Transient ischemic attacks (TIA) are disturbances of brain function, usually lasting from two minutes to two hours, but sometimes for as long as 24 hours, which leave no trace. During a TIA, the victim may be paralyzed, unable to talk, or experience tingling or other unusual feelings on one side of the face or in one side of the body. There may also be dizziness, or partial loss of vision and hearing. One or more of these phenomena can occur repeatedly, or they may appear in different combinations from time-to-time, ranging from momentary dimming of vision to severe but temporary strokelike attacks.

Caused by temporary blockage of arteries supplying the brain, TIAs often result from blood clots carried there from elsewhere in the body. A failing heart or a damaged heart valve is the usual site of the clot formation, but other conditions (including atherosclerosis, diabetes, or early tumors) may provide the stimulus for clotting. For this reason, anyone who begins having TIAs needs to be examined by a physician to determine whether medical or surgical treatment is required for an underlying disease.

Even when no underlying cause is found, TIA victims can benefit from continuous anticoagulant drug treatment to slow the clotting process. This treatment should be carefully monitored and changed at intervals to match the patient’s varying needs. Regular follow-up visits to the doctor are therefore essential, even though one may feel perfectly well.

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Signs and symptoms

The symptoms of sinusitis include fever (sometimes as high as 40.6°C), pain, stuffy nose, and cough. Depending on the location of the infection, headache may occur in the back of the head (infection of a sphenoid sinus), at the temples and over the eyes (infection of the ethmoid and frontal sinuses), or above and below the eyes (infection of the maxillary sinuses). Small children who have an infection in the ethmoid sinus develop red and swollen eyelids. However, the key to diagnosing sinusitis is the discharge from the nose.

With sinusitis, discharge from the nose is yellow, milky, or opaque. Pus in the sinuses can be revealed through an X ray, but it’s easily confused with a thickening of the lining of the sinuses because of a common cold or an allergy.

Home care

You can promote sinus drainage and protect against sinus infection by treating a cold with decongestants (taken by mouth) and nose drops, or by treating an allergy with antihistamines taken by mouth. These measures also encourage drainage after sinusitis has developed. To relieve pain and fever, heat may be applied to the affected sinuses, and aspirin or paracetamol given to the child.

Precautions

• A high fever (39.4°C to 40°C) plus signs of sinusitis indicate a potentially serious infection. See your doctor.

• A pus-like discharge or signs of sinusitis on one side of the nose suggest that a foreign object may be lodged in the nose or that the inside of the nose may be deformed. See your doctor.

Medical treatment

After identifying the infecting bacteria the doctor may prescribe antibiotics for the child to take by mouth. Suction may be used to drain the sinuses of older children with sinusitis. Surgical drainage is rarely indicated in children.

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Characteristics of the Grasses That Cause Allergy

Grasses cause three times as many allergies as trees because they grow almost anywhere in the world (from the frozen North to the equator), even though they thrive best in moderate climates. There are many kinds of grasses, some of which, like sugar cane, wheat, rye, corn, bamboo, and rice, are planted so far from human habitations that they rarely cause allergies. Timothy, Johnson orchard, Bermuda, blue, and June are the names of grasses which can cause allergies. They grow in meadows and lawns in and around densely populated areas and pollinate in the United States from May to August.

Allergy to grasses is easily diagnosed because the pollen of all grasses looks the same when seen under a microscope; as a result, the pollen of any kind of grass can be used for testing or desensitization. (There are two exceptions to this rule: Bermuda and Johnson grasses, which have importance only in limited localities.)

In subtropical countries like Israel, grasses pollinate all year around and are the main cause of pollen allergy.

Characteristics of the Weeds That Cause Allergies

The most common cause of pollen allergy in the United States is weeds.

Some weeds, like English plantain, pollinate in June and July, while ragweed pollinates from the middle of August to the first frost. There is a short variety of ragweed, a tall variety, and a giant one. The short variety reaches a height of one to five feet and has hairy green stems, parted leaves, and long green-to-yellow spikes. The giant variety may reach a height of fifteen feet and has either three-lobed or simple leaves.

