Archive for March 11th, 2009

THE DISABLING DISEASES: HERNIAS

‘Hernia’ is the medical term for a rupture. The word ‘rupture’ is not accurate, since it means ‘tear,’ and nothing is actually torn. What usually happens is that a weak spot develops in the bands of muscle tissue in the abdominal wall, and the intestines begin to bulge through this, forming a soft lump. When the person lies down, the intestines slide back to their proper place, and the bulge usually disappears entirely, especially if the hernia is of fairly recent origin-

Types of hernias

The most common type is the inguinal hernia, which occurs in the groins of males. The weakest spot in the male’s abdominal wall is located in the groin, where the cord leading to the testicles passes. Unfortunately, in some male infants the wall fails to shut tightly around the cord at this spot, leaving it especially weak In later years, a strain, such as lifting a heavy object, may cause the wall to give way suddenly, or constant straining may force it out gradually. The intestine begins to bulge out. At first, this may be hardly noticeable, and there may be little pain. As time passes, the bulge may become as large as, or larger than, a hen’s egg. Hernias may extend downwards into the scrotum, the hag of skin containing the testicles.

Hernias in women are most frequently located on the upper thigh, just below the groin. Hernias in this region arc called femoral hernias. In umbilical hernia, the navel protrudes This type is most common in new babies and is unusual in adults. Among other types of hernias are those that follow operations in which the scar does not heal properly, permitting bulging to occur.

Hernias may be aggravated by coughing, sneezing, or, especially in constipated individuals, straining to pass bowel movements.

Anyone with a hernia should sec a doctor without delay. One reason tor this is that strangulation may develop When this happens, a loop of intestine becomes caught in the bulge, and its blood supply is cut oft. I his results in gangrene of the strangulated loop of bowel, a condition that is as serious as a ruptured appendix It can cause death. If you have an untreated hernia that suddenly becomes painful, see your doctor immediately, or go to the casualty ward of a good general hospital. This is an emergency calling for quick medical help.

Treatment

The best treatment for hernia is an operation to repair the weakness in the muscles responsible for it. This operation is usually minor and quite safe. Even elderly people undergo it without difficulty. No one with a hernia should avoid or delay the operation if it has been recommended. With the modern advances in surgery, almost no reason exists for using a truss or other support. Trusses are inconvenient, frequently uncomfortable, and may add to the injury by enlarging the weak spot. Medical opinion today is opposed to the use of trusses except in unusual circumstances.

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RETREMENT AND THE LATER YEARS: INDEPENDENCE, USEFULNESS, AND INTEREST

The basic needs of older people will be satisfied if they are independent, useful, and interested.

I know how difficult family situations can become when old people must live under the same roof with their children. That is one reason why it is usually best for the elderly to maintain their own homes as long as possible. Often a room in a boarding house proves satisfactory if a house or home unit cannot be maintained because of the expense or the housework involved.

Entire communities have been organized to meet the special needs of the elderly. I urge older people to investigate these places, because many of them offer excellent facilities—physical, social, and medical. Before you agree to anything in writing, however, see your doctor, because you want to be sure that you are in sufficiently good health to settle in a new community, and because you want to ascertain that the medical facilities and staff will be adequate for your special needs. See your solicitor, too, because you should not sign away your property or income or commit yourself to a heavy financial obligation without being absolutely sure of what you are doing.

When ageing parents must live with their children, it is usually best not to separate them by putting the mother with one child and the father with another. Undoubtedly they enjoy each other’s company much more than you realize.

It is not easy for elderly people to divide their time among their various children, although this is usually the only fair arrangement. The difficulties can be minimized by establishing definite dates. Having a room of their own awaiting them, with some of their cherished possessions in it, adds immeasurably to the older couple’s feeling of security and independence.

Every effort should be made on the part of both generations to find means of achieving a degree of independence. Often, it is easier for a woman to feel she is paying her way than it is for a man, since she can help with the housework and the care of young children. But elderly men can be extremely useful, if enough time and thought are put into it. Hobbies, crafts, and ‘handyman’ skills often make it possible for them, too, to ‘earn their keep.’

