Tactile Health Dictionary

An inability to recognize objects despite adequate sensory information about them reaching the brain via the eyes or ears or through touch. Agnosia is caused by damage to areas of the brain that are involved in interpretative and recall functions. The most common causes of this kind of damage are stroke or head injury.

Agnosia is usually associated with just one of the senses of vision, hearing, or touch and is described as visual, auditory, or tactile respectively. Some people, after a stroke that damages the right cerebral hemisphere, seem unaware of any disability in their affected left limbs. This is called anosognosia or sensory inattention. There is no specific treatment for agnosia, but some interpretative ability may return eventually.... agnosia

Urinary incontinence The International Continence Society de?nes urinary incontinence as an involuntary loss of URINE that is objectively shown and is a social and hygiene problem. The elderly suffer most from this disorder because the e?ectiveness of the sphincter muscles surrounding the URETHRA declines with age. Men are less often affected than women; 20 per cent of women over 40 years of age have problems with continence. It is estimated that around three million people are regularly incontinent in the UK, a prevalence of about 40 per 1,000 adults.

Incontinence can be divided broadly into two groups: stress incontinence and incontinence due to an overactive URINARY BLADDER – also called detrusor instability – which affects one-third of incontinent women, prevalence increasing with age. Bladder symptoms do not necessarily correlate with the underlying diagnosis, and accurate diagnosis may require urodynamic studies – examination of urine within, and the passage of urine through and from, the urinary tract. However, such studies are best deferred until conservative treatment has failed or when surgery is planned.

Incontinence causes embarassment, inconvenience and distress in women, and men are reluctant to seek advice for what remains a social taboo for most people. Su?erers should be encouraged to seek help early and to discuss their anxieties and problems frankly. Often it is a condition which can be managed e?ectively at primary care centres, and quite simple measures can greatly improve the lives of those affected. STRESS INCONTINENCE is the most common cause of urinary incontinence in women. This is the involuntary loss of urine during activities that raise the intra-abdominal pressure, such as sneezing, coughing, laughing, exercise or lifting. The condition is caused by injury or weakness of the urethral sphincter muscle; this weakness may be either congenital or the result of childbirth, PROLAPSE of the VAGINA, MENOPAUSE or previous surgery. A CYSTOCOELE may be present. Urinary infection may cause incontinence or aggravate the symptoms of existing incontinence.

The ?rst step is to diagnose and treat infection, if present. Patients bene?t from simple advice on incontinence pads and garments, and on ?uid intake. Those with a high ?uid intake should restrict this to a litre a day, especially if frequency is a problem. Constipation should be treated and smoking stopped. The use of DIURETICS should be reduced if possible, or stopped entirely. Postmenopausal women may bene?t from oestrogen-replacement therapy; elderly people with chronic incontinence may need an indwelling urethral catheter.

Pelvic-?oor exercises can be successful and the insertion of vaginal cones can be a useful subsidiary treatment, as can electrical stimulation of the pelvic muscles. If these procedures are unsuccessful, then continence surgery may be necessary. The aim of this is to raise the neck of the bladder, support the mid part of the urethra and increase urethral resistance. Several techniques are available. URGE INCONTINENCE An overactive or unstable bladder results in urge incontinence, also known as detrusor incontinence – the result of uninhibited contractions of the detrusor muscle of the bladder. The bladder contracts (spontaneously or on provocation) during the ?lling phase while the patient attempts to stop passing any urine. Hyperexcitability of the muscle or a disorder of its nerve supply are likely causes. The symptoms include urgency (acute wish to pass urine), frequency and stress incontinence. Diagnosis can be con?rmed with CYSTOMETRY. Bladder training is the ?rst step in treatment, with the aim of reducing the frequency of urination to once every three to four hours. BIOFEEDBACK, using visual, auditory or tactile signals to stop bladder contractions, will assist the bladder training. Drug treatments such as CALCIUM-CHANNEL BLOCKERS, antimuscarinic agents (see ANTIMUSCARINE), TRICYCLIC ANTIDEPRESSANT DRUGS, and oestrogen replacement can be e?ective. Surgery is rarely used and is best reserved for di?cult cases. OVERFLOW INCONTINENCE Chronic urinary retention with consequent over?ow – more common in men than in women. The causes include antispasmodic drugs, continence surgery, obstruction from enlargement and post-prostatectomy problems (in men), PSYCHOSIS, and disease or damage to nerve roots arising from the spinal cord. Urethral dilatation or urethrotomy may be required when obstruction is the cause. Management is intermittent selfcatheterisation or a suprapubic catheter and treatment of any underlying cause.

