Recognizing Post Traumatic Stress Disorder

Recognizing Post Traumatic Stress Disorder

A middle aged man with signs and symptoms suggestive of Angina pectoris was seen a week earlier at the outpatient of one of the public hospitals with history of chest pain.

He said the chest feels like it is being pressed or squeezed by a heavy object, and also had pain on the arms.

The man was sent for various tests to rule out coronary heart disorders. Among the tests done are ECG, Chest X- ray, Lipid profile, urinalysis, echo cardiography.

While he was waiting for the results ordered which will take about a week, he stumbled into another consulting room.

The tests all came out normal and was also scheduled to see a cardiologist for review.

During the consultation which took about 40 minutes, it was discovered that the patient’s condition was more of an effect of a disagreement between him and the wife and not the Angina pectoris.

He said the symptoms of chest pain started a day after the wife packed out of the house with some vital documents.

He was now diagnosed of Post Traumatic Stress Disorder (PTSD) and placed on some anxiolytics which he responded well to. Most of the symptoms were gone after few days.

A new thinking

There is a paradigm shift in medical diagnosis, Clinical care now go beyond biomedicine because illness can now be fully understood in the context of psychologic, biologic, and social factor and not just the biomedical factor.

Biomedical factors (the physical illness) are but a small part of what patients bring to their physicians.

Effective treatment requires attention to these complex interactions and to integration of biologic and psychosocial factors. 

History

Five to 10 per cent of people will suffer from posttraumatic stress disorder (PTSD) at some point in their lives.

Frightening situations happen to everyone at some point. People can react in many different ways: they might feel nervous, have a hard time sleeping well, or go over the details of the situation in their mind.

These thoughts or experiences are a normal reaction. They usually decrease over time and the people involved can go back to their daily lives.

Post-traumatic stress disorder, on the other hand, lasts much longer and can seriously disrupt a person’s life.

Post-traumatic stress disorder (PTSD) is a particular set of reactions that can develop in people who have been through a traumatic event.

That is, they have experienced or witnessed an event which threatened their life or safety, or that of others around them, and led to feelings of intense fear, helplessness or horror.

This can be a car or other serious accident, failure from exams, divorce, death of loved ones, physical or sexual assault, rape, loss of job war or torture, armed robbery attacks, or disasters such as fires floods etc.

Signs and symptoms of PTSD

People with PTSD often experience feelings of panic or extreme fear, similar to the fear they felt during the traumatic event. A person with PTSD experiences four main types of difficulties.

There may be intense emotional or physical reactions, such as sweating, heart palpitations or panic when reminded of the event.

The person experiences sleeping difficulties, irritability and lack of concentration, becoming easily startled and constantly on the lookout for signs of danger.

The person deliberately avoids activities, places, people, thoughts or feelings associated with the event because they bring back painful memories.

The person loses interest in day-to-day activities, feels cut off and detached from friends and family, or feels emotionally flat and numb.

Anyone can develop PTSD following a traumatic event, but people are at greater risk if the event involved deliberate harm such as physical or sexual assault.
If a person experiences symptoms of PTSD that persist beyond two weeks, a doctor or a mental health professional may recommend starting treatment for PTSD.

Treatment helps deal with the symptoms so that people are able to get on with their life again.

Treatment usually involves psychological (talking) therapy with the person directly affected (and sometimes their family) by a qualified health professional such as a doctor or psychologist.

The sooner someone is diagnosed and receives treatment, the more likely it is they will recover sooner.

With help, a person can learn to manage their response in unavoidable situations that previously would have triggered a flashback.

 Medication can also be helpful for a time. With appropriate treatment and support people with PTSD are able to recover and get on with their lives.

In conclusion, a person who feels very distressed at any time after a traumatic event should talk to a doctor or other health professional.

Kindly visit my blog: www.doctoradesanya.blogspot.com for more health issues.

Seek treatment for herpes

I made reference to a recent press statement by the World Health Organisation in my previous article, which states that two-thirds of the world’s population under 50 years are afflicted with the highly infectious herpes virus that causes fever blisters and cold sores around the mouth.

 

The implication of this statement is that more than 3.7 billion people worldwide under the age of 50 suffer from the Herpes Simplex Virus type 1.

HSV-1 normally causes mouth ulcers and oral herpes infection, but it is becoming an increasing cause of genital infection too. 

This means people who are infected by HSV-1 may also have genital herpes.

A particular patient developed a rash with blisters on the skin which later turned to sores after the blisters burst.He had all the viral tests done with the diagnosis in favour of herpes simplex virus 1. He was managed for herpes and got well. 

A month later, the patient had a problem urinating. Sometimes he experiences a burning feeling while urinating. He has done several tests for urinary infections with no significant finding. He was subjected to a prostate test, which also comes out normal.

