Radiation Sickness

radiation sickness

Radiation injury occurs when ionizing radiation directly damages cellular RNA, DNA, or proteins, or when highly reactive free radicals are generated within cells and tissues.

Large doses of ionizing radiation cause cell death, while lower doses interfere with cellular proliferation. Chromosomal damage can result in malignant transformation or inheritable genetic defects.

On September 11, 2001, terrorist attacks on US soil raised concerns about the repetition of similar activities, including attacks on nuclear facilities or the use of nuclear devices. The detonation of a “dirty bomb” (a conventional weapon designed to scatter radioactive material) could expose a large number of citizens to high levels of radiation.

The extent of tissue damage caused by radiation depends on the source and duration of exposure. The majority of acute radiation syndromes are caused by gamma rays and x-rays because these forms of radiation can cause damage at great distances from their sources. Deterioration of unstable atoms, such as iodine-131, contributes to cellular injury.

Signs and Symptoms of Radiation Sickness

Acute radiation syndromes follow whole-body exposure and exhibit three phases (faster progression through the phases, with more severe symptoms, occurs with higher levels of exposure):
  1. Prodrome (0-2 days post-exposure): Lethargy, weakness, nausea, and vomiting
  2. Latent (1-20 days): Asymptomatic
  3. Overt systemic illness (2-60 days): Classified by the organ system involved (see below)

  • Cerebral syndrome: Universally fatal. Caused by extremely high, whole-body exposures. Prodrome lasts minutes to hours; insignificant latent phase, followed by tremors, seizures, cerebral edema, and loss of coordination. Death occurs within hours to a few days.
  • GI syndrome: Death is common. Prodromal symptoms, often severe, resolve within two days. Latent period of four to five days is followed by intractable nausea, vomiting, diarrhea, dehydration, electrolyte imbalances, and vascular collapse. Bowel necrosis may occur, leading to sepsis. Hair loss is common. Survivors usually exhibit hematopoietic syndrome.
  • Hematopoietic syndrome: Usually due to lower exposures than for cerebral or GI syndromes. Mild prodrome begins six to 12 hours after exposure and lasts 24 to 36 hours. Bone marrow cells are immediately affected--eventually leading to loss of white cells-- but victims remain asymptomatic for a week or more as marrow fails. As neutrophil count and antibody production fall, various infections ensue. Loss of platelets leads to bleeding episodes. Anemia eventually develops as well. Survivors are at increased risk for leukemia. (Mettler RA, Voelz GL. Major radiation exposure—what to expect and how to respond. NEJM 2002;346:1554-1561)

Treatment for Radiation Sickness


  • Decontamination of exposed victims is critical following exposure, both to protect medical personnel and to limit progressive tissue damage. Wounds are checked with Geiger counters and irrigated until counts normalize. Ingested radioactive material should be removed by lavage or induced vomiting.
  • Victims are isolated from other patients, and standard universal precautions are practiced by personnel.
  • Symptomatic treatment is administered for shock, pain, anxiety, and anoxia.
  • Cerebral syndrome is universally fatal; treatment is geared toward patient comfort. Seizure control and sedation are the mainstays of therapy.
  • Aggressive fluid resuscitation, parenteral nutrition to provide bowel rest, antibiotic therapy, blood products and hematopoietic growth factors are administered as indicated. Stem cell transplants may prove useful for selected patients.
  • Medications (potassium iodide, DTPA, or Prussian blue) may limit damage from specific kinds of radioactive particles.
  • Survivors are at increased risk for various cancers, cataracts, and thyroid disease. These conditions are treated as they occur.
  • All individuals living within ten miles of nuclear facilities should have access to a 24-hour supply of potassium iodide (KI) tablets. In the event of accident, KI is ingested prior to evacuation to limit damage due to I-131 exposure. (The Merck Manual, Eighteenth Edition 2006:2601-2606)

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Respiratory Disorders – Croup

croup

When an adult has cardiac related issues, there are numerous factors that may have been the cause. Heart disease, high cholesterol, obesity and high blood pressure, can all contribute to emergency cardiac incidents. In children and infants whose hearts are typically young and strong, a cardiac event is troubling because it is unexpected. Most cardiac arrests in the very young can be attributed to an alternate cause that is usually respiration related, like croup.

