Pills for Cheap

Two of the most important things you can do to get rid of high blood pressure are to keep slim and exercise. The results of dieting can be quite dramatic. An obese person with moderately high blood pressure can have their blood pressure brought down to normal simply by getting rid of their excess fat.

It may also help to limit your alcohol intake to lour units a week (one unit equals half a pint of beer, one measure of spirits, or one glass of wine).

Some doctors feel that limiting salt intake can help. The evidence for this is a bit mixed, but some patients with high blood pressure may be helped by reducing excess salt in their food. Don’t use too much in cooking, and certainly don’t add sail at the table.

Relaxation therapy (particularly biofeedback) is also thought to benefit the reduction of high blood pressure. However, relaxation therapy by itself will probably not bring down established high blood pressure. On the other hand, it will join together with other forms of treatment to reduce high blood pressure without requiring such heavy doses of drugs.

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A sub-arachnoid haemorrhage is a medical emergency of the first order. Immediate admission to hospital is necessary. Recovery from a sub-arachnoid haemorrhage can take a long time and may not be complete. The degree of recovery depends very much on how big the bleed was, and how quickly the patient was operated on. Untreated, sub-arachnoid haemorrhage is usually lethal; even after operation, in severe cases, there may be permanent brain damage; but a gratifyingly high proportion of patients make an excellent and complete recovery.

Sub-arachnoid haemorrhage leaves scars, both physical and mental. The external scars of the operation are unimportant; operations inside the brain are surprisingly easy to disguise because mostly they are hidden by hair.

The real scars are internal. There may be the after-effects of brain damage -stroke-like symptoms, where there is weakness or paralysis of the hands or feet; impediments in the speech; reduction in concentration; reduced quality of mental functions; and, of course, persistent headaches.

Often the biggest scar is psychological. There is frequently a feeling of terror that the same thing is going to happen again; after all, berry aneurysms are often multiple, and at first any headache (even from flu) is likely to set the patient telephoning the doctor in a panic. It can often take a long time for the patient to recover their confidence alter such a near death experience.

In actual fact, the prognosis for the future is bright. There’s often a slow, but steady return of physical and mental functions, with few set-backs. Second haemorrhages are very rare (though this doesn’t stop the patient feeling frightened, especially when doing anything that requires exertion or straining). In fact, the only thing that needs observation and control is blood pressure; sub-arachnoid haemorrhage tends to occur more frequently in patients with high blood pressure.

The bad news, however, is that persistent headaches may follow the haemorrhage, even after the patient has recovered from the bleed itself. Undoubtedly, some of this is due to anxiety and tension; but it would be amazing if there were no ill-effects after the bashing the brain has received from the massive bleed, the subsequent extra pressure, and the ensuing operation. These headaches are controllable, though, and usually subside with the passage of time.

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There are three aspects to orthodox medical treatment. The first is to stop any Infection with an antibiotic; the second is to reduce the swelling of the lining of the nose with a decongestant, such as pseudoephedrine, thus enlarging the Opening to the sinus; and thirdly, to reduce any allergic response.

Why is the allergic response so important? Simply because it causes the cells pound the hole leading to the sinus to become inflamed, swollen and produce I Vet) more mucus. All this reduces the diameter of the hole of the antrum even further. In fact, a large number of people get sinusitis mainly because they have nasal allergies to inhaled pollen, dust, tobacco smoke, or other substances. The more allergic we are, the more the cells lining the nose are likely to swell, and the more the antrum will get blocked.

Because the allergic response is so important, often your doctor will prescribe anti-allergic medication – an antihistamine; sodium cromoglycate as drops or spray; or a steroid nasal spray. Sometimes it’s convenient to use an over-the-counter decongestive cough remedy for a short time – these typically contain a decongestant to dry up the production of mucus, and an antihistamine to reduce the local inflammation.

Some people are more prone to sinusitis than others. In some, the antrum is anatomically on the small side; in others, allergies to pollen, dust, or foods may cause the cells lining it to swell, blocking it, or reducing its size enough to cause problems whenever an infection strikes – a cold, for example. Anyone with frequent attacks of sinusitis is usually well advised to try to keep under control any allergies he has.