Both plants can live in the poorest of soils and can resist all severe weather conditions but snow. About mid-August, a photochemical reaction (which depends upon the balance between daylight and darkness) causes all ragweed plants to produce flower spikes which contain pollen. After a day or two, pressure builds up in the spikes, they burst open, and the pollen is thrown out into the air. It lands on the plant’s leaves, dries up, and is then carried away by the wind for hundreds of miles. All ragweed pollen looks and acts very much alike, no matter what variety of ragweed plant originated it.

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IVF is a technique for fertilising your eggs with your partner’s sperm outside your body – hence the use of the phrase ‘test tube babies’. The fertilised egg is then implanted back into your womb.

Who Should Have It?

IVF may be used as a last resort by couples who have had unexplained fertility for a number of years. It is often chosen if the woman has damaged fallopian tubes or other specific problems which mean that normal fertilisation cannot take place.

IVF is also an option if there are any other problems and you are over the age of 35.

What Happens?

In order to prepare you and your body for this procedure, GnRH analogues are given, either as a nasal spray or daily injection, in order to work as an anti-hormone to put you into a temporary menopausal state. This is called down-regulation and stops your own hormones interfering with the IVF treatment. Another fertility drug, FSH or hMG, is then given in the form of injections to stimulate several follicles to develop.

Once there are enough follicles of the correct size (as monitored by ultrasound), you are given an injection of hCG which primes the eggs before they are collected.

Around 34-38 hours later the eggs are collected through the vagina, using an aspiration needle guided by ultrasound. You may be sedated for this procedure or have a general anesthetic.

Your partner provides a fresh semen sample, which is treated as in IUI (above), and up to 100,000 sperm are mixed with each egg. The aim is to collect about 20 eggs. The ones that are fertilised, and start to divide well, will be chosen to go back inside the womb. This takes place two or three days later and the embryos are transferred into the womb via the cervix, using a soft catheter.

Only a maximum of three embryos can be implanted back, according to UK law, and it is hoped that they will implant in the womb. Because the embryos are put directly into the womb, they end up there three or four days earlier than they would do normally. It takes an embryo (fertilised egg) approximately seven days to travel down the fallopian tube before it ends up in the womb.

In order to increase the chances of implantation, the hormone progesterone is given either as pessaries or injections.

Success Rate

Respite all the hype, the IVF success rate is relatively low – only 15-20 per cent.

IVF treatment most commonly fails at the implantation stage. Many couples tell me that everything went really well until they reached this point.

Sometimes the IVF cycle is abandoned because the drugs either failed to stimulate egg production or, at the other extreme, caused hyper-stimulation which is potentially dangerous. Sometimes no eggs can be retrieved from the follicles or the quality of the eggs is poor and fertilisation with the sperm is unsuccessful.

Assisted Hatching

In normal pregnancy, a hole is made naturally in the casing of the embryo and the embryo hatches and attaches itself to the lining of the womb. The enzymes present in the fallopian tube that usually soften the casing are not present in IVF because in IVF the embryos are put back straight into the womb. So, if there have been a number of failed attempts at IVF, a technique called assisted hatching may be used, whereby a needle or chemical is used to make a tiny hole in the casing of the embryo.

Frozen Embryos

Extra embryos resulting from the IVF treatment can be frozen if their quality is good. However, under the HFEA Act of 1990, these embryos can only be kept in storage for five years. They do not thaw out well and many have to be discarded. The embryos are stored in liquid nitrogen and, in order to prevent what is called ‘cooling injury’, as the embryos are thawed out, cryoprotectant chemicals are used. Of course, there are also moral and ethical issues, which have to be considered when deciding to freeze embryos, because it is not eggs that are being frozen but a potential baby.

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What is it?

A feeling that after some time with the same partner things have become predictable and lost their spice and excitement. Most couples who have been married for more than ten years or so complain that sex is boring some, or even all, of the time. Sexual boredom is not inevitable, though, and can be prevented as we shall see. Having said this, many couples are apparently perfectly happy with sex lives that would be judged as very ‘boring’ by others. It is what suits any one couple that matters and not what other people think.

