A common complaint that is usually the result of overwork or poor quality, or insufficient sleep. Persistent tiredness may be caused by a number of conditions, including depression, anxiety, anaemia, and diabetes.
Chronic fatigue is a symptom of some illnesses such as ANAEMIA, CHRONIC FATIGUE SYNDROME (CFS), HYPOTHYROIDISM, MONONUCLEOSIS, MOTOR NEURONE DISEASE (MND), MYASTHENIA GRAVIS, MYALGIC ENCEPHALOMYELITIS (ME) and others. Some drugs may also produce a feeling of fatigue.... fatigue
Doctors make the diagnosis of depression when they believe a patient to be ill with the latter condition, which may affect physical health and in some instances be life-threatening. This form of depression is common, with up to 15 per cent of the population suffering from it at any one time, while about 20 per cent of adults have ‘medical’ depression at some time during their lives – such that it is one of the most commonly presenting disorders in general practice. Women seem more liable to develop depression than men, with one in six of the former and one in nine of the latter seeking medical help.
Manic depression is a serious form of the disorder that recurs throughout life and is manifested by bouts of abnormal elation – the manic stage. Both the manic and depressive phases are commonly accompanied by psychotic symptoms such as delusions, hallucinations and a loss of sense of reality. This combination is sometimes termed a manic-depressive psychosis or bipolar affective disorder because of the illness’s division into two parts. Another psychiatric description is the catch-all term ‘affective disorder’.
Symptoms These vary with the illness’s severity. Anxiety and variable moods are the main symptoms in mild depression. The sufferer may cry without any reason or be unresponsive to relatives and friends. In its more severe form, depression presents with a loss of appetite, sleeping problems, lack of interest in and enjoyment of social activities, tiredness for no obvious reason, an indi?erence to sexual activity and a lack of concentration. The individual’s physical and mental activities slow down and he or she may contemplate suicide. Symptoms may vary during the 24 hours, being less troublesome during the latter part of the day and worse at night. Some people get depressed during the winter months, probably a consequence of the long hours of darkness: this disorder – SEASONAL AFFECTIVE DISORDER SYNDROME, or SADS – is thought to be more common in populations living in areas with long winters and limited daylight. Untreated, a person with depressive symptoms may steadily worsen, even withdrawing to bed for much of the time, and allowing his or her personal appearance, hygiene and environment to deteriorate. Children and adolescents may also suffer from depression and the disorder is not always recognised.
Causes A real depressive illness rarely has a single obvious cause, although sometimes the death of a close relative, loss of employment or a broken personal relationship may trigger a bout. Depression probably has a genetic background; for instance, manic depression seems to run in some families. Viral infections sometimes cause depression, and hormonal disorders – for example, HYPOTHYROIDISM or postnatal hormonal disturbances (postnatal depression) – will cause it. Di?cult family or social relations can contribute to the development of the disorder. Depression is believed to occur because of chemical changes in the transmission of signals in the nervous system, with a reduction in the neurochemicals that facilitate the passage of messages throughout the system.
Treatment This depends on the type and severity of the depression. These are three main forms. PSYCHOTHERAPY either on a one-to-one basis or as part of a group: this is valuable for those whose depression is the result of lifestyle or personality problems. Various types of psychotherapy are available. DRUG TREATMENT is the most common method and is particularly helpful for those with physical symptoms. ANTIDEPRESSANT DRUGS are divided into three main groups: TRICYCLIC ANTIDEPRESSANT DRUGS (amitriptyline, imipramine and dothiepin are examples); MONOAMINE OXIDASE INHIBITORS (MAOIS) (phenelzine, isocarboxazid and tranylcypromine are examples); and SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) (?uoxetine – well known as Prozac®, ?uvoxamine and paroxetine are examples). For manic depression, lithium carbonate is the main preventive drug and it is also used for persistent depression that fails to respond to other treatments. Long-term lithium treatment reduces the likelihood of relapse in about 80 per cent of manic depressives, but the margin between control and toxic side-effects is narrow, so the drug must be carefully supervised. Indeed, all drug treatment for depression needs regular monitoring as the substances have powerful chemical properties with consequential side-effects in some people. Furthermore, the nature of the illness means that some sufferers forget or do not want to take the medication. ELECTROCONVULSIVE THERAPY (ECT) If drug treatments fail, severely depressed patients may be considered for ECT. This treatment has been used for many years but is now only rarely recommended. Given under general anaesthetic, in appropriate circumstances, ECT is safe and e?ective and may even be life-saving, though temporary impairment of memory may occur. Because the treatment was often misused in the past, it still carries a reputation that worries patients and relatives; hence careful assessment and counselling are essential before use is recommended.
Some patients with depression – particularly those with manic depression or who are a danger to themselves or to the public, or who are suicidal – may need admission to hospital, or in severe cases to a secure unit, in order to initiate treatment. But as far as possible patients are treated in the community (see MENTAL ILLNESS).... depression
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.... lethargy
One of the major problems of the menopause which does not give rise to symptoms until many years later is osteoporosis (see BONE, DISORDERS OF). After the menopause, 1 per cent of the bone is lost per annum to the end of life. This is a factor in the frequency of fractures of the femur in elderly women as a result of osetoporosis, but it can be prevented by hormone replacement therapy (see below).
Hormone replacement therapy (HRT) This term has become synonymous with the scienti?cally correct term ‘OESTROGENS replacement therapy’ to signify the treatment of menopausal symptoms and signs with oestrogens, now usually combined with PROGESTOGEN. Oestrogen and combined treatment relieve the short-term symptoms such as hot ?ushes, sweats and vaginal dryness. Atrophic vaginitis and vulvitis (shrinking of the tissues of VULVA and VAGINA due to fall in natural oestrogen levels) also usually respond to treatment with oestrogens.
Cyclical therapy is necessary to avoid abnormal bleeding in women who have reached the menopause. If oestrogens are given alone, there is an increased risk of endometrial hyperplasia (overgrowth of the ENDOMETRIUM) which may lead to endometrial cancer, so these are restricted to women who have had a hysterectomy and are no longer at risk. Other women can be given oestrogen-progestogen combinations.
There is good evidence that oestrogen alone or in combination can prevent the bone-loss associated with the menopause by reducing the demineralisation of bone which normally occurs after the menopause; and, if it is started early and continued for years, it may prevent the development of osteoporosis. Oestrogen is far more e?ective than calcium supplements and has been shown greatly to reduce fractures affecting the spine, wrists and legs after the age of 50.
However, HRT is no longer licensed for ?rst-line treatment to prevent osteoporosis, as increased risk of stroke, breast cancer and coronary heart disease cannot justify treatment for long periods – unless the woman has severe menopausal symptoms. HRT is recommended for short-term use only in menopausal women whose lives are inconvenienced by vasomotor instability (severe ?ushes, etc.) or vaginal atrophy, although the latter may respond to local oestrogen treatment – creams or pessaries. In terms of oestrogenic activity, natural oestrogen such as oestradiol, oestrone and oestriol are more appropriate for HRT than synthetic oestrogens like ethinyloestradiol, mestranol and diethylstilboestrol.
Many experts believe that controversy surrounding the risks and bene?ts of HRT have been settled by a large randomised trial (the Women’s Health Initiative), published in 2003, which showed that combined treatment increases the risk of breast tumours, stroke and coronary heart disease (in the ?rst year). Oestrogen alone (given to women who have had a hysterectomy) also increases the risk of stroke. Five years of combined treatment may double the risk of breast cancer, and the heart-disease risk is nearly doubled during the ?rst year of use. This is in spite of the bene?cial effects of HRT on blood lipids. However, there are others who consider that di?erent dose combinations of di?erent hormones may one day prove bene?cial, so research continues.
HRT can also provoke minor adverse effects such as breast tenderness, ?uid retention, leg cramps and nausea. The risk of abnormal blood clotting means that HRT is not normally recommended for women who smoke heavily or have had THROMBOSIS, severe HYPERTENSION, stroke or liver disease. HRT has, however, brought symptomatic bene?ts to many menopausal women, who can then justify taking the other increased risks – only fully understood since the large trial results were published.
As the evidence stands at present, careful consideration of each woman’s medical history and the severity of her menopausal symptoms is necessary in deciding what combination of drugs should be given and for how long. In general, the indications should be severe menopausal symptoms that can be controlled by the lowest dose for the shortest time. Using HRT to alleviate mild symptoms, or to prevent future bone loss, is probably of insu?cient bene?t to counter the other risks described above.... menopause
Symptoms: (acute) abdominal pain, muscle weakness, vomiting, low blood pressure due to dehydration, tiredness, mental confusion, loss of weight and appetite. Vomiting, dizzy spells. Increased dark pigmentation around genitals, nipples, palms and inside mouth. Persistent low blood pressure with occasional low blood sugar. Crisis is treated by increased salt intake. Research project revealed a craving for liquorice sweets in twenty five per cent of patients.
Herbs with an affinity for the adrenal glands: Parsley, Sarsaparilla, Wild Yam, Borage, Liquorice, Ginseng, Chaparral. Where steroid therapy is unavoidable, supplementation with Liquorice and Ginseng is believed to sustain function of the glands. Ginseng is supportive when glands are exhausted by prolonged stress. BHP (1983) recommends: Liquorice, Dandelion leaf.
Alternatives. Teas. Gotu Kola, Parsley, Liquorice root, Borage, Ginseng, Balm.