Food allergies may also have a part to play. Some patients find that they are sensitive to a particular food, which makes them sneeze, and gives them a blocked-up, running nose. However, the role of food allergy in sinusitis is not fully accepted by all doctors, and while all agree that pollen and dust can cause problems in sensitive individuals, many doctors are hesitant about the role that food sensitivities play.

However, all doctors agree that once an allergy has been identified the substance causing it should be avoided where possible. Often this is easier said than done; for example, although it is possible to reduce your exposure to household dust, it’s impossible to get rid of it altogether, because even the best-kept house has dust floating in the air. Nor is it easy to avoid pollen; you can stay indoors on days with a high pollen count, wear dark glasses, avoid parks, gardens, fields and the countryside in general, and walk on the shady side of the street, but all you’ll do is minimise your exposure rather than remove it altogether.

Unfortunately, minimising your exposure in this way may not be enough. Because allergies tend to work in an all-or-nothing fashion, exposure to even small quantities may trigger off almost a maximum response.

On the other hand, it is quite possible, if sometimes a little awkward, to avoid foods to which you are sensitive. And, if there are other substances you’re allergic to, like chemicals, paint, and so on, you may be able to adapt your lifestyle to avoid them.

If it’s impossible to avoid those things to which you are allergic, then you’ll need a second or third line of defence. Calming down the inflammatory reaction in the nose with antihistamines, anti-allergy drops and sprays (such as sodium cromoglycate) and local steroid preparations (such as beclomethasone) can often be very helpful. Drops of dilute salt solution can also help by liquefying mucus.

One thing the chronic sinusitis sufferer should not use for any length of time are decongestant sprays, pills or linctuses. While these are very useful in the short term – say, up to ten days – using them for a longer period lets the mucous cells lining the nose get accustomed to the medication. Then, when the spray is stopped, there is rebound extra production of mucus. So the patient starts using the spray again, What he doesn’t realise is that the spray itself is making matters worse – the more he uses his decongestant spray the more rebound secretion will occur.

The really long-term sinus sufferer may need to see an ear, nose and throat (ENT) surgeon. Doing an operation to wash out the sinuses may help clear out accumulated debris and infection. This is important because the presence of foreign material, old pus, etc, can often act as a source of further and continuing infection.

Sometimes, where the hole into the sinus is small, or there’s gross obstruction from allergy or infection, and particularly where the sinuses never drain properly and keep on re-infecting themselves, the ENT surgeon can perform an operation called an antrostomy to widen the antrum, the hole which leads from the sinus into the nose. Because the sinuses are formed inside bone, the surgeon has to drill bone away in order to enlarge this hole.

Sometimes just a small increase in the aperture of the drainage hole is sufficient to allow the infected secretions inside to get out properly. An antrostomy is often combined with a sinus washout. Operations like these are done quite frequently, and are often very successful.

I mentioned earlier that the cells lining the sinus are covered with microscopic hairs, called cilia, which waft debris out of the sinus. These cells are very important. The antrum is actually up at the top of the sinus, so gravity won’t drain away debris. The cilia must be intact and working properly in order to pull the debris up the incline to the antrum.

Unfortunately, tobacco smoke poisons the cilia and stops them working, which is one reason why sinusitis sufferers should stop smoking. Without the cilia working properly, it’s much easier for debris to remain within the sinus – a prime source for infection.

The second reason why smoking is bad for your sinuses is that both by the direct effects of the smoke particles and through (he allergic reaction of the lining of the nose to tobacco smoke, smoking inflames the cells lining the sinuses and closes off the antrum, making infection more likely.

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There is only one place for a person with suspected meningitis, and that is the hospital, and very quickly, too. After a quick examination, the hospital doctor will perform a lumbar puncture, in which a needle is put in the small of the back so that it reaches the fluid surrounding the spinal cord. This is the safest place to tap cerebro-spinal fluid (CSF) without damaging the spinal nerves.