What is Croup?

Croup sounds awful. The seal bark cough (stridor) and wheezing, sets parents on high alert. It is an alarming medical event that causes anxiety and restlessness for infant and caregiver alike.

The medical name for croup is laryngotracheobronchitis and it occurs when the voice box (larynx), the windpipe (trachea), and the bronchi (pathways to the lungs) become inflamed. This inflammation causes the airway to partially swell, leading to the characteristic barking cough associated with croup. Predominently caused by the Parainfluenza virus, other viruses such as the respiratory syncytial virus, influenza, adenovirus and measles can also play a role in the development of croup.

Croup – Symptoms and Diagnosis

Prior to immunizations, croup was a daunting disease. Today this disorder is more mild, although it can on occasion develop potentially dangerous aspects. Typically croup hits children between the ages of three months to six years and while the virus is usually contracted one time only, reoccurrance can happen in some children that are prone to it, particularly boys.
If croup combines with a bacterial infection, bacterial tracheitis (a rare but infectious upper airway obstruction) can develop that may evolve into epiglottitis. This dangerous combination will require a hospital stay with airway evaluation and intravenous antibiotics.

Croup initially presents with the symptoms of the common cold and a low-grade fever. As croup progresses, additional symptoms that usually present within two to three days include:
  • a barking cough similar to a seal bark (worse at night)
  • wheezing upon breathing out
  • a sore throat, voice loss
  • restlessness and irritability

There are no specific tests for diagnosing croup. The distinctive cough is usually sufficient enough for a diagnosis but doctors will always assess for breathing difficulties, poor oxygen intake and additional complications or causes.
Severe croup must be evaluated immediately. If a child develops these additional symptoms, contact healthcare professionals immediately:
  • difficulty breathing and rapid shallow breathing that includes, sucked in ribs and chest (retractions); see-saw breathing (abdomen moves opposite to the chest) and nasal flaring
  • wheezing becomes high pitched
  • dehydration, no fluids being taken in and reduced urine output
  • bluish tinge to the skin (cyanosis)
  • difficulty talking, words being forced out one at a time

Treatment for Croup

Being a virus, there is no treatment for croup directly. Antibiotics are only prescribed if croup presents alongside a bacterial infection. Severe cases may require hospitalization and treatments with IV fluids, humidified oxygen therapy and albuterol administered through a nebulizer to open the airways. In extremely severe cases with additional complications, maintaining the airway may be necessary.

If a doctor deems the infant stable enough to be treated at home, then recovery may be aided by:
  • the use of a portable humidifier
  • in cool weather, wrap a child up and take them outside, the cool air can ease breathing
  • over-the-counter acetaminophen
  • keeping the child calm to prevent crying that stimulates coughing
  • keeping the infant propped semi-upright at night
  • pushing fluids like milk rather than thinner fluids that may loosen mucus and secretions and increase coughing

Croup is a contagious disease, so avoid exposure to the virus and keep an infected child at home. Keep the home smoke free and practice basic hygiene, particularly handwashing. Never hesitate to seek professional medical help if needed.

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Redefining Depression and Medicalizing Sadness

depression and medicalizing sadness

“And if ever, by some unlucky chance, anything unpleasant should somehow happen, why, there's always soma to give you a holiday from the facts. And there's always soma to calm your anger, to reconcile you to your enemies, to make you patient and long-suffering. In the past you could only accomplish these things by making a great effort and after years of hard moral training. Now, you swallow two or three half-gramme tablets, and there you are. Anybody can be virtuous now. You can carry at least half your mortality about in a bottle. Christianity without tears -- that's what soma is.”
-- Aldous Huxley, Brave New World

Sadness is an inevitable occurrence in the span of our transient lives. However, many cultures throughout history have recognized that some people are inexplicably stricken with a persistent despair that has no particular cause or that is not proportional to the loss suffered. This condition is what we know today as depression.