Faecal incontinence is the inability to control bowel movements and may be due to severe CONSTIPATION, especially in the elderly; to local disease; or to injury or disease of the spinal cord or nervous supply to rectum and anal muscles. Those with the symptom require further investigation.... incontinence

The advent of computing has had widespread effects in all areas of society, with medicine no exception. Computer systems are vital – as they are in any modern enterprise – for the administration of hospitals, general practices and health authorities, supporting payroll, ?nance, stock ordering and billing, resource and bed management, word-processing correspondence, laboratory-result reporting, appointment and record systems, and management audit.

The imaging systems of COMPUTED TOMOGRAPHY (CT) and magnetic resonance imaging (see MRI) have powerful computer techniques underlying them.

Computerised statistical analysis of study data, population databases and disease registries is now routine, leading to enhanced understanding of the interplay between diseases and the population. And the results of research, available on computerised indexes such as MEDLINE, can be obtained in searches that take only seconds, compared with the hours or days necessary to accomplish the same task with its paper incarnation, Index Medicus.

Medical informatics The direct computerisation of those activities which are uniquely medical – history-taking, examination, diagnosis and treatment – has proved an elusive goal, although one hotly pursued by doctors, engineers and scientists working in the discipline of medical informatics. Computer techniques have scored some successes: patients are, for example, more willing to be honest about taboo areas, such as their drug or alcohol consumption, or their sexual proclivities, with a computer than face to face with a clinician; however, the practice of taking a history remains the cornerstone of clinical practice. The examination of the patient is unlikely to be supplanted by technological means in the foreseeable future; visual and tactile recognition systems are still in their infancy. Skilled interpretation of the result by machine rather than the human mind seems equally as remote. Working its way slowly outwards from its starting point in mathematical logic, ARTIFICIAL INTELLIGENCE that in any way mimics its natural counterpart seems a distant prospect. Although there have been successes in computer-supported diagnosis in some specialised areas, such as the diagnosis of abdominal pain, workable systems that could supplant the mind of the generalist are still the dream of the many developers pursuing this goal, rather than a reality available to doctors in their consulting rooms now.

In therapeutics, computerised prescribing systems still require the doctor to make the decision about treatment, but facilitate the process of writing, issuing, and recording the prescription. In so doing, the system can provide automated checks, warning if necessary about allergies, potential drug interactions, or dosing errors. The built-in safety that this process o?ers is enhanced by the superior legibility of the script that ensues, reducing the potential for error when the medicine is dispensed by the nurse or the pharmacist.

Success in these individual applications continues to drive development, although the process has its critics, who are not slow to point to the lengthier consultations that arise when a computer is present in the consulting room and its distracting e?ect on communication with the patient.

Underlying these many software applications lies the ubiquitous personal computer – more powerful today than its mainframe predecessor of only 20 years ago – combined with networking technology that enables interconnection and the sharing of data. As in essence the doctor’s role involves the acquisition, manipulation and application of information – from the individual patient, and from the body of medical knowledge – great excitement surrounds the development of open systems that allow di?erent software and hardware platforms to interact. Many problems remain to be solved, not least the fact that for such systems to work, the whole organisation, and not just a few specialised individuals, must become computer literate. Such systems must be easy to learn to use, which requires an intuitive interface between user(s) and system(s) that is predictable and logical in its ordering and presentation of information.

Many other issues stand in the way of the development towards computerisation: standard systems of nomenclature for medical concepts have proved surprisingly di?cult to develop, but are crucial for successful information-sharing between users. Sharing information between existing legacy systems is a major challenge, often requiring customised software and extensive human intervention to enable the previous investments that an organisation has made in individual systems (e.g. laboratory-result reporting) to be integrated with newer technology. The beginnings of a global solution to this substantial obstacle to networking progress is in sight: the technology that enables the Internet – an international network of telephonically linked personal computers – also enables the establishment of intranets, in which individual servers (computers dedicated to serving information to other computers) act as repositories of ‘published’ data, which other users on the network may ‘browse’ as necessary in a client-server environment.

Systems that support this process are still in early stages of development, but the key conceptualisations are in place. Developments over the next 5–10 years will centre on the electronic patient record available to the clinician on an integrated clinical workstation. The clinical workstation – in essence a personal computer networked to the hospital or practice system – will enable the clinician to record clinical data and diagnoses, automate the ordering of investigations and the collection of the results, and facilitate referral and communication between the many professionals and departments involved in any individual patient’s care.