At the end of the consultation, he discovered that it was the herpes infection that is giving him the signs of difficulty in urinating.

Do you have problem urinating? It could be herpes.

The other causes of difficulty in passing urine like prostate disorders in men, a urinary tract infections are more common and will need to be ruled out, while also considering diagnosis of herpes.

Genital herpes, caused by the Herpes Simplex Virus type 2 , is a form of sexually transmitted disease and of serious public health importance.

Risk factors

A person usually gets infected with HSV-2 through sexual contact. Some people are more likely to get HSV-2. These people:

• Have had many sex partners.
• Had sex for the first time at a young age.
• Have (or had) another sexually transmitted infection.
• Have a weakened immune system due to a disease or medicine.

How people get genital herpes

Genital herpes can be got after coming into contact with HSV-1 or HSV-2. Most people get genital herpes from HSV-2, which they get during sex.

If someone has a cold sore and performs oral sex, this can spread HSV-1 to the genitals and cause herpes sores to appear on the genitals.

Mothers can give the herpes virus to their baby during childbirth. If the baby is born during the mother’s first episode of genital herpes, the baby may face serious problems.

Treatment

When a person becomes infected with a herpes virus, the virus never leaves the body. After the first outbreak, the virus moves from the skin cells to nerve cells.

At this stage, the virus is said to be dormant or asleep. But it can become active again.

Most people are treated with an antiviral medicine. An antiviral cream or ointment can relieve the burning, itching, or tingling and can shorten an outbreak of herpes.

Antiviral medicine approved for the treatment of both types of herpes simplex is a prescription drug.

Prevention

If there is tingling, burning, itching, or tenderness where one has herpes sore, that part of the body should be kept away from other people and sex should be avoided with uninfected partners.

Pregnant women should tell their doctors if they or their partners have genital herpes.

There is the need to take some medicines during pregnancy to prevent passing the virus to the unborn baby.

In conclusion, genital herpes is a sexually transmitted disease. Therefore, the STD, prevention strategy also applies:

1. Abstain from sex.
2. Be faithful to your partner.
3. Use condoms always.

MANAGING FEVER BLISTERS

A middle aged man had come for treatment in the hospital. He had multiple sores on his lips. The sores were giving him tingling and painful sensations. He said it was a symptom of malaria, that whenever sores appeared, he treated malaria (self medication) and he would be free of the sores.

Contrary to popular belief, cold sore or fever blisters is not a symptom or sign of malaria or typhoid fever. However, such recurrent sores are triggered by stress, illness, fever, menstrual periods, surgery and low immunity.Cold sores, also called fever blisters, are a common viral infection. They are tiny, fluid-filled blisters on and around the lips. 

After the blisters break, a crust forms over the resulting sore. Cold sores usually heal in two to four weeks without leaving a scar.

The World Health Organisation published a study recently, noting that two-thirds of the world’s population under 50 has the highly infectious herpes virus that causes cold sores around the mouth.

Cold sores are caused by a herpes simplex virus 1 (HSV-1), closely related to the one that causes genital herpes, herpes simplex virus type 2 (HSV-2).

Both of these viruses can affect the mouth or genitals and can be spread by oral sex. Cold sores are contagious even if the sores are not available.

Other names for cold sores caused by HSV-1 are oral herpes, mouth herpes and herpes simplex labialis.

Herpes is also a very common sexually transmitted infection. It is caused by one of two different viruses: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Once herpes has been contracted, it remains in the body for life.

While HSV-1 is more often found in the oral area, it can be contracted genitally as well and, in the same vein, HSV-2 is primarily found in the genital area, but can be contracted orally.

When someone has an outbreak of sores, they are most contagious and therefore at the highest risk of transmitting the virus. However, even when someone does not have any symptoms, it is still possible to pass the virus.

Symptoms

Tingling, itching, or burning, sores; one or more painful, fluid-filled blisters may appear. Blisters break open and often ooze fluid and form a crust, before healing.

For oral herpes (HSV-1), most blisters appear on the lips or around the mouth. Sometimes blisters form on the face or on the tongue.

Although these are the most common places to find oral herpes, the sores can appear anywhere on the skin.

Genital herpes (HSV-2): Sores typically occur on the penis, vagina, buttocks or anus. Women can have sores inside the vagina. Like oral herpes, these sores can also appear anywhere on the skin.

Flu-like symptoms: Fever, muscle aches, or swollen lymph nodes (glands) in the neck (oral herpes) or groin (genital herpes) are possible.

Problems urinating: People (most often women) with genital herpes may have trouble urinating or have a burning feeling while urinating.

Eye infection (herpes keratitis): Sometimes the herpes simplex virus can spread to one or both eyes. If this happens, one can have pain, light sensitivity, discharge, and a gritty feeling in the eye.

Without prompt treatment, scarring of the eye may result. Scarring can lead to a cloudy vision and even loss of vision.