The doctor will then check if the CSF is cloudy. If it is, the patient, has meningitis, probably bacterial. If it is clear, the patient may still have meningitis (more likely viral in this case). Analysis of the CSF in the lab, in particular culturing it for bacteria, will not only tell the doctor what type of infection the patient has, but also show the antibiotics to which the bacteria is sensitive.

The treatment for bacterial meningitis is antibiotics. Often a cocktail of several antibiotics is used, in case the bacteria are resistant to one of them. Often these antibiotics are initially given by injection, sometimes into muscle, sometimes into a drip which is inserted directly into a vein, which takes them directly into the bloodstream. In some cases, the doctor will inject antibiotics into the spine at the time of the lumbar puncture, so that the antibiotics go directly into the spinal fluid surrounding the infected meninges.

From then on it is a matter of waiting and hoping. Despite the fact that in lab tests the bacteria causing meningitis are often sensitive to antibiotics, in the patient the same antibiotics do not necessarily work as quickly nor as effectively as we would like. Even with full doses of antibiotics it is still quite possible for the patient to die, or be brain damaged, by the infection. One reason for this is that some types of bacteria release toxins, so that even if the bacteria have been killed the toxins are still in the system, doing damage and causing toxic shock.

After the initial infection is over, rest and recuperation are the order of the day, and it may be many weeks before the patient is fit enough to resume their usual duties.

What about viral meningitis? Here is a different problem. While bacterial meningitis is sensitive to antibiotics, viral meningitis isn’t. There are one or two anti-viral agents that can sometimes be used, but by and large, viral meningitis has to resolve of its own accord rather than by anything the doctor can do. After a time the immune system of the body works out how to respond to the invading viruses, and starts destroying them. Thankfully, viral meningitis doesn’t do anything like the same amount of damage as bacterial meningitis, though it can still be lethal.

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Migraine affects women differently from men. Attacks in women last slightly longer than in men, though this difference only becomes apparent after puberty, when oestrogen levels have started to rise.

In eighty per cent of cases, migraine improves dining pregnancy, but it can also worsen. Those who have had menstrual migraine tend to lose it during pregnancy because of the raised (and more constant) levels of oestrogen. It is also common for a migraine to occur around the fourth to sixth day after delivery, when the oestrogen levels drop after childbirth.

The level of attacks may also improve at the menopause, when oestrogen levels drop. However, although some women experience a decline in their migraine at this time, others find that this is when their symptoms start or get much worse. Sometimes migraine at the time of the menopause can be helped with hormone replacement therapy (HRT) which provides extra oestrogen. Pizotifen is a non-hormonal drug that can also be used.

About ten to fifteen per cent of women experience migraine occurring at the time of the period. This also responds to extra oestrogen, perhaps as a ‘patch’ stuck on to the skin. Just to confuse matters, the Pill (which contains oestrogen and progesterone) can make established migraine worse, or even cause an aura to appear where previously the attacks were without one. Remember: if you get a migraine for the first time on the Pill, discontinue taking it immediately, and contact your doctor.

Rapidly worsening migraine when on the Pill is also a signal to stop taking it; this is particularly the case where migraines change from common migraine to classical migraine (with an aura). Both these problems were much more common when the high dose Pill was used.

Occasionally patients find that their migraines occur when they are ovulating, in the middle of the cycle. Finally, and very interestingly, there seems to be no great alteration in migraine patterns alter hysterectomy or removal of the ovaries.

In other words, some migraines seem to be related to oestrogen. It must be remembered that oestrogen is not the only female hormone. Progesterone is also a major part of the female hormone cycle and there be other could links which we have not yet discovered. It may well be that the relationship between hormones and migraines in women is much more subtle, being affected by a relative balance of a group of hormones rather than the effects of a single hormone on its own.

Finally the trigger effects of oestrogen can combine with other triggering events. In other words, the effects of a missing meal may be much worse during your period; the triggering of the drop in blood sugar combines with the triggering effect of a drop in oestrogen often causing a migraine.

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