However, as Horwitz and Wakefield argue in their 2007 book The Loss of Sadness, the current DSM definition of depression also includes many people who are actually suffering normal sadness proportional to life events, rather than a mental disorder.

This overly broad definition risks medicalizing normal sadness, because currently many people who have reasonable cause for their sadness fit the diagnostic requirements for the medical condition of depression.

Distinguishing Sadness Proportional to a Cause from Depression

Horwitz and Wakefield distinguish between sadness proportional to a cause, which they posit is a normal human reaction, and persistent sadness without cause, which qualifies as depression.

They criticize the DSM definition for only exempting sadness from bereavement, and that only for two months; they compellingly argue that many other life events (breakups, divorce, losing one’s job, a diagnosis of a serious illness, etc.) can also cause symptoms of depression without being a true mental disorder.

When these problems are overcome, many people recover emotionally; this suggests their sadness was not a disorder, but a proportional reaction to distressing life events.

Moreover, many symptoms – such as tiredness or trouble sleeping – are common to much of the population, and may not indicate anything.

The Overdiagnosis of Depression

Depression diagnoses have skyrocketed, especially with the advent of symptom-based questionnaires with broad questions intended to detect all possible victims of depression. Questionnaires are much cheaper to use than actual physician consultations, and arguably more objective, but their inclusiveness inevitably results in a very high number of false positive diagnoses.

Ideally these initial diagnoses would all be reconsidered by a physician, but due to financial constraints, many are not. This overdiagnosis of depression can create many problems, such as unnecessary expense, stigma, change in one’s perception of self, side effects of drugs, and the increase of medical surveillance, even for people who may not be truly sick.
Moreover, diagnoses in people who are not sick may reduce the medical care available to those who truly need it (156).

The Increase of Medical Surveillance

The perception that depression is increasing and exists undiagnosed in many people has increased medical surveillance; for example, screening has become common in schools.

However, as Horwitz and Wakefield point out, screening has not proven accurate; the loss of a romantic attachment is the strongest predictor for depression, but teens usually soon recovered from these emotions (159).

Screening is often supported as a strategy to prevent teenage suicide, suggesting that depression is a social danger, but this too has not proven accurate. Some anti-depressants may even increase the risk of suicide or violence, potentially making depression an iatrogenic condition.

The Function of Sadness

Sadness is inevitable, but not necessarily desirable. Although many hypotheses exist for why humans have evolved to feel sadness, the question also remains as to whether there is any useful function of sadness in today’s world.

Normal sadness is not a medical disorder, but this does not necessary preclude it from medicalization. Many other natural life occurrences, such as death, birth, aging, and menopause, have also been medicalized because people prefer to reject them or wish to experience them in a different way.

Anti-Sadness Medicine: The Future?

The argument for clarifying the definition in the DSM is compelling, but even if depression is reconceived in narrower, more accurate terms, the specter of medicalized sadness under a different name still remains.

It is easy to imagine the marketing of anti-sadness medicine, and easy to understand its temptation. Like mental enhancement drugs, drugs to treat normal sadness may offer the choice to improve oneself through medicine. But this improvement may come with costs.

Brave New World: The Dystopia of a World Without Sadness

Aldous Huxley’s 1932 dystopian novel Brave New World, set in London in 2540, provides a portrayal of a world without sadness. Its society is highly medicalized, with complete state control of reproduction, and the ubiquitous use of soma, a “perfect drug.”

Soma is an antidepressant and hallucogenic drug with no harmful side effects – “All the advantages of Christianity and alcohol; none of their defects.” There is no sadness in this society, but no love, no intellectual or creative pursuits.
Sadness is considered deviant, and characters urge each other to take soma when they seem even a little glum. When a character accidentally forgets her soma during a stressful visit to a reservation (where people live as they do today), she can barely function without it.

The Meaning of Sadness as Part of Human Experience

Huxley’s novel implies that sadness is a necessary part of the human condition, and that life is meaningless without it. Soma is an escape, not only in the most literal sense that it provides a hallucinatory break from life, but it also is an escape from life’s problems, from life’s difficulties, which give our lives meaning.