Prevention

When there is a warning sign of an outbreak, people are to refrain from sexual contacts. Warning signs may include a burning, itching or tingling feeling.

It is advisable not to have vaginal, anal, or oral sex — even with a condom. Wait until seven days after the sore heals.

Use condoms between outbreaks to reduce the risk of transmission. Also, use herpes treatments. The risk of transmission can be greatly reduced if the partner with herpes takes a small daily dose of anti-herpes medication.

Treatment

There are medications that can help speed up the healing of sores and prevent them from returning. Such medicines, when taken on a daily basis, can decrease recurrence frequency to about once per year. And if a recurrence does occur, it is generally milder and lasts for a shorter time.

I will be concluding this piece with genital herpes, herpes simplex virus type 2 (HSV-2) since this is also of serious public health importance.

PALM WINE IS HARMFUL TO NEW MUM AND A BREASTFEEDING CHILD

My pastor‘s wife had sought for an advice from me concerning the choice of hospital for the delivery of her sister in-law.

Her Sister in-law who was based in another West African country had come back to Nigeria for the delivery of her baby.

She had her antenatal care in the West African country but came home to Nigeria for the delivery.

I had suggested hospitals to her based on locations, competence and convenience and expertise.

 The patient delivered safely, a baby girl with normal weight, mother and baby were fine.

I had gone to congratulate her and to see that the baby girl was doing fine. I met the mum she was happy, on a lighter mood baby was also happy as evidenced by the numerous spontaneous smiles from the baby.

I asked for my pastor’s wife, she was said to have gone out. I later met her at the reception and noticed she was worried. The following ensues between us:

Myself: Congrats Ma, where have you been?

Pastor’s wife: Doctor, I’ve been out all day in search of palm wine for the new mum.

Myself:  Palm wine! Palm what!

Pastor’s wife: The nurse requested i get the palm wine for the new mum so that the mother can lactate.

Myself: No ma, you need to hold on, you don’t need to get it, and the mum doesn’t need palm wine either.

Pastor’s wife: But the nurse asked us to go and get it, anyway thank God, thank you

I later approached the nurse, who requested for the palm wine to be brought and given to the new mum.

I asked her if she knows that palm wine contains on the average up to 6% alcohol, I also asked her whether she knows that alcohol passes through the breast milk and can affect the baby.

She replied that it is cultural practice that works but agreed that it was not a medical proven treatment and that it was not ordered by the doctor.

Medical Explanation

Naturally, palm wine is a low alcoholic drink. Its alcoholic content is as little three per cent, But fermented palm wine has the potential to breed as high 12 per cent alcoholic content.

When Palm wine a form of alcohol is taken by breastfeeding mum, it passes into the breast milk.

It is on record that there is no known safe level of alcohol consumption while breastfeeding.

Mums should avoid Palm wine/alcohol intake in the first month after a baby is born until breastfeeding is well established because it impedes the milk flow.

It takes about 2 hours for the average woman to clear 1 standard drink alcohol from her system,  therefore 4 hours for 2 drinks, 6 hours for 3 drinks and so on.

Effect of Palmwine/Alcohol on breastfeeding mum

Using alcohol may make the mum fall into a deep sleep which can be dangerous to the baby.

 Mums who are going to drink alcohol are strongly advised not to have their baby sleep with them on the bed .They are to always put babies in their cots.

They may not wake for the baby’s next feed, or if the baby becomes distressed. They are to make ‘safety plans’ – have a responsible adult to take care of the baby.

Palm wine is used by some mums as post natal beverage. This is dangerous to health; the levels of alcohol in breast milk remain close to those in the mother’s bloodstream.

Levels will be at their highest between 30 and 60 minutes after drinking, or 90 minutes if drinking with a meal.

It takes two hours for a unit of alcohol (a small glass of wine, or half a pint of ordinary-strength beer) to leave a mother’s blood.

Effect of Palmwine/ Alcohol on breastfed babies

While large amounts of alcohol in breast milk can have a sedative effect on the babies, it’s more likely to make the babies agitated and disrupt their sleep patterns.
When a nursing mother takes it, it gets into the breast milk and the baby sleeps and nobody is suckling anything. Soon, the mother starts complaining that she is not lactating enough.
Alcohol inhibits a mother’s let-down (the release of milk to the nipple). Studies have shown that babies take around 20% less milk if there’s alcohol present, so they’ll need to feed more often.
 Some infants have been known to go on ‘nursing strike’, probably because of the altered taste of alcohol in the milk.
In conclusion, drinking palm wine by breastfeeding mums is counterproductive because it is proven scientifically that palm wine does not make the breast flow. It reduces the flow contrary to perceived increase by traditions.
The act of palmwine drinking by new mum is a myth, with no scientific basis or benefit. Most importantly, it is a HARMFUL PRACTICE.