Once data is digitised – and that includes text, statistical tables, graphs, illustrations and radiological images, etc. – it may be as freely networked globally as locally. Consultations in which live video and sound transmissions are the bonds of the doctor-patient relationship (the techniques of telemedicine) are already reality, and have proved particularly convenient and cost-e?ective in linking the patient and the generalist to specialists in remote areas with low population density.

As with written personal medical records, con?dentiality of personal medical information on computers is essential. Computerised data are covered by the Data Protection Act 1984. This stipulates that data must:

be obtained and processed fairly and lawfully.

be held only for speci?ed lawful purposes.

•not be used in a manner incompatible with those purposes.

•only be recorded where necessary for these purposes.

be accurate and up to date.

not be stored longer than necessary.

be made available to the patient on request.

be protected by appropriate security and backup procedures. As these problems are solved, concerns about

privacy and con?dentiality arise. While paper records were often only con?dential by default, the potential for breaches of security in computerised networks is much graver. External breaches of the system by hackers are one serious concern, but internal breaches by authorised users making unauthorised use of the data are a much greater risk in practice. Governing network security so that clinical users have access on a need-to-know basis is a di?cult business: the software tools to enable this – encryption, and anonymisation (ensuring that clinical information about patients is anonymous to prevent con?dential information about them leaking out) of data collected for management and research processes – exist in the technical domain but remain a complex conundrum for solution in the real world.

The mushroom growth of websites covering myriad subjects has, of course, included health information. This ranges from clinical details on individual diseases to facts about medical organisations and institutes, patient support groups, etc. Some of this information contains comments and advice from orthodox and unorthodox practitioners. This open access to health information has been of great bene?t to patients and health professionals. But web browsers should be aware that not all the medical information, including suggested treatments, has been subject to PEER REVIEW, as is the case with most medical articles in recognised medical journals.... information technology in medicine

An inability to recognize objects by touch when they are placed in the hand, even though there is no defect of sensation in the fingers or difficulty in holding the object.

Astereognosis is either left- or right-sided; tactile recognition is normal on the other side.

If both sides are affected, the condition is called tactile agnosia.

Astereognosis and tactile agnosia are caused by damage to parts of the cerebrum (main brain mass) involved in recognition by touch and may occur as a result of a stroke or head injury.... astereognosis

Also called tic douloureux, this is one of the most severe forms of NEURALGIA. It affects the main sensory nerve in the face (TRIGEMINAL NERVE), and may occur in one or more of the three divisions in which the nerve is distributed.

It is usually con?ned to one side. It is more common in women than in men, usually occurring over the age of 50. The attack is often precipitated by movements of the jaw, as in talking or eating, or by tactile stimuli such as a cold wind or washing the face. When the ?rst or upper division of the nerve is involved, the pain is mostly felt in the forehead and side of the head. It is usually of an intensely sharp, cutting, or burning character, either constant or with exacerbations each day while the attack continues. There is also pain in the eyelid, redness of the eye and increased ?ow of tears. When the second division of the nerve is affected, the pain is chie?y in the cheek and upper jaw. When the third division of the nerve suffers, the pain affects the lower jaw. Attacks may recur for years; and, although interfering with sleeping and eating, they rarely appear to lead to any serious results. Nevertheless, the pain may become intolerable.

Treatment The outlook in trigeminal neuralgia was radically altered by the introduction of the drug CARBAMAZEPINE, which usually relieves the pain. If the side-effects – for example, dizziness, headache, nausea or drowsiness – are unacceptable or pain not relieved, PHENYTOIN SODIUM may help. Otherwise, surgery is needed in the shape of controlled, radio-frequency heat damage to the appropriate part of the trigeminal nerve.... trigeminal neuralgia

A general term for a group of psychotic illnesses that are characterized by disturbances in thinking, emotional reaction, and behaviour.

Onset can be at any age but is most common in late adolescence and the early 20s, and may be triggered by stress. No causes have been identified, but many have been implicated. It is likely that inheritance plays a role. Disruption of the activity of some neurotransmitters in the brain is a possible mechanism. Brain imaging techniques have revealed abnormalities of structure and function in people with schizophrenia.