Projects outside the home help to bring a feeling of independence and prevent the irritations of too much personal contact. Church, charitable affairs, and visiting someone, if possible on a regular weekly basis, are stimulating breaks in otherwise monotonous routines. Doctors, clergymen, and social service workers can often find a need for the older person to fill. This is particularly important for those who do not have families or friends whom they can serve.

In this chapter I have spoken very little of true senility, or morbid senility, as contrasted with normal ageing.

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CARING FOR YOUR BABY: DIGESTIVE DIFFICULTIES

Vomiting. Most babies vomit, or ‘spit up,’ from time to time, usually right after being fed. It usually does not mean anything—not even if it happens daily—provided the baby is healthy and is gaining weight. If your baby does not seem well, if he vomits a large amount more often than once a day, and above all, if he vomits with great force (projectile vomiting), be sure to consult your doctor. Colic. Many babies have attacks of colic until they are about three months old. A baby with colic is apt to pull up his legs and to expel wind. Putting him on his stomach and patting him on the back may help. Your doctor will try to determine what is responsible for these attacks, so that they can be eliminated. Occasionally, the baby’s diet needs alteration; or he may need more relaxation and less stimulation. Diarrhoea. Young babies usually have between one and ten bowel movements a day, and these are usually quite loose. Breast-fed babies have a green-yellow stool with a birdseed appearance. Bottle-fed babies tend to have a more pasty, moist, and yellow bowel movement. However, if the number of a baby’s bowel movements increases a great deal and if the stools become watery and perhaps greenish, you should consult your doctor.

Constipation. A breast-fed baby is almost never constipated. If he should be, give him a little strained prune juice; try a teaspoonful at first, increasing the amount the next day to two teaspoonfuls, if it has not been effective.

A bottle-fed baby who is really constipated—that is, whose movements are hard as well as infrequent—should also be given prune juice. In addition, substitute brown sugar, for the sugar you have been using in his formula, and avoid boiling the milk. Do not do anything else about constipation without consulting your doctor.

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PROCEDURE OF THE MEDICAL EXAMINATION: THE MEDICAL HISTORY

The doctor will ask a great many questions at your first check-up in order to learn every detail of your health background. In subsequent periodic check-ups, your doctor will want particularly to learn if any serious illness, such as cancer, tuberculosis, heart trouble, or diabetes, has shown any symptoms. Some doctors use a computerized method of history-taking where you sit before a computer-driven typewriter which types out questions and you, in turn, type single-letter replies for yes or no. It is really very easy and there is a specially trained sister on hand to explain the method to you and help if necessary. The computer does not make a diagnosis, but merely provides the doctor with a list of questions and answers about your health. The doctor, by looking at the list, can then concentrate on the things that are worrying you. In other words, by doing some preliminary questioning the computer has given you and the doctor more time to get down to the real purpose of your medical consultation. Computers will never replace doctors; they just help the doctor to do his job more efficiently.

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DISEASES OF TEETH AND GUMS

Tooth decay—which your dentist calls dental caries—is the most common disease in the country. It is the chief cause of cavities, toothache, pulp and root abscesses, and extractions.

Another important dental disease, which involves the gums and tooth sockets, is called pyorrhoea. If untreated, this disease causes loosening of the teeth to the point where they fall out or need to be extracted.

Other dental troubles are the result of impacted teeth, accidents, and poor alignment of teeth. When teeth are not correctly aligned, the bite does not work properly, and our chewing is inadequate or difficult or the teeth overlap and stick out in an unattractive manner. A dentist specializing in orthodontics can correct this condition.

At one time, people used to have a tooth extracted as soon as it started to ache, or even before. Dentists now try to save every tooth they can. Dentures involve time, trouble, and expense. They seldom do as good a job of chewing as one’s own teeth, and the proper chewing of food is of great value to digestion. However, modern dentures are remarkable, and many of my patients who have artificial teeth tell me that they look and feel much better than they expected.

An alternative to dentures is the reconstruction of teeth. A specialist in this field of dentistry can grind your teeth and cap them with natural-looking materials. This process can involve a few teeth or the entire mouth. The effect of reconstruction is that the combination of your teeth and the caps becomes permanent. In the process, the dental specialist may also adjust the alignment of your teeth.

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