In his 1958 nonfiction Brave New World Revisited, Huxley concludes that our world is moving towards that of his dystopian novel faster than he had anticipated.

The Consequences of Medicalizing Sadness

Horwitz and Wakefield conclude that “if they find that their lives seem brighter when they are medicated, a belief in autonomy and free choice dictates that people should not be prevented from seeking that relief from a responsible physician” (192).

But the consequences of making treatments for normal sadness available could be widespread. If it becomes common to treat sadness with drugs, then normal coping networks of friends, family, religion, spirituality, and so on, might disappear.
Deviancy and normality could be redefined so that one might not have a choice about how to cope with one’s sadness. It could become socially unacceptable to be sad, taboo to grieve.

Autonomy and free choice are worthy goals, but medicalization is often a process invisible to the public, which then results in a structure that seems so natural that few question it. And once in place, the medicalization of a condition may be supported by the authority of the medical profession, societal norms, and even the government.

Horwitz and Wakefield present a compelling argument to tighten the definition of depression to exclude those with normal sadness. However, the issue of medicalizing normal sadness as something different from depression still remains.

The medicalization of normal sadness has the potential to not only make another option available to people, but also risks causing a fundamental shift in the way sadness is understood, which would affect everyone in society.

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Recovering from Hernia Surgery

hernia surgery
Hernias of any type do not self-correct – they require surgery to be properly repaired. One of the most common hernias in males is the inguinal hernia, which occurs near the groin area when part of the intestine protrudes through a weak spot in the abdomen.

If left uncorrected, a hernia will become larger in size, as well as more uncomfortable. The hernia is typically caused by heavy lifting or straining, paired with a weakness in the abdominal wall. Further lifting or straining can make the hernia worse, but as time goes on, even small amounts of strain such as blowing the nose or having a bowel movement can cause the hernia to expand.

The true danger in a hernia lies in the possibility that a part of the bowel will also poke out through the abdominal wall, leading to a strangulation of that part of the bowel and possibly death for the patient. While this is an unlikely outcome, patients who are suffering severe nausea and a sharp pain in the area of their hernia, rather than the usual sense of pressure, should consult a doctor immediately.

The hernia repair itself is quite simple – the intestine is pushed back into the abdominal wall and sealed up with a mesh. This is a day surgery procedure and usually takes less than an hour.

After the surgery is completed, there are several things which patients should expect to experience.

Pain and Swelling

A pain medication such as Tylenol 3 is usually prescribed for after surgery, and can do wonders in the first few days to alleviate pain. There will have been a small incision made above the groin, which will have been stitched up and is usually covered with small strips that will come off in approximately one week.

There will be pain from the incision itself, as the body has undergone a moderate trauma in being cut open, and there is usually swelling of the incision area as well as one or both of the testicles. Tylenol 3 or other pain medication is used to both assist in the management of the pain and also to reduce the swelling. The time spent on the medication varies from person to person with some using it only for a few days and some for a week or more.

The important thing to know is that any heavy lifting or vigorous activity is out of the question for at least four weeks, or else the patient risks rupturing the same hernia again.

Stiffness

This is a natural consequence of the surgery. As the incision heals, it will become tight and stiff, and the patient will feel discomfort if they try to straighten up fully or walk around. Both of these things are key, however. Walking around not only gets the blood flowing, but helps the body adjust to the incision and the new state of affairs.

The temptation is to remain seated or lying down for the bulk of the recovery time, and while this is necessary to give the body a chance to rest, it is important to move around as well. A few walks around the house can make all the difference in helping to speed recovery.

When initially standing up, most people feel a "pulling" sensation, and will often feel a sharp pain as the incision shifts around. It is important to use the arms and legs as much as possible, rather than the abdominal muscles when getting up, sitting down or any other usual movement – this will prevent strain on the incision and limit the possibility of a re-tearing of the abdominal wall.

As mentioned above, walking around will usually result in a pulling sensation as the body will have become used to sitting or reclining. As long as movements such as standing up or walking are done in a slow and controlled motion, this pulling can be a good thing as the body gets used to the new incision site.