Schizophrenia may begin insidiously, with the individual becoming slowly more withdrawn and losing motivation. In other cases, the illness comes on more suddenly, often in response to external stress. The main symptoms are various forms of delusions such as those of persecution (which are typical of paranoid schizophrenia); hallucinations, which are usually auditory (hearing voices), but which may also be visual or tactile; and thought disorder, leading to impaired concentration and thought processes. Disordered thinking is often reflected in muddled and disjointed speech. Behaviour is eccentric, and selfneglect common. In a rare form of schizophrenia, catatonia may occur, in which rigid postures are adopted for prolonged periods, or there are outbursts of repeated movement.

Diagnosis of schizophrenia may take some time and, in some cases, it may be difficult to make a diagnosis at all.

Treatment is mainly with antipsychotic drugs, such as phenothiazine drugs, and new atypical antipsychotic drugs such as risperidone. In some cases, the drugs are given as monthly depot injections. Once the symptoms are controlled, community care, vocational opportunities, and family counselling can help to prevent a relapse.

Some people may make a complete recovery. However, the majority have relapses punctuated with partial or full recovery. A small proportion have a severe life-long disability.... schizophrenia

n. a false sensory perception of something that is not really there; the perception is subjectively convincing but lacks an external stimulus. Hallucinations may be visual, auditory, tactile, gustatory (of taste), or olfactory (of smell). They may be provoked by mental illness (such as *schizophrenia or severe anxiety disorders), *personality disorders, or physical disorders affecting the brain (such as temporal lobe *epilepsy, sepsis, acute organic syndrome, or stroke) or they may be caused by drugs, alcohol, or sensory deprivation. Hallucinations should be distinguished from dreams and from *illusions (which are misinterpretations of real stimuli). A substantial minority of the population experiences hallucinations not caused by mental illness. Some hallucinations are not always pathological: hypnagogic hallucinations occur in the state between wakefulness and sleep, and the images are often very distinct; these hallucinations occur in 30–60% of patients with *narcolepsy. Hypnopompic hallucinations occur in the state between sleep and full wakefulness; like hypnagogic hallucinations, the experiences may be very vivid.... hallucination

 Sugar diabetes. Chronic disorder of fat, protein and carbohydrate metabolism. A decrease of insulin by the pancreas gives rise to high level blood sugar (glucose) which is eliminated in the urine by the kidneys. With low insulin production the body cannot convert food into energy. In Britain over 30,000 new cases are diagnosed each year. One in five people go blind because of diabetes. The genetic factor is important; it may run in families due to defect in the immune system. Women who have German measles during the first three months of pregnancy can have a child who develops diabetes during adolescence.

Etiology. The more severe form, in younger patients, needs insulin treatment, without which ketosis and diabetic coma are possible. The milder form in older patients can be managed with diet and hypoglycaemic agents. Now considered due to auto-immune attack on Islet of Langerhams cells in pancreas which secrete insulin. “The Pill” often raises blood sugar. Lack of trace minerals (chromium and zinc). Zinc is a component of insulin and Chromium produces enzymes to stimulate metabolism of sugars. Diabetes can cause heart attack, stroke, hardening of arteries, blindness. It is the leading cause of kidney failure and gangrene.

Symptoms. Great thirst. Urine of high specific gravity. Weakness, emaciation, skin ulcers, loss of tactile sensation in the fingertips (Vitamin B6). In men there may be inflammation of the glans penis and in women, itching of the vulvae. Boils are common. In spite of large appetite there may by severe weight loss. Magnesium deficiency.

Diabetics are subject to glaucoma and detachment of the retina. There is a high incidence of cataract of the eye. While surgery may be necessary, effective supportive herbal treatment can do much. Regular visits to the Hospital Specialist help detect in time future eye, kidney and circulation damage.

High fibre, low fat, high carbohydrate. To help control blood sugar a diabetic must avoid sweets.

Exercise lowers blood sugar.

Agents used with some success: Alfalfa, Damiana leaves, Fenugreek seeds, Aloe Vera juice, Dandelion, Fringe Tree, Guar gum, Garlic (anti-diabetic action shown by Dr Madaus, West Germany, 1967), Bilberry berries, Goat’s Rue (dried aerial parts reduce blood sugar BHP (1983), Olive leaves, onions, Nettles, Pipsissewa, White Horehound, Sweet Sumach, Jambul seeds rapidly reduce sugar in the urine. Karela. Gurmar, (Gymnema sylvestre) leaves are chewed in India to reduce sugar in the urine (mild cases). Balsam pear. Bitter melon (Momordica charastia).