Tea formula. Combine equal parts: Balm and Gotu Kola. Preparation of teas and tea mixture: 1 heaped teaspoon to each cup boiling water: infuse 5-10 minutes; 1 cup 2 to 3 times daily.
Tablets/capsules. Ginseng, Seaweed and Sarsaparilla, Wild Yam, Liquorice. Dosage as on bottle. Formula. Combine: Gotu Kola 3; Sarsaparilla 2; Ginseng 1; Liquorice quarter. Doses. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 30-60 drops. Tinctures: 1-2 teaspoons 2 to 3 times daily.
Formula. Alternative. Tinctures 1:5. Echinacea 20ml; Yellow Dock 10ml; Barberry 10ml; Sarsaparilla 10ml; Liquorice (liquid extract) 5ml. Dose: 1-2 teaspoons thrice daily.
Supplementation. Cod liver oil. Extra salt. B-Vitamins. Folic acid. ... addison’s disease
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
Treatment If organic disease is identi?ed, it should, where possible, be treated; otherwise the treatment of dementia is alleviation of its symptoms. The affected person must be kept clean and properly fed. Good nursing care in comfortable surroundings is important and sedation with appropriate drugs may be required. Patients may eventually need institutional care. (See ALZHEIMER’S DISEASE.)... dementia
Arrhythmias An abnormal rate or rhythm of the heartbeat. The reason is a disturbance in the electrical impulses within the heart. Sometimes a person may have an occasional irregular heartbeat: this is called an ECTOPIC beat (or an extrasystole) and does not necessarily mean that an abnormality exists. There are two main types of arrhythmia: bradycardias, where the rate is slow – fewer than 60 beats a minute and sometimes so slow and unpredictable (heartblock) as to cause blackouts or heart failure; and tachycardia, where the rate is fast – more than 100 beats a minute. A common cause of arrhythmia is coronary artery disease, when vessels carrying blood to the heart are narrowed by fatty deposits (ATHEROMA), thus reducing the blood supply and damaging the heart tissue. This condition often causes myocardial infarction after which arrhythmias are quite common and may need correcting by DEFIBRILLATION (application of a short electric shock to the heart). Some tachycardias result from a defect in the electrical conduction system of the heart that is commonly congenital. Various drugs can be used to treat arrhythmias (see ANTIARRHYTHMIC DRUGS). If attacks constantly recur, the arrhythmia may be corrected by electrical removal of dead or diseased tissue that is the cause of the disorder. Heartblock is most e?ectively treated with an arti?cial CARDIAC PACEMAKER, a battery-activated control unit implanted in the chest.
Cardiomyopathy Any disease of the heart muscle that results in weakening of its contractions. The consequence is a fall in the e?ciency of the circulation of blood through the lungs and remainder of the body structures. The myopathy may be due to infection, disordered metabolism, nutritional excess or de?ciency, toxic agents, autoimmune processes, degeneration, or inheritance. Often, however, the cause is not identi?ed. Cardiomyopathies are less common than other types of heart diseases, and the incidence of di?erent types of myopathy (see below) is not known because patients or doctors are sometimes unaware of the presence of the condition.
The three recognised groups of cardiomyopathies are hypertrophic, dilated and restrictive.
•Hypertrophic myopathy, a familial condition, is characterised by great enlargement of the muscle of the heart ventricles. This reduces the muscle’s e?ciency, the ventricles fail to relax properly and do not ?ll suf?ciently during DIASTOLE.
In the dilated type of cardiomyopathy, both ventricles overdilate, impairing the e?ciency of contraction and causing congestion of the lungs.
In the restrictive variety, proper ?lling of the ventricles does not occur because the muscle walls are less elastic than normal. The result is raised pressure in the two atria (upper cavities) of the heart: these dilate and develop FIBRILLATION. Diagnosis can be di?cult and treatment is symptomatic, with a poor prognosis. In suitable patients, heart TRANSPLANTATION may be considered. Disorders of the heart muscle may also be
caused by poisoning – for example, heavy consumption of alcohol. Symptoms include tiredness, palpitations (quicker and sometimes irregular heartbeat), chest pain, di?culty in breathing, and swelling of the legs and hands due to accumulation of ?uid (OEDEMA). The heart is enlarged (as shown on chest X-ray) and ECHOCARDIOGRAPHY shows thickening of the heart muscle. A BIOPSY of heart muscle will show abnormalities in the cells of the heart muscle.
Where the cause of cardiomyopathy is unknown, as is the case with most patients, treatment is symptomatic using DIURETICS to control heart failure and drugs such as DIGOXIN to return the heart rhythm to normal. Patients should stop drinking alcohol. If, as often happens, the patient’s condition slowly deteriorates, heart transplantation should be considered.
Congenital heart disease accounts for 1–2 per cent of all cases of organic heart disease. It may be genetically determined and so inherited; present at birth for no obvious reason; or, in rare cases, related to RUBELLA in the mother. The most common forms are holes in the heart (atrial septal defect, ventricular septal defect – see SEPTAL DEFECT), a patent DUCTUS ARTERIOSUS, and COARCTATION OF THE AORTA. Many complex forms also exist and can be diagnosed in the womb by fetal echocardiography which can lead to elective termination of pregnancy. Surgery to correct many of these abnormalities is feasible, even for the most severe abnormalities, but may only be palliative giving rise to major diffculties of management as the children become older. Heart transplantation is now increasingly employed for the uncorrectable lesions.
Coronary artery disease Also known as ischaemic heart disease, this is a common cause of symptoms and death in the adult population. It may present for the ?rst time as sudden death, but more usually causes ANGINA PECTORIS, myocardial infarction (heart attack) or heart failure. It can also lead to a disturbance of heart rhythm. Factors associated with an increased risk of developing coronary artery disease include diabetes, cigarette smoking, high blood pressure, obesity, and a raised concentration of cholesterol in the blood. Older males are most affected.
Coronary thrombosis or acute myocardial infarction is the acute, dramatic manifestation of coronary-artery ischaemic heart disease – one of the major killing diseases of western civilisation. In 1999, ischaemic heart disease was responsible for about 115,000 deaths in England and Wales, compared with 153,000 deaths in 1988. In 1999 more than 55,600 people died of coronary thrombosis. The underlying cause is disease of the coronary arteries which carry the blood supply to the heart muscle (or myocardium). This results in narrowing of the arteries until ?nally they are unable to transport su?cient blood for the myocardium to function e?ciently. One of three things may happen. If the narrowing of the coronary arteries occurs gradually, then the individual concerned will develop either angina pectoris or signs of a failing heart: irregular rhythm, breathlessness, CYANOSIS and oedema.
If the narrowing occurs suddenly or leads to complete blockage (occlusion) of a major branch of one of the coronary arteries, then the victim collapses with acute pain and distress. This is the condition commonly referred to as a coronary thrombosis because it is usually due to the affected artery suddenly becoming completely blocked by THROMBOSIS. More correctly, it should be described as coronary occlusion, because the ?nal occluding factor need not necessarily be thrombosis.
Causes The precise cause is not known, but a wide range of factors play a part in inducing coronary artery disease. Heredity is an important factor. The condition is more common in men than in women; it is also more common in those in sedentary occupations than in those who lead a more physically active life, and more likely to occur in those with high blood pressure than in those with normal blood pressure (see HYPERTENSION). Obesity is a contributory factor. The disease is more common among smokers than non-smokers; it is also often associated with a high level of CHOLESTEROL in the blood, which in turn has been linked with an excessive consumption of animal, as opposed to vegetable, fats. In this connection the important factors seem to be the saturated fatty acids (low-density and very low-density lipoproteins [LDLs and VLDLs] – see CHOLESTEROL) of animal fats which would appear to be more likely to lead to a high level of cholesterol in the blood than the unsaturated fatty acids of vegetable fats. As more research on the subject is carried out, the arguments continue about the relative in?uence of the di?erent factors. (For advice on prevention of the disease, see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELFHELP.)
Symptoms The presenting symptom is the sudden onset, often at rest, of acute, agonising pain in the front of the chest. This rapidly radiates all over the front of the chest and often down over the abdomen. The pain is frequently accompanied by nausea and vomiting, so that suspicion may be aroused of some acute abdominal condition such as biliary colic (see GALLBLADDER, DISEASES OF) or a perforated PEPTIC ULCER. The victim soon goes into SHOCK, with a pale, cold, sweating skin, rapid pulse and dif?culty in breathing. There is usually some rise in temperature.
Treatment is immediate relief of the pain by injections of diamorphine. Thrombolytic drugs should be given as soon as possible (‘rapid door to needle time’) and ARRHYTHMIA corrected. OXYGEN is essential and oral ASPIRIN is valuable. Treatment within the ?rst hour makes a great di?erence to recovery. Subsequent treatment includes the continued administration of drugs to relieve the pain; the administration of ANTIARRHYTHMIC DRUGS that may be necessary to deal with the heart failure that commonly develops, and the irregular action of the heart that quite often develops; and the continued administration of oxygen. Patients are usually admitted to coronary care units, where they receive constant supervision. Such units maintain an emergency, skilled, round-the-clock sta? of doctors and nurses, as well as all the necessary resuscitation facilities that may be required.