What causes it?

•     Being bored with yourself. If you feel you are boring and don’t get much joy out of life it is hardly surprising that sex seems boring too.

•     As well as being bored some people are boring-they do the same things time after time, so that having them in bed is like making love with a robot. This is a common criticism of men by their women. Many such people are boring out of bed too.

•     Just letting things slip. This is a common cause. Most couples are not bores-they’ve just stopped putting in much effort. This can happen in all departments of the relationship, of course-not just with regard to sex.

•     Laziness. Most people settle for the least sexual activity they can get away with within their relationship and then wonder why they get bored. We all expect to spend time and care shopping for and preparing a good meal, yet most people expect good sex simply to happen as if by magic. Of course, it rarely does and those whose sex lives are not boring spend time preparing and planning for sex.

•     Being aware of what your partner wants. Quite often what your partner does to you is what they want to be done to them.

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Relief

When a doctor finally puts a name to all that pain and suffering you feel relieved. At last someone has recognized that you do have something wrong with you and it is not all in your head. No, you are not neurotic and your symptoms have a name. Endometriosis. You do not have cancer and you can at last do something about your problem.

Denial

Some women cannot accept that they have a disease. They will not accept the fact that it may cause infertility, may interrupt their lives, relationships and careers. They believe that if they ignore it the symptoms and disease will just go away. They turn a blind eye to it all and bury their head in the sand.

Confusion

For others, the relief of finally knowing what is wrong is clouded by fear and confusion, particularly if they have never heard of endometriosis or know only a little about the disease.

Many women are told the best ‘cure’ is to have a baby. For teenagers, those not in a relationship, or those who had decided not to have children, this can be a confusing and annoying ‘solution’.

It is normal to want to know the answers to several questions. The most common questions are:

• what causes endometriosis can I have children

• what treatment is available

• will the treatment I choose get rid of the pain

• can I be cured

• is it hereditary

• is it a sexually transmitted disease

• where do I go from here.

The more accurate information and support that you receive soon after you have been diagnosed, the less likely you will be confused and unsure of the next steps in dealing with this disease.

Overwhelmed

• You may feel overwhelmed by the various options of treatment that are presented to you. These options may include having no treatment at all – adopting a wait and see approach. This may be the case especially if your endometriosis is mild with few symptoms and you are planning to get pregnant.

Perhaps you were trying to get pregnant before your endometriosis was discovered and the prospect of a six to nine month course of drugs which will prevent you from getting pregnant during that time will be exasperating.

You may have to consider going on a course of fertility drugs if you want to get pregnant – something you may never have considered before.

Having to make a decision about which hormonal or surgical treatment is best for you will almost certainly be overwhelming.

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Although many learned researchers talk about the ‘psychodynamics’ (i.e. the interplay between physiological and other factors) of accidents, especially accidents in the home, there is little doubt that most accidents are caused through carelessness and thoughtlessness. Over 2 million people are involved in accidents in their homes every year in the UK, a figure which considerably exceeds (in numbers if not severity) the far more widely publicized figure for road accidents. In Britain, accidents at home account for one in 112 of all deaths, and 37 per cent of all accidental deaths. This represents over 6,000 deaths in any one year. The very old and the very young are especially at risk from domestic hazards.

Most accidents at home occur in the kitchen (12 per cent) or living room (12 per cent), with the seemingly more dangerous garden next (9 per cent). In very young children, falls, burns and scalds, fires, suffocation and poisoning head the list of dangers, whereas older children suffer cuts, bruises and broken bones. Old people may accidentally take too many drugs. They may also fall more as their senses dull and this leads to an increase in cuts and burns. Seventy-five per cent of all injuries needing hospital treatment are cuts and bruises, sprains, fractures, dislocations, burns or scalds. Prevention often simply involves careful planning of your environment and daily life to reduce the risk of accidents.

