Glaucoma

Glaucoma refers to a series of eye conditions that affect vision and can cause blindness if left untreated. It is most common in those who are over 40 and is associated with elevated pressure in the eye (intraocular). It is commonly associated with damage to the optic nerve that is caused by a high pressure in the eye. This is due to a build up of fluid in the eye as fluid takes too long to drain correctly, this is an example of open angle glaucoma. Another risk factor for glaucoma is high blood pressure which can affect and elevate ocular blood pressure as a side effect.

At first, glaucoma presents with no symptoms and vision appears to be normal. However, if left untreated it can lead to loss of peripheral vision (vision to the side), over time central vision can also decline leading to very limited vision and blindness.

There are two types of glaucoma:

  • Open angle glaucoma – The eye drainage system begins to falter and results in a build up of fluid and pressure in the eye.
  • Closed angle glaucoma – When the iris in the eye is close to the drainage area and blocks the draining angle. When the drain becomes completely blocked eye pressure rises rapidly and it is classified an emergency.

Vision loss cannot be recovered with glaucoma, so it is vital that it is caught early. Due to the lack of symptoms in the early stages, it is incredibly difficult to detect and necessitates regular visits to an ophthalmologist or optician.

Symptoms:

  • Open angle – Loss of peripheral vision, tunnel vision and patchy spots.
  • Close angle – Eye pain, nausea, vomiting, headaches, severe eye pain, blurry vision, rainbow coloured rings or halos around lights.

The cause of primary glaucoma is unknown. However, secondary glaucoma may be due to pre-existing conditions such as diabetes, cancerous tumors, advanced cataract or inflammation.

There are a number of risk factors associated with glaucoma, which include:

  • Old Age
  • Cataracts
  • Diabetes
  • Ethnic Background – East Asians/African Americans/those of Hispanic descent are more likely to develop glaucoma.
  • Myopia (short-sightedness)
  • Eye surgeries and other eye conditions.

 

References:

http://www.glaucoma.org/glaucoma/glaucoma-awareness-video-with-robert-fechtner-md.php

https://www.glaucomafoundation.org/about_glaucoma.htm

http://www.medicalnewstoday.com/articles/9710.php

https://nei.nih.gov/health/glaucoma/glaucoma_facts

https://www.aao.org/eye-health/diseases/what-is-glaucoma

http://www.mayoclinic.org/diseases-conditions/glaucoma/basics/symptoms/con-20024042

http://www.medicinenet.com/glaucoma/article.htm

 

Multiple Sclerosis

Multiple Sclerosis is a life long condition that affects the brain and spinal cord. It usually diagnosed in people who are in their 20s and 30s.

It is an autoimmune condition, the immune system attacks the brain or spinal cord. In MS the immune system attacks the myelin sheath, a protective coating, around nerve cells. This results in messages transmitted along these nerves being disrupted, slowed and weakened.

Symptoms include:

  • Fatigue
  • Numbness
  • Balance and co-ordination problems
  • Muscle stiffness and spasms
  • Cognitive difficulties
  • Difficulty walking
  • Problems with vision

MS can occur in two ways:

  1. Relapsing-remitting MS

This occurs when symptoms progressively worsen in the span of a few days. The attacks may occur every few years. Although around half of the people with MS of this sort do go on to develop the second type within the next 15-20 years.

2. Primary progressive MS

In this type of MS there are no periods of remission, but instead symptoms progressively worsen.

Treatments include using steroids to treat relapses. Disease-modifying therapies can be used to reduce the frequency of relapses as well as specific treatments focused on alleviating symptoms.  At present, there is no cure for either type of MS and it will progressively get worse. However research is leading to strides in the development of new medication.