The outcome varies considerably. The ?rst (golden) hour is when the patient is at greatest risk of death: if he or she is treated, then there is a 50 per cent reduction in mortality compared with waiting until hospital admission. As each day passes the prognosis improves with a ?rst coronary thrombosis, provided that the patient does not have a high blood pressure and is not overweight. Following recovery, there should be a gradual return to work, care being taken to avoid any increase in weight, unnecessary stress and strain, and to observe moderation in all things. Smoking must stop. In uncomplicated cases patients get up and about as soon as possible, most being in hospital for a week to ten days and back at work in three months or sooner.
Valvular heart disease primarily affects the mitral and aortic valves which can become narrowed (stenosis) or leaking (incompetence). Pulmonary valve problems are usually congenital (stenosis) and the tricuspid valve is sometimes involved when rheumatic heart disease primarily affects the mitral or aortic valves. RHEUMATIC FEVER, usually in childhood, remains a common cause of chronic valvular heart disease causing stenosis, incompetence or both of the aortic and mitral valves, but each valve has other separate causes for malfunction.
Aortic valve disease is more common with increasing age. When the valve is narrowed, the heart hypertrophies and may later fail. Symptoms of angina or breathlessness are common and dizziness or blackouts (syncope) also occur. Replacing the valve is a very e?ective treatment, even with advancing age. Aortic stenosis may be caused by degeneration (senile calci?c), by the inheritance of two valvular leaflets instead of the usual three (bicuspid valve), or by rheumatic fever. Aortic incompetence again leads to hypertrophy, but dilatation is more common as blood leaks back into the ventricle. Breathlessness is the more common complaint. The causes are the same as stenosis but also include in?ammatory conditions such as SYPHILIS or ANKYLOSING SPONDYLITIS and other disorders of connective tissue. The valve may also leak if the aorta dilates, stretching the valve ring as with HYPERTENSION, aortic ANEURYSM and MARFAN’S SYNDROME – an inherited disorder of connective tissue that causes heart defects. Infection (endocarditis) can worsen acutely or chronically destroy the valve and sometimes lead to abnormal outgrowths on the valve (vegetations) which may break free and cause devastating damage such as a stroke or blocked circulation to the bowel or leg.
Mitral valve disease leading to stenosis is rheumatic in origin. Mitral incompetence may be rheumatic but in the absence of stenosis can be due to ISCHAEMIA, INFARCTION, in?ammation, infection and a congenital weakness (prolapse). The valve may also leak if stretched by a dilating ventricle (functional incompetence). Infection (endocarditis) may affect the valve in a similar way to aortic disease. Mitral symptoms are predominantly breathlessness which may lead to wheezing or waking at night breathless and needing to sit up or stand for relief. They are made worse when the heart rhythm changes (atrial ?brillation) which is frequent as the disease becomes more severe. This leads to a loss of e?ciency of up to 25 per cent and a predisposition to clot formation as blood stagnates rather than leaves the heart e?ciently. Mitral incompetence may remain mild and be of no trouble for many years, but infection must be guarded against (endocarditis prophylaxis).
Endocarditis is an infection of the heart which may acutely destroy a valve or may lead to chronic destruction. Bacteria settle usually on a mild lesion. Antibiotics taken at vulnerable times can prevent this (antibiotic prophylaxis) – for example, before tooth extraction. If established, lengthy intravenous antibiotic therapy is needed and surgery is often necessary. The mortality is 30 per cent but may be higher if the infection settles on a replaced valve (prosthetic endocarditis). Complications include heart failure, shock, embolisation (generation of small clots in the blood), and cerebral (mental) confusion.
PERICARDITIS is an in?ammation of the sac covering the outside of the heart. The sac becomes roughened and pain occurs as the heart and sac rub together. This is heard by stethoscope as a scratching noise (pericardial rub). Fever is often present and a virus the main cause. It may also occur with rheumatic fever, kidney failure, TUBERCULOSIS or from an adjacent lung problem such as PNEUMONIA or cancer. The in?ammation may cause ?uid to accumulate between the sac and the heart (e?usion) which may compress the heart causing a fall in blood pressure, a weak pulse and circulatory failure (tamponade). This can be relieved by aspirating the ?uid. The treatment is then directed at the underlying cause.... heart, diseases of
K
Diagram of glomerulus (Malpighian corpuscle).
Fortunately the body has two kidneys and, as most people can survive on one, there is a good ‘functional reserve’ of kidney tissue.
Symptoms Many patients with kidney disorders do not have any symptoms, even when the condition is quite advanced. However,
others experience loin pain associated with obstruction (renal colic) or due to infection; fevers; swelling (oedema), usually of the legs but occasionally including the face and arms; blood in the urine (haematuria); and excess quantities of urine (polyuria), including at night (nocturia), due to failure of normal mechanisms in the kidney for concentrating urine. Patients with chronic renal failure often have very di?use symptoms including nausea and vomiting, tiredness due to ANAEMIA, shortness of breath, skin irritation, pins and needles (paraesthesia) due to damage of the peripheral nerves (peripheral neuropathy), and eventually (rarely seen nowadays) clouding of consciousness and death.
Signs of kidney disease include loin tenderness, enlarged kidneys, signs of ?uid retention, high blood pressure and, in patients with end-stage renal failure, pallor, pigmentation and a variety of neurological signs including absent re?exes, reduced sensation, and a coarse ?apping tremor (asterixis) due to severe disturbance of the body’s normal metabolism.
Renal failure Serious kidney disease may lead to impairment or failure of the kidney’s ability to ?lter waste products from the blood and excrete them in the urine – a process that controls the body’s water and salt balance and helps to maintain a stable blood pressure. Failure of this process causes URAEMIA – an increase in urea and other metabolic waste products – as well as other metabolic upsets in the blood and tissues, all of which produce varying symptoms. Failure can be sudden or develop more slowly (chronic). In the former, function usually returns to normal once the underlying cause has been treated. Chronic failure, however, usually irreparably reduces or stops normal function.
Acute failure commonly results from physiological shock following a bad injury or major illness. Serious bleeding or burns can reduce blood volume and pressure to the point where blood-supply to the kidney is greatly reduced. Acute myocardial infarction (see HEART, DISEASES OF) or pancreatitis (see PANCREAS, DISORDERS OF) may produce a similar result. A mismatched blood transfusion can produce acute failure. Obstruction to the urine-?ow by a stone (calculus) in the urinary tract, a bladder tumour or an enlarged prostate can also cause acute renal failure, as can glomerulonephritis (see below) and the haemolytic-uraemia syndrome.
HYPERTENSION, DIABETES MELLITUS, polycystic kidney disease (see below) or AMYLOIDOSIS are among conditions that cause chronic renal failure. Others include stone, tumour, prostatic enlargement and overuse of analgesic drugs. Chronic failure may eventually lead to end-stage renal failure, a life-threatening situation that will need DIALYSIS or a renal transplant (see TRANSPLANTATION).
Familial renal disorders include autosomal dominant inherited polycystic kidney disease and sex-linked familial nephropathy. Polycystic kidney disease is an important cause of renal failure in the UK. Patients, usually aged 30–50, present with HAEMATURIA, loin or abdominal discomfort or, rarely, urinary-tract infection, hypertension and enlarged kidneys. Diagnosis is based on ultrasound examination of the abdomen. Complications include renal failure, hepatic cysts and, rarely, SUBARACHNOID HAEMORRHAGE. No speci?c treatment is available. Familial nephropathy occurs more often in boys than in girls and commonly presents as Alport’s syndrome (familial nephritis with nerve DEAFNESS) with PROTEINURIA, haematuria, progressing to renal failure and deafness. The cause of the disease lies in an absence of a speci?c ANTIGEN in a part of the glomerulus. The treatment is conservative, with most patients eventually requiring dialysis or transplantation.
Acute glomerulonephritis is an immune-complex disorder due to entrapment within glomerular capillaries of ANTIGEN (usually derived from B haemolytic streptococci – see STREPTOCOCCUS) antibody complexes initiating an acute in?ammatory response (see IMMUNITY). The disease affects children and young adults, and classically presents with a sore throat followed two weeks later by a fall in urine output (oliguria), haematuria, hypertension and mildly abnormal renal function. The disease is self-limiting with 90 per cent of patients spontaneously recovering. Treatment consists of control of blood pressure, reduced ?uid and salt intake, and occasional DIURETICS and ANTIBIOTICS.
Chronic glomerulonephritis is also due to immunological renal problems and is also classi?ed by taking a renal biopsy. It may be subdivided into various histological varieties as determined by renal biospy. Proteinuria of various degrees is present in all these conditions but the clinical presentations vary, as do their treatments. Some resolve spontaneously; others are treated with steroids or even the cytotoxic drug CYCLOPHOSPHAMIDE or the immunosuppressant cyclosporin. Prognoses are generally satisfactory but some patients may require renal dialysis or kidney transplantation – an operation with a good success rate.
Hydronephrosis A chronic disease in which the kidney becomes greatly distended with ?uid. It is caused by obstruction to the ?ow of urine at the pelvi-ureteric junction (see KIDNEYS – Structure). If the ureter is obstructed, the ureter proximal to the obstruction will dilate and pressure will be transmitted back to the kidney to cause hydronephrosis. Obstruction may occur at the bladder neck or in the urethra itself. Enlargement of the prostate is a common cause of bladder-neck obstruction; this would give rise to hypertrophy of the bladder muscle and both dilatation of the ureter and hydronephrosis. If the obstruction is not relieved, progressive destruction of renal tissue will occur. As a result of the stagnation of the urine, infection is probable and CYSTITIS and PYELONEPHRITIS may occur.
