Tuesday, June 14th, 2011
Archive for June, 2011
Saturday, June 25th, 2011
I have one patient who had a bone density scan just after her fortieth birthday, a time when many doctors are still reluctant to send a patient for the test. Ruth had a lifetime of excellent diet and exercise habits, but was concerned because her mother had osteoporosis. Since she felt strongly about it, I wrote the referral. The scan revealed that she already had low bone density. And her real danger zone—menopause— was still years away!
With this knowledge, she stepped up her efforts to prevent further bone loss. She increased the amount of time she spent exercising, and began taking calcium and vitamin D supplements, along with a multivitamin-and-trace-minerals supplement, aiming to get herself back to the density of a healthy 30-year-old with peak bone mass.
Although encroaching osteoporosis in such a young woman is alarming, to me the truly scary part of this story is thinking about what would have happened if Ruth hadn’t had the bone scan. Without knowing she needed to take positive steps now, and staying on top of her progress, I fear she would have ended up with a fracture before long, possibly before menopause. She would have lost a great deal of height, found an ever-increasing forward curve in her upper back, perhaps suffered bone pain, and maybe would have had to curtail her many and varied activities. Not only did the bone density scan perhaps save Ruth’s life, it surely saved her lifestyle.
Wendy had her first complex partial seizure when she was 13. Her initial evaluation, including a CT scan and EEG, revealed no cause, and medication was prescribed. Phenobarbital made her sleepy, and phenytoin (Dilantin) only slightly reduced the frequency of her seizures, now occurring three to four times a week. Carbamazepine (Tegretol) was added, and the seizures became less frequent. However, Wendy’s school work began to suffer while she was taking several medications, and she became depressed. At sixteen she couldn’t drive and because of embarrassment she became less social and more isolated. When she was eighteen, valproic acid (Depakene) became available, but despite attempts to adjust medication, her physicians were unable to completely control her seizures. By this time, Wendy’s school work had suffered and she had been turned down by the colleges of her choice. She was about to enter the local junior college.
When we first saw Wendy, she was a highly motivated young lady, depressed about the seizures and about her future. She had received psychological counseling, which had helped some, but the seizures—suddenly stopping what she was doing, staring, then wandering about the room, picking at her clothes, and remaining in a confused state for ten to fifteen minutes—were still occurring several times each week despite good levels of medication.
Our evaluation suggested that the seizures came from the right temporal lobe. Surgery was discussed, but Wendy, now twenty-two, was afraid. We worked with her, long distance, to adjust the medications, but she either had problems with drug toxicity or with seizure control. Nevertheless, she finished college and began a masters program in psychology. Finally she decided she was willing to have the surgery. Repeat evaluation suggested that the focus was in the anterior right temporal lobe. This was removed surgically and revealed “mesial temporal sclerosis,” an old scar that had not been visible on the scans.
Wendy has had no seizures in the past five years, has finished her Ph.D. in psychology, and says that life and her work are both much easier now without seizures and without any medication. “I only wish that we had done the surgery much earlier,” she says. “It would have made growing up so much easier.”
Wednesday, June 8th, 2011
There is no need to be. If you are aware of the risks, you can take preventive action before these conditions have a chance to develop. If you have regular check-ups, minor changes can be identified at a time when something can be done about them. This is one reason why it is important to keep your] appointments even if you feel well and your blood glucose levels are all right. Most people with diabetes are untroubled by complications, and even if you develop them, a great deal can be done to treat them.
• Have regular health check-ups.
• Tell your doctor at once if you have any trouble with your vision; notice any change in sensation in your limbs; have pain or burning on passing urine or need to urinate very often; have soreness or irritation between the legs; pain in your calves when you walk; pain in your chest; or any problems with your feet.
• Do not smoke.
• Watch your weight.
• Eat a high fibre diet, without added salt, with reduced fat content, low in saturated and high in polyunsaturated fats.
• Keep your blood glucose levels normal.
• Take any pills prescribed by your doctor.