 

References:

https://www.nice.org.uk/guidance/cg186

http://www.nhs.uk/conditions/Multiple-sclerosis/Pages/Introduction.aspx

https://www.mssociety.org.uk/what-is-ms

http://www.ms-uk.org/whatisms

Trigeminal Neuralgia

The trigeminal nerve or fifth cranial nerve is the nerve that sends pain impulses to the brain. When the nerve malfunctions, impulses can be sent at the wrong time, when there is no real pain. However, the sufferer will still feel sharp pain of great intensity. It usually occurs when the protective coating around the trigeminal nerve, the myelin sheath is damaged. High blood pressure, tumours and multiple sclerosis can cause this damage. Rarely, a tangle of arteries and veins called an arteriovenous malformation can also lead to the attack. The attacks can span from a few seconds or to a few minutes, the pain is often unbearable It often only affects one side of the face, usually the right hand side.

The attacks are often brought about by light touching of the face, this can be due to light intensity, wind, air conditioning, eating, washing and even breathing. This means that it is incredibly difficult to control. It usually occurs in those who are over 40 and is more frequent in women than in men.

Treatment can vary but usually:

  1. Anticonvulsant Drugs

Carbamazepine is often used in treatment in order to prevent nerve firing. It slows down nerve impulses, reducing the ability to transmit pain messages. It has to be taken in large doses in order to be effective.

2.  Surgery

Surgery such as nerve replacement therapy can be used in treatment. Through cutting part of the nerve, numbness occurs and the pain is dulled or ceases. However, the nerve may regrow which results in further pain and the need for more surgery and medications.

The National Institute of Neurological Disorders and Stroke (NINDS) is researching the disease. Mice can be used to understand the relationship between the nervous system and the vascular system. Researchers are looking at the role estrogens may play in affecting nerve pain activity, due to the disease being more prevalent in women compared to men.

 

References:

https://www.tna.org.uk/pages/condition.html

https://www.tna.org.uk/pages/condition.html

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Trigeminal-Neuralgia-Fact-Sheet#3236_1

The Liver

The liver is the second largest organ in the body and is responsible for:

  • Detoxification of poisonous substances like alcohol.
  • Producing bile that is used in lipid digestion.
  • Controlling cholesterol levels by breaking down cholesterol through use of HDL’s.
  • Aiding blood clotting.
  • Fighting infections.

Types of liver diseases:

  1. Alcohol-related

Alcohol consumption can lead to a build up of fats within the liver. Fatty liver disease is reversible, if alcohol consumption is reduced drastically for around a month. Alcoholic hepatitis can occur after substance abuse with alcohol and binge drinking. Cirrhosis can also occur when the liver has been scarred. A liver transplant is only required, usually, in the late stages of cirrhosis. However usual treatment is to reduce alcohol consumption drastically after diagnosis and maintaining a balanced life style.

2. Non-alcoholic fatty liver disease.

This usually occurs in people who are overweight or obese and leads to a build up of fat within the liver. This can lead to fibrosis which causes persistent inflammation that leads to  scar tissue around the liver and nearby blood vessels. This can then later turn into cirrhosis.

3. Hepatitis

This is inflammation of the liver due to a viral infection or damage caused by alcohol. Symptoms include joint pain, high temperature, feeling sick, jaundice and itchy skin to name a few. Types of hepatitis:

  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E
  • Alcoholic hepatitis
  • Autoimmune hepatitis

4. Haemochromatosis

This is an inherited condition that is due to a slow build up of iron in the body. Symptoms include: weight loss, joint pain, fatigue, weakness etc. Treatments include: phlebotomy: removal of blood to stabilise iron levels and chelation therapy: medication to reduce iron levels. Haemochromatosis is caused by a faulty gene that affects how the body absorbs iron from food.

5. Primary biliary cirrhosis

This occurs when the bile ducts in the liver become damaged. This leads to a build up of bile in the liver that leads to cirrhosis, scarring. The immune system attacks bile ducts, this scars bile ducts making it difficult for bile to move out of the liver. It is a progressive condition that worsens over time.

Liver disease can usually be treated in a variety if ways, but in the worst cases a transplant may be required.