Impaired blood supply may be the outcome of diabetes mellitus and physiological shock, which lowers the blood pressure, also affecting the blood supply. The result can be acute tubular necrosis. POLYARTERITIS NODOSA and SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) may damage the large blood vessels in the kidney. Treatment is of the underlying condition.
Infection of the kidney is called pyelonephritis, a key predisposing factor being obstruction of urine ?ow through the urinary tract. This causes stagnation and provides a fertile ground for bacterial growth. Acute pyelonephritis is more common in women, especially during pregnancy when bladder infection (CYSTITIS) spreads up the ureters to the kidney. Symptoms are fever, malaise and backache. Antibiotics and high ?uid intake are the most e?ective treatment. Chronic pyelonephritis may start in childhood as a result of congenital deformities that permit urine to ?ow up from the bladder to the kidney (re?ux). Persistent re?ux leads to recurrent infections causing permanent damage to the kidney. Specialist investigations are usually required as possible complications include hypertension and kidney failure.
Tumours of the kidney are fortunately rare. Non-malignant ones commonly do not cause symptoms, and even malignant tumours (renal cell carcinoma) may be asymptomatic for many years. As soon as symptoms appear – haematuria, back pain, nausea, malaise, sometimes secondary growths in the lungs, bones or liver, and weight loss – urgent treatment including surgery, radiotherapy and chemotherapy is necessary. This cancer occurs mostly in adults over 40 and has a hereditary element. The prognosis is not good unless diagnosed early. In young children a rare cancer called nephroblastoma (Wilm’s tumour) can occur; treatment is with surgery, radiotherapy and chemotherapy. It may grow to a substantial size before being diagnosed.
Cystinuria is an inherited metabolic defect in the renal tubular reabsorption of cystine, ornithine, lysine and arginine. Cystine precipitates in an alkaline urine to form cystine stones. Triple phosphate stones are associated with infection and may develop into a very large branching calculi (staghorn calculi). Stones present as renal or ureteric pain, or as an infection. Treatment has undergone considerable change with the introduction of MINIMALLY INVASIVE SURGERY (MIS) and the destruction of stone by sound waves (LITHOTRIPSY).... kidneys, diseases of
Caffeine reduces fatigue, improves concentration, makes the heart pump blood faster, and has a diuretic effect.
Large quantities may produce side effects such as agitation and tremors.
A regular high intake may lead to increased tolerance and withdrawal symptoms, such as headaches and tiredness, after a few hours without caffeine.
Caffeine is used in some drug preparations, particularly in combination with analgesics and with ergotamine in preventive treatments for migraine.... caffeine
Stress and anxiety are probably the most common causes of headache and, where possible, the reasons – overwork, family problems, unemployment, ?nancial diffculties, etc. – should be tackled. An unpleasant environment such as tra?c pollution or badly ventilated or overcrowded working conditions may provoke headaches in some people, as may excessive smoking or ca?eine intake. MIGRAINE is a characteristic and often disabling type of headache; high blood pressure may cause the condition (see HYPERTENSION); and, occasionally, refractive errors of the eyes (see EYE, DISORDERS OF) are associated with headaches. SINUS infections are often characterised by frontal headaches. Rheumatism in the muscles of the neck and scalp produce headaches; fever is commonly accompanied by a headache; and sunstroke and HEAT STROKE customarily result in headaches. Finally, diseases in the brain such as meningitis, tumours and HAEMORRHAGE may ?rst manifest themselves as persistent or recurrent headaches.
Treatment Obtaining a reliable diagnosis – with the help of further investigations, including CT (see COMPUTED TOMOGRAPHY) or MRI scanning when indicated – should always be the initial aim; treatment in most cases should then be aimed at the underlying condition. Particular concerns include headache that worsens at night or in the early morning; ever-increasing headaches; those associated with abnormal neurological signs on examination; or those associated with ?ts (see FIT).
Whether the cause is physical or stress-induced, used sensibly and for a limited period a low dose of aspirin or paracetamol may be helpful. In many cases of stress-induced headache, however, the most e?ective treatment is relaxation. There are many speci?c treatments for migraine and hypertension. Sinusitis is treated with antibiotics and sometimes by surgery.... headache
Treatment of acute hypoglycaemia depends upon the severity of the condition. Oral carbohydrate, such as a sugary drink or chocolate, may be e?ective if the patient is conscious enough to swallow; if not, glucose or GLUCAGON by injection will be required. Comatose patients who recover after an injection should then be given oral carbohydrates. An occasional but dangerous complication of coma is cerebral oedema (see BRAIN, DISEASES OF – Cerebral oedema), and this should be considered if coma persists. Emergency treatment in hospital is then needed. When the patient has recovered, management of his or her diabetes should be assessed in order to prevent further hypoglycaemic attacks.... hypoglycaemic coma
Diagnosis is confirmed by blood tests.
Treatment is by thyroid hormone replacement therapy, which is life-long.... hashimoto’s thyroiditis
It often causes belching and abdominal discomfort.
Long-term use may cause swollen ankles, muscle cramps, tiredness, and nausea.... sodium bicarbonate
Viral infections by any of hepatitis A, B, C, D, or E viruses and also CYTOMEGALOVIRUS (CMV), EPSTEIN BARR VIRUS, and HERPES SIMPLEX.
Autoimmune disorders such as autoimmune chronic hepatitis, toxins, alcohol and certain drugs – ISONIAZID, RIFAMPICIN, HALOTHANE and CHLORPROMAZINE.
WILSON’S DISEASE.
Acute viral hepatitis causes damage throughout the liver and in severe infections may destroy whole lobules (see below).
Chronic hepatitis is typi?ed by an invasion of the portal tract by white blood cells (mild hepatitis). If these mononuclear in?ammatory cells invade the body (parenchyma) of the liver tissue, ?brosis and then chronic disease or cirrhosis can develop. Cirrhosis may develop at any age and commonly results in prolonged ill health. It is an important cause of premature death, with excessive alcohol consumption commonly the triggering factor. Sometimes, cirrhosis may be asymptomatic, but common symptoms are weakness, tiredness, poor appetite, weight loss, nausea, vomiting, abdominal discomfort and production of abnormal amounts of wind. Initially, the liver may enlarge, but later it becomes hard and shrunken, though rarely causing pain. Skin pigmentation may occur along with jaundice, the result of failure to excrete the liver product BILIRUBIN. Routine liver-function tests on blood are used to help diagnose the disease and to monitor its progress. Spider telangiectasia (caused by damage to blood vessels – see TELANGIECTASIS) usually develop, and these are a signi?cant pointer to liver disease. ENDOCRINE changes occur, especially in men, who lose their typical hair distribution and suffer from atrophy of their testicles. Bruising and nosebleeds occur increasingly as the cirrhosis worsens, and portal hypertension (high pressure of venous blood circulation through the liver) develops due to abnormal vascular resistance. ASCITES and HEPATIC ENCEPHALOPATHY are indications of advanced cirrhosis.
Treatment of cirrhosis is to tackle the underlying cause, to maintain the patient’s nutrition (advising him or her to avoid alcohol), and to treat any complications. The disorder can also be treated by liver transplantation; indeed, 75 per cent of liver transplants are done for cirrhosis. The overall prognosis of cirrhosis, however, is not good, especially as many patients attend for medical care late in the course of the disease. Overall, only 25 per cent of patients live for ?ve years after diagnosis, though patients who have a liver transplant and survive for a year (80 per cent do) have a good prognosis.
Autoimmune hepatitis is a type that most commonly occurs in women between 20 and 40 years of age. The cause is unknown and it has been suggested that the disease has several immunological subtypes. Symptoms are similar to other viral hepatitis infections, with painful joints and AMENORRHOEA as additional symptoms. Jaundice and signs of chronic liver disease usually occur. Treatment with CORTICOSTEROIDS is life-saving in autoimmune hepatitis, and maintenance treatment may be needed for two years or more. Remissions and exacerbations are typical, and most patients eventually develop cirrhosis, with 50 per cent of victims dying of liver failure if not treated. This ?gure falls to 10 per cent in treated patients.
Viral hepatitis The ?ve hepatic viruses (A to E) all cause acute primary liver disease, though each belongs to a separate group of viruses.
•Hepatitis A virus (HAV) is an ENTEROVIRUS
which is very infectious, spreading by faecal contamination from patients suffering from (or incubating) the infection; victims excrete viruses into the faeces for around ?ve weeks during incubation and development of the disease. Overcrowding and poor sanitation help to spread hepatitis A, which fortunately usually causes only mild disease.
Hepatitis B (HBV) is caused by a hepadna virus, and humans are the only reservoir of infection, with blood the main agent for transferring it. Transfusions of infected blood or blood products, and injections using contaminated needles (common among habitual drug abusers), are common modes of transfer. Tattooing and ACUPUNCTURE may spread hepatitis B unless high standards of sterilisation are maintained. Sexual intercourse, particularly between male homosexuals, is a signi?cant infection route.
Hepatitis C (HCV) is a ?avivirus whose source of infection is usually via blood contacts. E?ective screening of blood donors and heat treatment of blood factors should prevent the spread of this infection, which becomes chronic in about 75 per cent of those infected, lasting for life. Although most carriers do not suffer an acute illness, they must practise life-long preventive measures.