There are special hazards encountered with fire, electricity, gas and water. Fire can often be prevented. The Home Office booklet Dangers from Fire is free to every household and is well worth reading. It is aimed at prevention and is available from local authorities, local fire prevention departments and county fire brigade headquarters. Electricity and gas in the home should be treated with respect. Always consult experts if in doubt. Many domestic fires start because of unsafe wiring, plugs and appliances.

It is never too early to start thinking about safety. If you have small children you have moral and certain legal responsibilities to protect them from danger. Remember too that a child under the age of 16 cannot be held responsible for his or her own safety and well-being or for that of another child under 16-you as the adult are responsible. Get your children to respect danger, especially in connection with fire, gas, electricity and water and encourage them to think of the safety of others as soon as they are old enough.

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So antigens are the enemy, they challenge our immunity, and the immune system fights back. How?

One method of attack is for certain immune cells to “eat” the antigen. Another is to cut a hole in the surface of the bacteria’s cell. This destroys the bacteria by allowing water, sodium and other substances to leak in and out of the cell, upsetting its homeostasis (“steady state”). Poison can be used to kill the antigen. Or a cover can be slapped over that part of the antigen which does the damage (toxic site).

Some of the immune cells are born knowing how to locate and destroy antigens. Other parts of the immune system must wait until they receive specific instructions, telling them what the antigen looks like.

The actual battle is fought by various cells and proteins. The brunt of the battle falls on the white blood cells, which we call leucocytes. (“Leuco” refers to the color white and “cytes” to the cells.)

Using a video screen hooked up to a microscope, I often show my patients what a drop of their blood looks like. There are lots of circular red blood cells: 5,200,000 per cubic millimeter in normal men, give or take 300,000. (For women the figure is 4,700,000, plus or minus 300,000.) Far less numerous are the white blood cells: only about 7,000 in a cubic millimeter of normal adult blood.

There are different kinds of white blood cells, each with its own name, size, shape and function:

Neutrophils (leucocytes/phagocytes) Monocyte/Macrophages (leucocytes/phagocytes) Eosinophils (leucocytes/phagocytes) Basophils (leucocytes) Lymphocytes (leucocytes) T-cells (lymphocytes)

Natural Killer Cells (NKs)

Helper Cells (T4s)

Suppressor Cells (T8s) B-cells (lymphocytes)

White blood cells aren’t the only immune soliders. The complement system, immunoglobulins, interferon and interleukin, which I’ll discuss later, are also important parts of your defense network.

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‘Uncued’—spontaneous panic attacks

The experience of an uncued attack is the central feature of panic disorder. An uncued panic attack is an attack that occurs spontaneously, irrespective of what the person may be doing at the time. It is not triggered by situations and places. People who

experience this type of attack may also experience them at night while asleep.

‘Cued’ panic attacks

Unlike the experience of a spontaneous attack, the cued attack does relate to and is triggered by specific situations or places. The cued attack is one of the components of post traumatic stress disorder, obsessive compulsive disorder and social phobia. It is unusual for people with panic disorder to experience this type of attack.

‘Situationally predisposed panic attacks’

Some people may be predisposed to having panic attacks in some situations and/or places. The attack is not necessarily triggered by the particular situation and/or place and may happen on some occasions and not on others. People with spontaneous panic attacks may go on to develop this type of attack.

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Panic disorder; generalised anxiety disorder; post traumatic stress disorder; obsessive compulsive disorder; and social phobia are classified as anxiety disorders. Anxiety disorders affect 12.6% per cent of the population over a twelve-month period (Andrews 1994). Research suggests anxiety disorders represent the largest mental health problem in the general population (APA 1980). Using the current Australian population figure of 18 million (ABS 1995), this means that 2.2 million people are affected by these disorders. The age of onset of the disorders is usually between the late teens and the mid thirties, although they have begun in childhood and as late as seventy.

Central to the anxiety disorders are the experience of panic attacks. Until the introduction in 1994 of three separate and distinct types of panic attacks (APA 1994), all panic attacks were considered one and the same. The introduction of these three categories is a major step forward in the understanding of the subjective experience of these attacks.

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