References:

http://www.nhs.uk/conditions/liver-disease/Pages/Introduction.aspx

http://www.medicinenet.com/liver_disease/page3.htm

http://www.nhs.uk/conditions/Liver_disease_(alcoholic)/Pages/Introduction.aspx

http://www.nhs.uk/Conditions/fatty-liver-disease/Pages/Introduction.aspx

http://www.nhs.uk/conditions/Hepatitis/Pages/Introduction.aspx

http://www.webmd.boots.com/a-to-z-guides/digestive-diseases-hepatitis

https://www.britishlivertrust.org.uk/liver-information/liver-conditions/hepatitis-c/

http://www.nhs.uk/conditions/Haemochromatosis/Pages/Introduction.aspx

https://www.britishlivertrust.org.uk/liver-information/liver-conditions/haemochromatosis/

http://haemochromatosis.org.uk/

http://www.nhs.uk/conditions/Primary-biliary-cirrhosis/Pages/Introduction.aspx

http://www.mayoclinic.org/diseases-conditions/primary-biliary-cirrhosis/basics/definition/con-20029377

https://www.britishlivertrust.org.uk/liver-information/liver-conditions/primary-biliary-cirrhosis/

 

Female genital mutilation

Female genital mutilation (FGM) refers to the procedures involving removal of parts of female genitalia. The genitals may be cut, injured or deliberately altered for non-medical reasons. FGM usually takes place when girls are infants until the age of puberty. The practice is banned in the UK.  FGM is globally recognised as a human rights violation, but despite being banned, some people choose to carry the procedure out illegally at home or in a private community.

As it has no medical/health benefits FGM is usually carried out for cultural, religious and social reasons. In some communitites it is seen to prepare a woman for marriage or to preserve her virginity. It must be stressed that there is no justification for these kinds of procedures and as a society we must continue to strive to prevent more women from having to suffer throught such a harmful and dangerous procedure.

There are four main types:

  1. Clitoridectomy – this is a removal of the clitoris and can be partial, sometimes only the skin around the clitoris is removed.
  2. Excision – removal of the clitoris as well as of the labia minora, but not the labia majora, which is a larger flap of skin around the vagina.
  3. Infibulation – implanting a seal over the vaginal opening and narrowing it, this is done by removing pieces of skin from elsewhere and placing them over the vaginal opening using stitches in most cases.
  4. Other – harmful procedures include: pricking, cauterizing and scraping the vaginal area.

 

It is clearly evident that undergoing FGM is traumatic for any woman involved and the effects will be with a woman for the rest of her life., but sometimes women and girls can die from the procedure due to unsanitary conditions and lack of medical guidance when carrying out the mutilation. Some of the side effects include:

  • Severe pain
  • Urinary problems
  • Shock
  • Haemorrhage – severe bleeding
  • Swelling of the genital area
  • Scar tissue malformation
  • Childbirth complications risk increasing
  • Infections
  • Sexual problems, during and after intercourse
  • Psychological problems following the emotional trauma

Treatment:

In some cases, treatment will not help, but in others procedures can be undertaken such as deinfibulation to widen the vaginal opening and to recontruct damaged areas of tissue.

If you know someone who is having an FGM procedure, has had one or if you have had one or will have one yourself it is essential to call the police and to obtain aid. You can see your GP or visit a gynaecologist for additional help.

Police: 999

NSPCC: 0800 028 3550

Childline: 0800 1111

References:

http://forwarduk.org.uk/key-issues/fgm/

http://www.nhs.uk/Conditions/female-genital-mutilation/Pages/Introduction.aspx

http://www.who.int/mediacentre/factsheets/fs241/en/

Alzheimer’s Disease and Dementia

Alzheimer’s disease is the most common cause of dementia. It is caused by a build up of protein in the brain to form plaques and tangles. Plaques are clusters of proteins called beta-amyloid that build up between nerve cells. Smaller clumps block signals between nerve cells which leads to damage within the brain. The inflammation caused can trigger the immune system to attack brain cells. Tangles are formed within dying cells and are twists of proteins known as tau. They disintegrate the transport system within cells therefore, depriving cells of their vital nutrients, leading to cell death. The plaques and tangles usually form in the cerebral cortex in areas associated with memory and language.  There is also damage to the hippocampus and it often shrinks with Alzheimer’s disease.