Hepatitis D (HDV) cannot survive independently, needing HBV to replicate, so its sources and methods of spread are similar to the B virus. HDV can infect people at the same time as HBV, but it is capable of superinfecting those who are already chronic carriers of the B virus. Acute and chronic infection of HDV can occur, depending on individual circumstances, and parenteral drug abuse spreads the infection. The disease occurs worldwide, being endemic in Africa, South America and the Mediterranean littoral.
Hepatitis E virus (HEV) is excreted in the stools, spreading via the faeco-oral route. It causes large epidemics of water-borne hepatitis and ?ourishes wherever there is poor sanitation. It resembles acute HAV infection and the patient usually recovers. HEV does not cause chronic infection. The clinical characteristics of the ?ve hepatic
viruses are broadly similar. The initial symptoms last for up to two weeks (comprising temperature, headache and malaise), and JAUNDICE then develops, with anorexia, nausea, vomiting and diarrhoea common manifestations. Upper abdominal pain and a tender enlarged liver margin, accompanied by enlarged cervical lymph glands, are usual.
As well as blood tests to assess liver function, there are speci?c virological tests to identify the ?ve infective agents, and these are important contributions to diagnosis. However, there is no speci?c treatment of any of these infections. The more seriously ill patients may require hospital care, mainly to enable doctors to spot at an early stage those developing acute liver failure. If vomiting is a problem, intravenous ?uid and glucose can be given. Therapeutic drugs – especially sedatives and hypnotics – should be avoided, and alcohol must not be taken during the acute phase. Interferon is the only licensed drug for the treatment of chronic hepatitis B, but this is used with care.
Otherwise-?t patients under 40 with acute viral hepatitis have a mortality rate of around
0.5 per cent; for those over 60, this ?gure is around 3 per cent. Up to 95 per cent of adults with acute HBV infection recover fully but the rest may develop life-long chronic hepatitis, particularly those who are immunode?cient (see IMMUNODEFICIENCY).
Infection is best prevented by good living conditions. HVA and HVB can be prevented by active immunisation with vaccines. There is no vaccine available for viruses C, D and E, although HDV is e?ectively prevented by immunisation against HBV. At-risk groups who should be vaccinated against HBV include:
Parenteral drug abusers.
Close contacts of infected individuals such as regular sexual partners and infants of infected mothers.
Men who have sex with men.
Patients undergoing regular haemodialysis.
Selected health professionals, including laboratory sta? dealing with blood samples and products.... hepatitis
Habitat: Indigenous to tropical Africa; now distributed throughout the plains and sub-Himalayan tracts of India.
English: Tamarind tree.Ayurvedic: Amli, Amlikaa, Suktaa, Chukraa, Chukrikaa, Chinchaa, Chandikaa, Tintidika.Unani: Tamar HindiSiddha/Tamil: Puli, Aanvilam.Action: Pulp of fruit—cooling, digestive, carminative, laxative, antiscorbutic; infusion prescribed in febrile diseases and bilious disorders; used as a gargle in sore throat; applied as a poultice on inflammatory swellings.
The Ayurvedic Pharmacopoeia of India recommends the fruit pulp in tiredness without exertion.Leaves—juice, used for bleeding piles, bilious fever and dysuria. Stem- bark—antipyretic and astringent.Used for diarrhoea. Bark is also prescribed in asthma and amenor- rhoea. Seed-kernel—stimulant; used as a supporting tonic in sexual debility in Unani medicine.Water stored in the tumbler, made out of the wood, is given for treating splenic enlargement.Ethanolic extract of the seed coat exhibited antioxidant activity. Kernel gave polysaccharides composed of D- glucose, D-xylose, D-galactose and L- arabinose in a molar ratio of 8:4:2:1. Polysaccharides showed immunomod- ulatory activities such as phagocytic enhancement, leukocyte migration inhibition and inhibition of lymphocyte proliferation.The leaves gave flavone C-glycosi- des—orientin, vitexin, iso-orientin and iso-vitexin. The leaves and fruits gave tartaric acid and malic acid. The fruit pulp yielded amino acids—ser- ine, beta-alanine, proline, pipecolinic acid, phenylalanine and leucine.A bitter principle, tamarindienal, isolated from the fruit pulp, showed fungicidal and bactericidal activity against Aspergillus nigar, Candida al- bicans, Bacillus subtilis, Staphylococcus aureus, E. coli and Pseudomonas aerug- inosa.The ash of the bark is given in colic and indigestion. The ash is also used in gargles and mouthwash for apthous sores.Dosage: Fruit pulp without seeds— 4-10 g. (API, Vol. IV.)... tamarindus indicaAetiology: heavy menstrual loss, feeble constitution from hereditary weakness, poor diet, hidden or known blood loss from gastric ulcer, pregnancy, bleeding piles or insufficient food minerals: iron, copper, calcium, etc, chronic liver or kidney disease, worms, anorexia nervosa, rheumatoid arthritis, tuberculosis. Symptoms. Tiredness, dizziness, breathlessness, palpitations, pale face and mucous membranes. White of eyes may be blue. Enlarged flabby tongue often bears impression of teeth marks. Hair lifeless, fingernails brittle and ridged. There may be angina, tinnitus and general reduced efficiency.
Treatment. The object is to achieve absorption of iron to raise normal haemoglobin levels and increase red cells. Echinacea has a reputation for regeneration of red cells. Herbs used with success: Echinacea, Gentian, Motherwort, Mugwort, Barberry, Hops, Nettles, Saw Palmetto, Chaparral, Red Clover, Dandelion.
Bitter herbs stimulate absorption of vital nutrients from the stomach, toning liver and pancreas, increasing the appetite; usually given half hour before meals. See: BITTERS.
Gentian. 1 teaspoon fine-cut chips to 2 cups cold water steeped 8 hours (overnight). Dose: Half-1 cup thrice daily before meals.
Tea. Formula. Combine: Agrimony 1; Barberry bark 1; Nettles 2; White Poplar bark half. Place 1oz (30g) in 1 pint (500ml) cold water and bring to boil. Simmer 10 minutes. Drink cold: Half-1 cup thrice daily, before meals.
Powders. Formula. Echinacea 2; Gentian 1; Kelp 1; pinch Red Pepper. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily, before meals.
Liquid extracts. Formula: Echinacea 1; Queen’s Delight 1; Ginseng 1; Ginger quarter. Dose: 30-60 drops in water, thrice daily, before meals.
Infusion Gentian Co Conc BP (1949). Dose: 30-60 drops.
Diet. Dandelion coffee, as desired. Molasses. Desiccated liver.
Floradix. A pre-digested iron preparation. Readily assimilable by the body. Compounded by Dr Otto Greither (Salus Haus). Iron is fed onto yeast which breaks down the metal and absorbs its cells. Other tonic ingredients include extracts of nettles, carrots, spinach, fennel, Vitamin C plus supplements;
Angelica root, Mallow, Horsetail, Yarrow, Juniper and Rosehips. Not chemically preserved.
Avoid chocolate, egg yolk, tea, coffee, wheat bran.
Supplements. Daily. Vitamin C (1g morning and evening). Vitamin B12, Folic acid 400mcg. Vitamin C is the most potent enhancer of iron absorption. Multivitamin containing iron.
Note: Iron absorption is decreased by antacids, tetracyclines, phosphates, phytates (phytic acid from excessive intake of wholewheat bread), and excessive calcium supplements. Lack of stomach hydrochloric acid impairs iron absorption, especially in the elderly. ... anaemia: iron deficiency
Symptoms: dry cough, difficult breathing usually at night. Loss of weight, tiredness, feverishness with rise of temperature. (Clinical Allergy, 1984. 14,429)
Tea. Yarrow, Elderflowers, Comfrey herb: equal parts.
Tablets/capsules. Garlic. Lobelia. Iceland Moss.
Powders. Formula. Pleurisy root 2; Hyssop 1; Iceland Moss 1. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.
Liquid Extracts. Formula. Pleurisy root 2; Liquorice 1; Hyssop 1. 1 teaspoon in water thrice daily, and when necessary. ... canary fancier’s lung
Diagnosis is confirmed by sputum test, chest X-ray, bronchoscopy or biopsy. Earliest symptoms are persistent cough, pain in the chest, hoarseness of voice and difficulty of breathing. Physical examination is likely to reveal sensitivity and swelling of lymph nodes under arms.
Symptoms. Tiredness, lack of energy, possible pains in bones and over liver area. Clubbing of finger-tips indicate congestion of the lungs. Swelling of arms, neck and face may be obvious. A haematologist may find calcium salts in the blood. The supportive action of alteratives, eliminatives and lymphatic agents often alleviate symptoms where the act of swallowing has not been impaired.
Broncho-dilators (Lobelia, Ephedra, etc) assist breathing. Mullein has some reputation for pain relief. To arrest bleeding from the lesion (Blood root).
According to Dr Madaus, Germany, Rupturewort is specific on lung tissue. To disperse sputum (Elecampane, Red Clover). In advanced cases there may be swollen ankles and kidney breakdown for which Parsley root, Parsley Piert or Buchu may be indicated. Cough (Sundew, Irish Moss). Soft cough with much sputum (Iceland Moss). To increase resistance (Echinacea).
Alternatives. Secondary to primary treatment. Of possible value.