Trouble with Bowel Movements

This is something that isn't always mentioned, but is almost a certainty, according to the May 8, 2008 article at UWhealth. Medication which is taken after hernia surgery, especially anything with codeine, tends to clog up the system. Add to that the fact that the abdominal muscles have been traumatized and that no "straining" should take place when in the process of a bowel movement and it can become quite a challenge.

The first thing to remember is that walking around will help alleviate this by getting the bowels moving. As well, eating foods high in fiber and drinking more water than normal will also be of benefit. If need be, a fiber supplement such as Metamucil can be used, but be careful if choosing to go this route.

Metamucil requires that even more extra water be consumed in order to work, or else the psyllium fiber in the capsules will make matters even worse. Any "harsher" products such as Ex-Lax should be avoided as they could put unnecessary strain on the stomach and abdominal region. A few days without a bowel movement after surgery is quite common, but if it reaches the four day mark, a call to the doctor may be in order.

While recovering from hernia surgery is a slow and sometimes painful process, knowing what to expect can make it a speedier and less intimidating process.

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Post-Traumatic Stress Disorder

post-traumatic stress disorder

Someone may develop post-traumatic stress disorder when he experiences or witnesses an event that causes intense fear and helplessness.

What Are the Symptoms of PTSD?

PTSD symptoms typically begin within three months of a traumatic event. It is important to get treatment as soon as possible after symptoms develop to prevent PTSD from becoming a long-term condition. Symptoms are commonly grouped into three types: Re-experiencing symptoms (flashbacks), avoidance, and increased anxiety or emotional arousal (hyperarousal):
  • Re-experiencing symptoms: flashbacks, bad dreams and repeated frightening thoughts-reliving the trauma over and over
  • Avoidance symptoms: avoiding places, events, or objects that are reminders of the experience.
  • Hyperarousal symptoms: being easily startled, feeling tense, having difficulty sleeping, and/or having angry outbursts.

The symptoms that children or teenagers experience may not be the same as with adults. In very young children, these symptoms can include:
  • Bedwetting, when they'd learned how to use the toilet before
  • Forgetting how or being unable to talk
  • Acting out the scary event during playtime
  • Being unusually clingy with a parent or other adult.

Older children and teens usually show symptoms more like those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors.

What Causes PTSD?

People of all ages can have post-traumatic stress disorder. But it's more common among adults, with about 8 percent of the population having PTSD at some time in their lives. PTSD is especially common among those who have served in combat, and it's sometimes called "shell shock," "battle fatigue" or "combat stress."

Women are four times more likely than men to develop PTSD. Women are at increased risk of experiencing the kinds of interpersonal violence - such as sexual violence - most likely to lead to PTSD.

Many other traumatic events also can cause PTSD, including a fire or natural disasters; mugging, assault or robbery; a car, train or plane crash; torture, kidnapping or terrorist attack; a life-threatening medical diagnosis, or any other extreme or life-threatening events.

Symptoms of PTSC can come and go, and may resurface under times of stress or when a person experiences a reminder of a traumatic event. A war veteran may hear a car backfire and relive combat experiences. Or a woman may see a report on the news about a rape, and feel again the horror and fear of her assault.

When Should Someone With PTSD See a Doctor?

When someone has these disturbing feelings for more than a month, if they're severe, or if she feels she is having trouble getting her life under control, it is likely time to see a health care professional.

The main treatments for people with PTSD are psychotherapy ("talk" therapy), medications, or both. Everyone is different, so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health care provider who is experienced with PTSD. Some people with PTSD need to try different treatments to find what works for their symptoms.

If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be treated. Other ongoing problems can include panic disorder, depression, substance abuse, and feeling suicidal. If someone has thoughts of suicide, she should go to an emergency room or call 911 immediately.

For less urgent symptoms of PTSD, patients should make an appointment with their family doctor or general practitioner. The doctor can help begin the process of understanding whether symptoms may be related to a traumatic experience. In many cases, this doctor will refer a patient to a mental health professional for ongoing treatment.

Are There Ways to Cope With PTSD?