Hypoglycaemic herbs can be effective where the pancreas still functions. Type 1 diabetes, suffered by children whose insulin-producing cells have been destroyed and who produce no insulin at all will always require administered insulin. Maturity-onset diabetes (Type 11) occurs in middle life, insulin- production being insufficient. This form is usually associated with obesity for which herbs are helpful.

Diabetics are specially prone to infections; a course of Echinacea at the onset of winter is beneficial. Coronary artery disease is common in diabetics (especially women) who may develop atherosclerosis at an early age. High blood pressure places undue strain upon kidneys which may excrete too much protein (Yarrow, Lime flowers, Hawthorn). Lack of sensation in the feet exposes the subject to unconscious bruising and injury from which septic ulceration may arise (Chamomile foot baths).

Alternatives. Liver herbs work positively on the pancreas. Diabetic cases should receive treatment for the liver also, Dandelion and Fringe Tree being a reliable combination. Dr John Fearn, California (Ellingwood) used Fringe Tree for all his cases of sugar in the urine: 10 drops, Liquid Extract, 4-5 times daily.

Tea. Equal parts: Peppermint leaves, Dandelion leaves, Goat’s Rue leaves. 1-2 teaspoons to each cup boiling water infuse 5-15 minutes. Cup 2-3 times daily.

Teas from any one of the following: Bilberry berries or leaves, Nettles, White Horehound, Alfalfa, Olive leaves.

Decoction. Fenugreek seeds. 2 teaspoons to each large cup water simmered gently 5 minutes. One cup daily, consuming the seeds.

Powders. Equal parts: Sweet Sumach, Jambul seeds, Dandelion. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.

Tinctures. Formula. Equal parts: Jambul, Fringe Tree, Goat’s Rue. Dose: 1 teaspoon thrice daily and at bedtime.

Tablets. Dr Alfred Vogel: tablet containing: Bilberry, Kidney Bean, Tormentil, English Walnut leaves, Alfalfa leaves, Cuckoo flowers.

Karela (Momordica Charantia) Hypoglycaemic action gave good results in clinical trials. Daily dose: 50/60ml fresh juice.

Evening Primrose. See entry.

Guar Gum. 5g unit dose sachets (Guarina) containing dispersible granules. This gum has shown beneficial effects for insulin-dependants.

Hypoglycaemics (second degree). Allspice, Bugleweed, Burdock, Ginseng, Lily of the Valley, Wormwood, Nettles.

Diabetic gangrene. Tinctures: equal parts, Echinacea, Thuja. Internally and externally. Internal dose: 30- 60 drops.

Diabetic neuralgia. Cayenne pepper (Capsicum). Frequently successful.

American traditional. It is claimed that 500mg Bayleaf, Cinnamon, Cloves and Turmeric halve the need for insulin in diabetics.

Diet. Dietary treatment has changed over the past few years. Patients are now advised by the British Diabetic Association to eat food rich in complex carbohydrates (starches) and high in fibre as in wholemeal bread, oats and wholegrain breakfast cereals, wholewheat pasta, brown rice, beans and lentils, vegetables and fruit. Fat intake should be carefully watched (lean meat); skimmed milk, polyunsaturated or low-fat cheeses and salad dressings. Certain foods are known to encourage the pancreas to produce more insulin: banana, barley, cabbage, lettuce, oats, olive, papaya, turnip, sweet potato.

Coffee intake should be limited to prevent hypoglycaemic symptoms.

Barley. A study has shown that the use of barley flour as a substitute for wheat in bread helps to control diabetes, in Iraq. (Naismith D, et al, ‘Therapeutic Value of Barley in Management of Diabetes’: Annals Nutr Metab, 35, 61-64 1991)

Supplementation. Vitamins A, B-complex, C, D, E, F. Vitamin B6. Brewer’s yeast. Minerals: Chromium 50mcg; Manganese 15mg; Magnesium 300mg; Zinc 25mg; to normalise glucose metabolism.

Note: Over 400 traditional plant medicines have been documented for diabetes, but few have been evaluated for efficacy. In the undeveloped countries they are chiefly used for non-insulin dependent diabetes. (Diabetes Care, 1989, Sept 12, p553)

Insulin dependents. Whether adults or children, insulin dependents should under no circumstances discontinue insulin injections.

Treatment by or in liaison with general medical practitioner.

Information. British Diabetic Association, 10 Queen Anne Street, London W1M 0BD, UK. Send SAE. ... diabetes, mellitus