Teas. Violet leaves, Mullein leaves, Yarrow leaves, Gotu Kola leaves, White Horehound leaves. Flavour with a little Liquorice if unpalatable.
Tablets/capsules. Lobelia, Iceland Moss, Echinacea, Poke root.
Formula. Equal parts: Violet, Red Clover, Garden Thyme, Yarrow, Liquorice. Dose: Powders: 750mg (three 00 capsules or half a teaspoon. Liquid Extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Thrice daily, and during the night if relief is sought.
Practitioner. Tinctures BHP (1983). Ephedra 4; Red Clover 4, Yellow Dock 2; Bugleweed 2; Blood root quarter; Liquorice quarter (liquid extract). Mix. Start low: 30-60 drops in water before meals and at bedtime increasing to maximum tolerance level.
Aromatherapy. Oils: Eucalyptus or Thyme on tissue to assist breathing. Inhale.
Diet. See: DIET – CANCER.
Treatment by a general medical practitioner or hospital specialist. ... cancer - bronchial carcinoma
Constituents: ammoniacal salts, saponin, tannic acid, inulin.
Action: vulnerary. Acts upon muscle fibres of blood vessels. “A princely remedy for the aches and pains of old gardeners.” (Dr C. Burnett) Discutient.
Relations: Arnica, Calendula, St John’s Wort, Witch Hazel.
Uses: Tumours resulting from a blow. Injuries, sprains, bruises, excessive tiredness.
Preparation. Infusion. Half a cup fresh or dried flowerheads to two cups water. Bring to boil; remove vessel when boiling point is reached; strain when cold. Use externally as a lotion or with suitable material as a compress. Internal: 2 teaspoons thrice daily.
Note: A glycosidase inhibitor has been found in the leaves of the common daisy which is very similar to castanospernine and other HIV drugs. It is believed this may prevent the spread of the HIV virus. ... daisy
Fibre-deficient foods lead to poor elimination of body wastes and constipation, disposing the colon to a toxic state. This induces depression, a coated tongue and tiredness during the day. Such foods bring about a change in the balance of bowel bacterial flora, and form gas which may cause pouches of diverticulitis to develop. One of its less obvious effects is to enhance the risk of tooth and gum disease. Soon calcium is expelled by the urine and the intake of magnesium reduced, thus favouring the development of stone.
All plant material; leaves, stalks, seeds etc contain fibre. High-fibre foods include: whole grains, wholemeal bread, wholemeal flour (100 per cent extraction rate), crispbreads, biscuits (digestive, bran, oatmeal or coconut), raw green salad materials, potatoes boiled in their jackets, breakfast cereals (porridge, muesli, All-Bran, Shredded Wheat), brown rice, bran (2 teaspoons thrice daily; increase if necessary), fresh or dried fruit once or twice daily. ... diet - high fibre
Symptoms. Mild fever, sore throat, headache, tiredness, malaise, swelling of glands under arm and in neck. These progress to high fever with painful lymph nodes. Puffiness of upper eyelids.
Treatment. Bedrest, when febrile.
Alternatives:– Echinacea, Eucalyptus, Garlic, Mountain Grape, Myrrh, Poke root, Wild Indigo, Wormwood, Elecampane, Blue Flag root.
Tea. Yarrow or Elder – early stages of fever in children.
Decoction: Formula. Equal parts, Echinacea, Blue Flag root. Half an ounce to 1 pint water gently simmered 20 minutes. Half-1 cup every 3 hours, with pinch of Cayenne. Children: 5-12 years three- quarters dose.
Formula. Echinacea 2; Blue Flag 1; Goldenseal half; pinch Cayenne. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid Extracts: 1 teaspoon. Tinctures: 1-2 teaspoons. Thrice daily. Children 5-12 years – as many drops as years of age.
Convalescence. Give a general tonic. See: TONICS.
Garlic. 2 capsules at night.
Diet. Commence with 3-day fast with herb teas (Marigold petals, Red Clover or Yarrow) and fruit juices, followed by vegetarian, salt-free diet. Vitamin C, 1g morning and evening. Vitamin B-complex. Supplements. Daily. B-complex. Vitamin C 3g.
To be treated by or in liaison with a qualified medical practitioner. ... glandular fever
Constituents. flavonoids, terpenoids, volatile oil.
Action. Adaptogen, alterative, de-toxifier, bitter, diuretic, digestant, powerful blood tonic, central nervous system relaxant, laxative, emmenagogue, Ginseng-like effect, antibiotic (ointment and dusting powder).
Uses: Mentioned in most Eastern religions and medical systems. Has a reputation for longevity. Under the name Fo-ti-tieng it was prescribed and taken by Professor Li-Ching-Yun, Chinese herbalist who died 1933 at the reputed age of 256. (Guinness Book of Records) The herb is active in Ayurvedic Medicine, having a long history for leprosy and tumour. Prominent as a mild analgesic to alleviate pains of the female generative organs, for mental illness. Some success has been reported for cancer of the cervix. In Chinese medicine it covers a wide range including infertility, insomnia, crumbling nails, impaired vision, chronic sinusitis, sexual debility and some venereal diseases (juice of the fresh leaves).
It is a medicine of some versatility. In the West it has been used for recovery from surgical operation, drug withdrawal. Addison’s disease (copper-coloured complexion), rheumatism. For skin disorders: discharging ulcers, acne, pemphigus and lupus (where not ulcerative). It is said to heal without a scar. Of value for tiredness, depression, loss of memory, and to improve the nervous system generally in Parkinson’s disease.
Recent research reports improved memory and the overcoming of stress, fatigue and mental confusion. Preparations. Average dose: half-1g. Thrice daily. Tea. Quarter to half a teaspoon to each cup boiling water; infuse 10 minutes; dose – 1 cup.
Liquid extract: 1:1. Dose – 2-4ml (half-1 teaspoon).
Bengal tincture. 1 part coarsely powdered dried plant in 5 parts by weight of strong alcohol. Macerate 8 days in well-corked bottle in a dark place; shake daily; strain; filter. Dose – 1-2 teaspoons in water.
Use for not more than 6 weeks without a break. Not used in pregnancy or epilepsy. ... gotu kola
Causes (female). Absence of menses, dry vaginal entrance, tension, stress, tiredness, deformed or retroverted womb, cervical polyps, inflammation of the cervix or ovaries, fibroids, cystic ovaries, diabetes, drugs, steroids, psychogenic factors. Women who use intra-uterine devices may become infertile from tubal infection. The Pill affects fertility. Vitamin E deficiency. Professor Richard Morisset (World Health Organisation) asserts STD’s account for more than 50 per cent infertility in women. Alcohol is a factor.
Causes (male). Inadequate seman, testicular or prostate infection, orchitis (from past mumps), kidney failure, chronic lung disease from smoking, thyroid deficiency, liver and other infections, calcium or Vitamin E deficiency. Low sperm count is found in regular drinkers of alcohol. 30 per cent cases of infertility are found to be due to the male.
“Women who drink more than one cup of coffee a day may find it harder to become pregnant.” (American study reported in The Guardian, 28.12.88)
“Vegetarian women have lower levels of oestrogen. The amount of fibre women eat is believed to affect oestrogen levels in their blood.” (Dr Elwyn Hughes, University of Wales Institute of Science and Technology)
“Drinking more than four cups of coffee a day and smoking more than 20 cigarettes could be a dangerous combination for male fertility.” (Research study, North Carolina, USA)
Women whose mothers smoked when they were pregnant are only 50 per cent as fertile as women who were not exposed (when in the uterus) to a mother’s tobacco smoke. (C. Weinberg, “Reduced Fecundity in Women with Prenatal exposure to cigarette smoking.” American Journal of Epidemiology 1989; 129 p1072)
Margarine has been implicated in low sperm counts.
Alternatives. Endocrine balancers.
Female. Tea. Equal parts: herbs – Motherwort, Agnus Castus and Oats. Mix. 2 teaspoons to each cup boiling water; infuse 15 minutes. Dose, 1 cup 2-3 times daily.
Tablets: Agnus Castus, dosage as on bottle.
Liquid Extracts: equal parts Agnus Castus and Helonias: 1 teaspoon in water 2-3 times daily.
Maria Treben: 25 drops fresh Mistletoe juice in water, on empty stomach, night and morning.
External: Castor oil abdominal packs twice weekly.
Male. Ginseng, Gotu Kola, or the traditional combination of Damiana, Saw Palmetto and Kola. Tablets, liquid extracts, powders or tinctures. Tinctures (practitioner): Capsicum Fort BPC 5ml; Saw Palmetto (1:5) 10ml; Damiana (1:5) 50ml; Prickly Ash (1:5) 10ml. Aqua to 100ml. 1 teaspoon in water, thrice daily. (Arthur Hyde FNIMH)
An orange a day helps keep sperm OK. (Important role of Vitamin C – New Scientist 1992 NO.1812 p20)
Fasting. Mrs A. Rylin, Sweden, had been trying to conceive for 2 years. Conventional medicine proved ineffective until both she and her husband decided to fast for ten days. Within a month she conceived. Other successes reported.
Diet. (For both partners) Vitamin A foods. Wholefoods, oatmeal products (breakfast oats, etc). Regular raw food days. No alcohol. The key mineral for infertility is zinc, a deficiency of which may be made up with bran which is not only high in zinc but in soluble fibre. Not to eat any green peas, which are mildly contraceptive.