While waiting to see a doctor, some for PTSD patients to cope include learning more about the disorder as well as talking to friends, family, and PTSD survivors for support. Joining a support group may be helpful.

Other tips include reducing stress by using relaxation techniques (for example, breathing exercises, positive imagery), increasing positive lifestyle routines (for example, exercise, healthy eating, distracting oneself through a healthy work or volunteer) and minimizing negative lifestyle practices like substance abuse, drinking alcohol, social isolation, working to excess, and other self-destructive behaviors.

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Salicylates

All types of salicylates (from the main ingredient acetylsalicylic acid or ASA), have been implicated in a condition called Reye’s Syndrome, associated with ASPIRIN® ingestion, especially by children, used to treat feverish colds or viral diseases.

salicylates

Drugs studies using acetaminophen (paracetamol outside N. A.), as well as ibuprofen and others, have only shown some unproven implications for Reye’s. With the advent of alternative pain killers, Reye’s has become less common in recent years. Nonetheless, it is important to realize that even such routinely used over-the-counter medications must be used sparingly and wisely. Headache and pain sufferers sometimes have to make tough choices.

Awareness of Reye's Syndrome is Key to Prevention

Reye's can strike quickly, affecting all body organs, especially the brain and the liver (although usually without jaundice). It is frequently associated with the use of any form of salicylate-containing drugs (ASPIRIN®-type medications) for treating colds, fevers, and influenza-like illnesses.

In 1974, the National Reye's Syndrome Foundation was the first citizens' group to generate an organized lay movement to eradicate Reye's. The U.S. Surgeon General, the Food and Drug Administration, the Centers for Disease Control and Prevention, and the American Academy of Pediatrics, all issued recommendations to avoid using ASPIRIN®-type products in anyone under 19 years of age (although no age group is immune) to treat episodes of fever-causing illness, especially flu or chicken pox. Most cases of Reye’s occur in children ages 4–12, usually following an upper respiratory or feverish infection by about one week.

User’s Must Check Drug Labeling for Safety

Words that might appear on drug labels containing salicylates could be any of the following: ASPIRIN®, acetylsalicylate, acetylsalicylic acid, salicylic acid, or salicylate, salicylamide, or phenyl salicylates. Having Reye’s Syndrome uncaused by the ingestion of ASPIRIN® has not been ruled out, but all documented cases have been traced back to that connection, so recommendations were developed on that basis, although there is no data that salicylate other than ASPIRIN® has been associated with Reye's.

Reye's Symptoms to Watch For

Reye’s presents with sudden and acute brain damage (often mistaken for encephalopathy) and liver inflammation, and symptoms that may include long bouts of vomiting. This is followed by disorientation, irritability, and aggression, and as the condition progresses, may include lethargy, confusion, loss of consciousness, delirium, and coma, as well as seizures or personality changes with ultimate permanent brain damage.

Also noticed have been unusual placement of arms and legs, with arms extended straight and turned inward toward the body, and legs held straight with toes pointed downward. Other symptoms may mimic a stroke, including double vision, hearing loss, paralysis or muscle weakness in extremities, and speech difficulty. Immediate emergency care is necessary for early diagnosis, and prevention of brain damage or death.

There is no specific treatment for this disorder, other than to monitor the symptoms to confirm the individual’s condition. A comatose victim is considered to have suffered an acute episode, and if recovering, the overall outcome is considered good.

Only Give a Child ASPIRIN® On a Doctor’s Instructions

Reye's syndrome can result in death in children, and the usual brain inflammation and liver damage caused indicate the body reacting as if to poisoning. Few cases of Reye’s have been documented in adults, with most completely recovering within a few weeks. But in children, results have been serious, with permanent brain damage and an average of 30 percent fatalities.

Connection to Chicken Pox

Any ASPIRIN®-like drugs should be avoided if a person has been diagnosed with chicken pox, or for several weeks after a child has received a chickenpox vaccination or any fever symptoms. In addition, the treating doctor must be given this information. OTC medications like Pepto-Bismol® or anything containing Wintergreen oil generally contain salicylates and should not be given to someone with either a cold or fever.

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