headaches, and irritability.
Severe withdrawal syndromes require medical treatment.
Symptoms may be suppressed by giving the patient small quantities of the drug he or she had been taking.
More commonly, a substitute drug is given, such as methadone for opioid drugs or diazepam for alcohol.
The dose of the drug is then gradually reduced.... withdrawal syndrome
FAMILY: Asteraceae (Compositae)
SYNONYMS: Helichrysum, everlasting, St John’s herb.
GENERAL DESCRIPTION: A strongly aromatic herb, up to 0.6 metres high with a much-branched stem, woody at the base. The brightly coloured, daisy-like flowers become dry as the plant matures, yet retain their colour.
DISTRIBUTION: Native to the Mediterranean region, especially the eastern part and North Africa. It is cultivated mainly in Italy, Yugoslavia, Spain and France.
OTHER SPECIES: There are several other Helichrysum species such as H. arenarium found in florist shops and H. stoechas which is also used to produce an absolute. H. orientale is grown for its oil.
HERBAL/FOLK TRADITION: In Europe it is used for respiratory complaints such as asthma, chronic bronchitis and whooping cough; also for headaches, migraine, liver ailments and skin conditions including burns, allergies and psoriasis. Usually taken in the form of a decoction or infusion.
ACTIONS: Anti-allergenic, anti-inflammatory, antimicrobial, antitussive, antiseptic, astringent, cholagogue, cicatrisant, diuretic, expectorant, fungicidal, hepatic, nervine.
EXTRACTION: 1. Essential oil by steam distillation from the fresh flowers and flowering tops. 2. An absolute (and concrete) are also produced by solvent extraction.
CHARACTERISTICS: 1. A pale yellow to red oily liquid with a powerful, rich honeylike scent with a delicate tealike undertone. 2. A yellowy-brown viscous liquid with a rich, floral, tealike scent. It blends well with chamomile, boronia, labdanum, lavender, mimosa, oakmoss, geranium, clary sage, rose, Peru balsam, clove and citrus oils.
PRINCIPAL CONSTITUENTS: Nerol and neryl acetate (30–50 per cent), geraniol, pinene, linalol, isovaleric aldehyde, sesquiterpenes, furfurol and eugenol, among others.
SAFETY DATA: Non-toxic, non-irritant, non-sensitizing.
Skin care: Abscess, acne, allergic conditions, boils, burns, cuts, dermatitis, eczema, inflammation, spots, wounds etc.
Circulation muscles and joints: Muscular aches and pains, rheumatism, sprains, strained muscles.
Respiratory system: Asthma, bronchitis, chronic coughs, whooping cough.
Digestive system: Liver congestion, spleen congestion.
Immune system: Bacterial infections, colds, ’flu, fever.
Nervous system: Depression, debility, lethargy, nervous exhaustion, neuralgia, stress-related conditions.
OTHER USES: Used as fixatives and fragrance components in soaps, cosmetics and perfumes. The absolute is used to flavour certain tobaccos; used for the isolation of natural anethole.... immortelle
FAMILY: Lamiaceae (Labiatae)
SYNONYMS: Satureia hortensis, Calamintha hortensis, garden savory.
GENERAL DESCRIPTION: An annual herb up to 45 cms high with slender, erect, slightly hairy stems, linear leaves and small, pale lilac flowers.
DISTRIBUTION: Native to Europe, naturalized in North America. Extensively cultivated, especially in Spain, France, Yugoslavia and the USA for its essential oil.
OTHER SPECIES: Closely related to the thyme family, with which it shares many characteristics. There are several different types ‘of savory’ which include S. thymbra, found in Spain, which contains mainly thymol, and the winter savory (S. montana) – see separate entry.
HERBAL/FOLK TRADITION: A popular culinary herb, with a peppery flavour. It has been used therapeutically mainly as a tea for various ailments including digestive complaints (cramp, nausea, indigestion, intestinal parasites), menstrual disorders and respiratory conditions (asthma, catarrh, sore throat). Applied externally, the fresh leaves bring instant relief from insect bites, bee and wasp stings.
‘This kind is both hotter and drier than the winter kind ... it expels tough phlegm from the chest and lungs, quickens the dull spirits in the lethargy.’.
ACTIONS: Anticatarrhal, antiputrescent, antispasmodic, aphrodisiac, astringent, bactericidal, carminative, cicatrisant, emmenagogue, expectorant, fungicidal, stimulant, vermifuge.
EXTRACTION: Essential oil by steam distillation from the whole dried herb. (An oleoresin is also produced by solvent extraction.)
CHARACTERISTICS: A colourless or pale yellow oil with a fresh, herbaceous, spicy odour. It blends well with lavender, lavandin, pine needle, oakmoss, rosemary and citrus oils.
PRINCIPAL CONSTITUENTS: Carvacrol, pinene, cymene, camphene, limonene, phellandrene and borneol, among others.
SAFETY DATA: Dermal toxin, dermal irritant, mucous membrane irritant. Avoid during pregnancy.
AROMATHERAPY/HOME: USE None. ‘Should not be used on the skin at all.’.
OTHER USES: Occasionally used in perfumery work for its fresh herbaceous notes. The oil and oleoresin are used in most major food categories, especially meat products and canned food.... savory, summer
Health Encyclopedia