Supplements. Daily. Vitamin C (1 gram). Vitamin E (500iu). One B-complex tablet, including B6. The calcium ion is the key regulator of human sperm function – Calcium Lactate 300mg (2 tablets thrice daily at meals). Zinc – 2 tablets or capsules at night. Folic acid, 400mcg. Dolomite. Iron.
Notes. Consider Vitamin B12 and Iron deficiency when evaluating anaemia in infertile couples.
20 percent of men suffer infertility and produce high levels of superoxide radicals in their semen. Vitamin E, an antioxidant, is believed to mop up their superoxide radicals.
Observe sign of zinc deficiency: white flecks on nails. ... infertility
Symptoms: chill, shivering, headache, sore throat, weakness, tiredness, dry cough, aching muscles and joints, body temperature rise, fever. Virus tends to change, producing new strains.
Influenza lowers the body’s resistance to infection. For stomach influenza, see: GASTROENTERITIS. Effects of influenza may last for years.
Treatment. (Historical) One of the most virulent strains of history was during the outbreak after World War I. The American Eclectic School of physicians treated successfully with: 5 drops Liquid Extract Lobelia, 5 drops Liquid Extract Gelsemium, and 10 drops Liquid Extract Bryonia. Distilled water to 4oz. 1 teaspoon 4-5 times daily.
Bedrest. Drink plenty of fluids (herb teas, fruit juices). Hot bath at bedtime.
Alternatives. Teas. Elderflowers and Peppermint, Yarrow, Boneset, Pleurisy root.
Tablets/capsules. Lobelia, Cinnamon.
Potter’s Peerless Composition Essence.
Powders. Cinnamon, with pinch of Cayenne.
Dose: 500mg (two 00 capsules or one-third teaspoon) every 2 hours.
Formula. Lobelia 2; Pleurisy root 1; Peppermint quarter; Valerian half. Dose: Liquid Extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Acute cases: every 2 hours in hot water. On remission of temperature: thrice daily.
Nurse Ethel Wells, FNIMH. Half an ounce each: Elderflowers, Yarrow, White Horehound, Peppermint, Boneset. Infuse 2 tablespoons in 1 pint boiling water in a clean teapot. Drink teacupful at bedtime and the remainder, cold, in teacupful doses the following day.
Inhalant. Aromatherapy: 5 drops each, Niaouli, Pine and Eucalyptus oils in bowl of hot water; inhale steam with head covered. See also: FRIAR’S BALSAM. 4 drops Peppermint oil in bath.
Diet. 3-day fast, where possible, with herb teas and fruit juices.
Supplements. Daily. Vitamin A 7,500iu. Vitamin C 3g. ... influenza
Deficiency. May lead to disorders of arteries or kidneys; brittle bones, pre-menstrual tension, heart disease, muscle cramps, hypoglycaemia, insomnia, palpitation, tremor of hands or lower limbs; anorexia, anxiety, depression, tiredness, dizziness, confusion. Studies reveal that two-thirds of patients with peripheral vascular disease are magnesium-deficient. Absorption is blocked by the contraceptive pill, a high milk or high fat intake. Chronic fatigue syndrome.
Heart attack. “An imbalance in the Magnesium/Calcium ratio may contribute to myocardial infarction.” (Dr H.J. Holtmeier, University of Freiburg, Germany)
Body effects. Co-ordination of nerves and muscles. Healthy teeth and bones. This metal activates more enzymes in the body than any other mineral. Heart patients on Digoxin have less palpitation when magnesium level is normal.
Sources. Most foods. Meat, milk, eggs, seafood, nuts (peanuts etc), brown rice, wheatbran, cocoa, Soya beans and flour, almonds, walnuts, maize, oats.
Fruits: apples, avocado, bananas, black grapes, seeds.
Herbs: Bladderwrack, Black Willow bark, Broom, Carrot leaves, Devil’s Bit, Dulse, Dandelion, Gotu Kola, Kale, Kelp, Meadowsweet, Mistletoe, Mullein, Okra, Parsley, Peppermint, Primrose flowers, Rest Harrow, Silverweed, Skunk Cabbage, Toadflax, Walnut leaves, Watercress, Wintergreen. Teas made from any of this list can be effective for low-grade magnesium deficiency.
RDA 300mg: 450mg (pregnant women and nursing mothers). ... magnesium
Treatment. Uterine restoratives, nerve relaxants. Formula. Tea. Equal parts: Raspberry leaves; Skullcap; Agnus Castus. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes; drink freely. Alternative formula. Agnus Castus 2; Black Cohosh 1. Dose: Liquid Extracts: 1-2 teaspoons. Tinctures:
2-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon). Thrice daily.
Feverfew: good results reported.
Evening Primrose oil capsules. 500mg thrice daily.
Sleep. One in two patients find relief in ‘sleeping it off’ any time of the day or night. Hot bath. Passion flower tea or tablets.
Diet. High fibre, low fat, low salt. Hot soup. A cooked meal but not with rich fatty or spicy foods. Oatmeal porridge.
Supplements. Vitamin B6, 50mg daily. Magnesium, Zinc.
Preventative: Raspberry leaf tea 3 days before periods. ... menstrual headache
Symptoms are directly related to the actions of aldosterone. Too much sodium is retained in the body, leading to a rise in blood pressure, and excess potassium is lost in the urine. Low potassium causes tiredness and muscle weakness and impairs kidney function, leading to thirst and overproduction of urine.
Treatment in all cases includes restriction of dietary salt and use of the diuretic drug spironolactone.
If the cause of aldosteronism is an adrenal tumour, this may be surgically removed.... aldosteronism
Vitamin B12 is found only in foods of animal origin, such as meat and dairy products. It is absorbed from the small intestine after first combining with intrinsic factor, a chemical produced by the stomach lining. The most common cause of vitamin B12 deficiency is failure of the stomach lining to produce intrinsic factor, usually due to an autoimmune disorder; this is called pernicious anaemia. Total gastrectomy (removal of the stomach) prevents production of intrinsic factor, and removal of part of the small intestine prevents B12 absorption, as does the intestinal disorder Crohn’s disease. In a minority of cases, vitamin B12 deficiency is due to a vegan diet.
Folic acid is found mainly in green vegetables and liver. The usual cause of deficiency is a poor diet. Deficiency can also be caused by anything that interferes with the absorption of folic acid from the small intestine (for example Crohn’s disease or coeliac disease). Folic acid requirements are greater than normal in pregnancy.
Many people with mild megaloblastic anaemia have no symptoms. Others may experience tiredness, headaches, a sore mouth and tongue, and mild jaundice. If B12 deficiency continues for a long time, additional symptoms due to nerve damage, including numbness and tingling in the feet, may develop.
Megaloblastic anaemia is diagnosed by blood tests and a bone marrow biopsy. Megaloblastic anaemia due to poor diet can be remedied with a short course of vitamin B12 injections or folic acid tablets and the introduction of a normal diet. A lifelong course of vitamin B12 injections or folic acid tablets is required if the underlying cause of malabsorption is untreatable.... anaemia, megaloblastic
A number of drugs are used to prevent intermittent arrhythmias or to slow the rate if an arrhythmia is persistent. These include amiodarone, beta-blocker drugs, calcium channel blockers, digitalis drugs, disopyramide, flecainide, lidocaine (lignocaine), mexiletine, and procainamide. Side effects are common and often include nausea and rash. Some antiarrhythmics can result in tiredness or breathlessness because they reduce the heart’s pumping ability.... antiarrhythmic drugs
The cause of the condition is unclear. In some cases, it develops after recovery from a viral infection or after an emotional life event such as bereavement. In other cases, there is no such preceding illness or event. The main symptom is persistent tiredness. Other symptoms of the syndrome vary, but commonly include impairment of short-term memory or concentration, sore throat, tender lymph nodes, muscle and joint pain, muscle fatigue, unrefreshing sleep, and headaches. The syndrome is often associated with depression or anxiety.
There is no specific diagnostic test for chronic fatigue syndrome, and investigations are usually aimed at excluding other possible causes of the symptoms, such as anaemia.
A physical examination, blood tests, and psychological assessment may be carried out.
If no cause can be found, diagnosis of chronic fatigue syndrome is made from the symptoms.
Analgesic drugs or antidepressant drugs may relieve the symptoms.
Physiotherapy or psychotherapy may also be helpful.
Chronic fatigue syndrome is a longterm disorder, but the symptoms clear up after several years in some people.... chronic fatigue syndrome
Diagnosis is made by blood, urine, and faeces tests and jejunal biopsies, in which small samples of the lining of the intestine are taken for examination.
Coeliac disease is treated by a lifelong gluten-free diet, which usually relieves symptoms within weeks of introduction.... coeliac disease
Most attacks are harmless and are caused by a fall in the pressure of blood to the brain. This can occur when getting up quickly from a sitting or lying position (called postural hypotension). Similar symptoms may result from a transient ischaemic attack, in which there is temporary, partial blockage in the arteries that supply the brain. Other causes include tiredness, stress, fever, anaemia, heart block, hypoglycaemia, and subdural haemorrhage.
Dizziness as part of vertigo is usually due to a disorder of the inner ear, the acoustic nerve, or the brainstem. The principal disorders of the inner ear that can cause dizziness and vertigo are labyrinthitis and Ménière’s disease. Disorders of the acoustic nerve, such as acoustic neuroma, are rare causes of dizziness and vertigo. Brainstem disorders which can cause dizziness and vertigo include a type of migraine, brain tumours, and vertebrobasilar insufficiency. Brief episodes of mild dizziness usually
clear up after taking a few deep breaths or after resting for a short time. Severe, prolonged, or recurrent dizziness should be investigated by a doctor. Treatment depends on the underlying cause.... dizziness
Chronic hepatitis may cause slight tiredness or no symptoms at all.
It is diagnosed by liver biopsy.
Autoimmune hepatitis is treated with corticosteroid drugs and immunosuppressants.
Viral infections often respond to interferon.
In the drug-induced type, withdrawal of the medication can lead to recovery.
For metabolic disturbances, treatment depends on the underlying disorder.... hepatitis, chronic
Hyperparathyroidism is most often caused by a small noncancerous tumour of 1 or more of the parathyroid glands. It may also occur when the glands become enlarged for no known reason. It usually develops after age 40 and is twice as common in women as in men.
Hyperparathyroidism may cause depression and abdominal pain. However, often the only symptoms are those caused by kidney stones. If hypercalcaemia is severe, there may be nausea, tiredness, excessive urination, confusion, and muscle weakness.
The condition is diagnosed by X-rays of the hands and skull and by blood tests.
Surgical removal of abnormal parathyroid tissue usually cures the condition.
If the remaining tissue is unable to produce enough parathyroid hormone, treatment for hypoparathyroidism is required.... hyperparathyroidism
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
Many X-ray imaging techniques have been superseded by newer procedures. These include ultrasound scanning, MRI (magnetic resonance imaging), PET scanning, and radionuclide scanning. However, X-rays are used in CT scanning. Some of these techniques use computers to process the raw imaging data and produce the actual image. Others can produce images without a computer, although one may be used to enhance the image. imipramine A tricyclic antidepressant drug most commonly used as a longterm treatment for depression. Possible adverse effects include excessive sweating, blurred vision, dizziness, dry mouth, constipation, nausea, and, in older men, difficulty passing urine.... illusion
Exposure to certain chemicals (such as benzene and some anticancer drugs) or high levels of radiation may be a cause in some cases. Inherited factors may also play a part; there is increased incidence in people with certain genetic disorders (such as Fanconi’s anaemia) and chromosomal abnormalities (such as Down’s syndrome). People with blood disorders such as chronic myeloid leukaemia (see leukaemia, chronic myeloid) and primary polycythaemia are at increased risk, as their bone marrow is already abnormal.
The symptoms and signs of acute leukaemia include bleeding gums, easy bruising, headache, bone pain, enlarged lymph nodes, and symptoms of anaemia, such as tiredness, pallor, and breathlessness on exertion. There may also be repeated chest or throat infections. The diagnosis is based on a bone marrow biopsy. Treatment includes transfusions of blood and platelets, the use of anticancer drugs, and possibly radiotherapy. A bone marrow transplant may also be required. The outlook depends on the type of leukaemia and the age of the patient. Chemotherapy has increased success rates and 6 in 10 children with the disease can now be cured, although treatment is less likely to be completely successful in adults.... leukaemia, acute
After entering the body, mercury accumulates in organs, principally the brain and kidneys. Mercury deposits in the brain cause tiredness, incoordination, excitability, tremors, and numbness in the limbs. In severe cases, there may be impaired vision and dementia. Deposits of mercury in the kidneys may lead to kidney failure.
Treatment may involve chelating agents, which help the body to excrete the mercury quickly; haemodialysis (see dialysis); and induced vomiting or pumping out the stomach, if mercury has been swallowed within the previous few hours.... mercury poisoning
Diagnosis usually requires ultrasound scanning, CT scanning or MRI of the upper abdomen, or ERCP.
In early stages, pancreatectomy, radiotherapy and anticancer drugs may provide a cure.
In later stages, little can be done apart from provision of palliative treatment.... pancreas, cancer of
Most mothers first get the “blues” 4–5 days after childbirth and may feel miserable, irritable, and tearful. The cause is hormonal changes, perhaps coupled with a sense of anticlimax or an overwhelming sense of responsibility for the baby. With reassurance and support, the depression usually passes in 2–3 days. In about 10–15 per cent of women, the depression lasts for weeks and causes a constant feeling of tiredness, difficulty in sleeping, loss of appetite, and restlessness. The condition usually clears up of its own accord or is treated with antidepressant drugs.
Depressive psychosis usually starts 2–3 weeks after childbirth, causing severe mental confusion, feelings of worthlessness, threats of suicide or harm to the baby, and sometimes delusions.
Hospital admission, ideally with the baby, and antidepressant drugs are often needed.... postnatal depression
Thiamine plays a role in the activities of various enzymes involved in the utilization of carbohydrates and thus in the functioning of nerves, muscles, and the heart. Sources include whole-grain cereals, wholemeal breads, brown rice, pasta, liver, kidney, pork, fish, beans, nuts, and eggs.
Those susceptible to deficiency include elderly people on a poor diet, and people who have hyperthyroidism, malabsorption, or severe alcohol dependence. Deficiency may also occur as a result of severe illness, surgery, or injury.
Mild deficiency may cause tiredness, irritability, and loss of appetite. Severe deficiency may cause abdominal pain, constipation, depression, memory impairment, and beriberi; in alcoholics, it may cause Wernicke–Korsakoff syndrome. Excessive intake is not known to cause harmful effects.
Riboflavin is necessary for the activities of various enzymes involved in the breakdown and utilization of carbohydrates, fats, and proteins; the production of energy in cells; the utilization of other B vitamins; and hormone production by the adrenal glands. Liver, whole grains, milk, eggs, and brewer’s yeast are good sources. People who are susceptible to riboflavin deficiency include those taking phenothiazine antipsychotic drugs, tricyclic antidepressant drugs, or oestrogen-containing oral contraceptives, and those with malabsorption or severe alcohol dependence. Riboflavin deficiency may also occur as a result of serious illness, surgery, or injury.
Prolonged deficiency may cause soreness of the tongue and the corners of the mouth, and eye disorders such as amblyopia and photophobia.
Excessive intake of riboflavin is not known to have any harmful effects.
Niacin plays an essential role in the activities of various enzymes involved in the metabolism of carbohydrates and fats, the functioning of the nervous and digestive systems, the manufacture of sex hormones, and the maintenance of healthy skin. The main dietary sources are liver, lean meat, fish, nuts, and dried beans. Niacin can be made in the body from tryptophan (an amino acid). Most cases of deficiency are due to malabsorption disorders or to severe alcohol dependence. Prolonged niacin deficiency causes pellagra. Excessive intake is not known to cause harmful effects.
Pantothenic acid is essential for the activities of various enzymes involved in the metabolism of carbohydrates and fats, the manufacture of corticosteroids and sex hormones, the utilization of other vitamins, the functioning of the nervous system and adrenal glands, and growth and development. It is present in almost all vegetables, cereals, and animal foods. Deficiency of pantothenic acid usually occurs as a result of malabsorption or alcoholism, but may also occur after severe illness, surgery, or injury. The effects include fatigue, headache, nausea, abdominal pain, numbness and tingling, muscle cramps, and susceptibility to respiratory infections. In severe cases, a peptic ulcer may develop. Excessive intake has no known harmful effects.Pyridoxine aids the activities of various enzymes and hormones involved in the utilization of carbohydrates, fats, and proteins, in the manufacture of red blood cells and antibodies, in the functioning of the digestive and nervous systems, and in the maintenance of healthy skin. Dietary sources are liver, chicken, pork, fish, whole grains, wheatgerm, bananas, potatoes, and dried beans. Pyridoxine is also manufactured by intestinal bacteria. People who are susceptible to pyridoxine deficiency include elderly people who have a poor diet, those with malabsorption or severe alcohol dependence, or those who are taking certain drugs (including penicillamine and isoniazid). Deficiency may cause weakness, irritability, depression, skin disorders, inflammation of the mouth and tongue, anaemia, and, in infants, seizures. In very large amounts, pyridoxine may cause neuritis.
Biotin is essential for the activities of various enzymes involved in the breakdown of fatty acids and carbohydrates and for the excretion of the waste products of protein breakdown. It is present in many foods, especially liver, peanuts, dried beans, egg yolk, mushrooms, bananas, grapefruit, and watermelon. Biotin is also manufactured by bacteria in the intestines. Deficiency may occur during prolonged treatment with antibiotics or sulphonamide drugs. Symptoms are weakness, tiredness, poor appetite, hair loss, depression, inflammation of the tongue, and eczema. Excessive intake has no known harmful effects.
Folic acid is vital for various enzymes involved in the manufacture of nucleic acids and consequently for growth and reproduction, the production of red blood cells, and the functioning of the nervous system. Sources include green vegetables, mushrooms, liver, nuts, dried beans, peas, egg yolk, and wholemeal bread. Mild deficiency is common, but can usually be corrected by increasing dietary intake. More severe deficiency may occur during pregnancy or breastfeeding, in premature or low-birthweight infants, in people undergoing dialysis, in people with certain blood disorders, psoriasis, malabsorption, or alcohol dependence, and in people taking certain drugs. The main effects include anaemia, sores around the mouth, and, in children, poor growth. Folic acid supplements taken just before conception, and for the first 12 weeks of pregnancy, have been shown to reduce the risk of a neural tube defect.... vitamin b complex
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
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