Symptoms include:

  • Memory problems.
  • Personality changes.
  • Disorientation.
  • Problems with speech and language.
  • Hallucination.
  • Depression.
  • Anxiety.

Usually, those over 65 are affected by Alzheimer’s, but early onset alzheimer’s can occur in people who are younger. It is very difficult to diagnose alzheimer’s due to the progressive nature of the disease.

There is no cause for Alzheimer’s disease, but symptoms can be treated with medication. In most cases, treatment is used to slow down progression of the disease. Psychological treatments such as cognitive stimulation therapy may be used. It is a life-limiting condition and can lead to other problems such as difficulty swallowing. In many cases, people survive 8-10 years after diagnoses but this can vary from person to person; most people require palliative care.

 

Dementia is caused by Alzheimer’s disease and is used to describe a wide range of progressive neurological disorders.

Symptoms include:

  • Memory problems.
  • Difficulty with concentrating.
  • Language problems.
  • Spatial Visualisation problems.
  • Difficulty reasoning.

Types of dementia:

  1. Alzheimer’s disease (see above)
  2. Vascular dementia – Due to a series of small strokes which cause pockets of cell damage in the brain. Memory is less affected, but instead language and speech problems ensue. It is possible to have Alzheimer’s as well as vascular dementia at the same time, this is mixed dementia.
  3. Frontotemporal dementia – Affects personality and behaviour more than memory. It is known as frontal lobe or Pick’s disease. It can be confused with depression and psychosis.
  4. Dementia with Lewy Bodies – Movement is affected including motor skills. Tremors are common, similar to those of Parkinson’s disease, in addition, tremors can also occur.
  5. Early Onset Dementia – Occurs in those below 65 and can be accompanied by depression and anxiety in younger people as well as familial stress.

Dementia can be treated via drug use and the most common form of treatment for Alzheimer’s are three drugs known as donepezil, rivastigmine or galantamine. Memantine can be used to treat a more progressive form of Parkinson’s disease.  Those with vascular dementia are treated in order to alleviate symptoms such as high blood pressure and cholesterol. Those with dementia with Lewy bodies are treated with the same drugs as alzheimer’s in order to treat hallucinations.

 

References:

https://www.dementiauk.org/understanding-dementia/about-dementia/

https://www.alzheimers.org.uk/info/20007/types_of_dementia/1/what_is_dementia

http://www.alz.org/what-is-dementia.asp

http://www.nhs.uk/Conditions/dementia-guide/Pages/about-dementia.aspx

https://www.alzheimers.org.uk/info/20007/types_of_dementia/2/alzheimers_disease

http://www.nhs.uk/Conditions/Alzheimers-disease/Pages/Introduction.aspx

 

Breast Cancer

Cancer is caused by the uncontrollable division of cells and can come in two forms: benign and malignant. Malignant tumors invade surrounding body tissue and are able to metastasize and spread to other parts of the body, whereas benign tumors are relatively harmless.

Symptoms of breast cancer include:

  • Breast Lumps (90% are not cancerous)
  • Change in size/shape/feel of breast
  • Breast pain
  • Skin Changes
  • Changes in nipple position
  • Fluid from nipples

Risks include:

  • Age
  • Ethnicity
  • Substance Abuse
  • Diet/Exercise
  • Overweight/Obese Patients
  • Genetics – family with cancer
  • Cancer genes
  • Many more

The TNM staging system stands for Tumour, Node, Metastasis.

  • T describes the size of the tumour
  • N describes whether there are any cancer cells in the lymph nodes
  • M describes whether the cancer has spread to a different part of the body

Number staging ranges from 1-4 and relate to size of tumor and its spread.

Early, locally advanced and secondary breast cancer.

Early: The cancer has not spread to areas outside the breast.

Locally Advanced: Cancer has not spread but the tumor is 5cm or larger, growing in chest skin/muscle or present in the lymph nodes in the armpits.

Secondary: Also known as stage 4 is when the cancer has spread to other parts of the body.

Grading is also used:

  • low grade – grade 1 (slow growing)
  • intermediate grade – grade 2
  • high grade – grade 3 (faster growing)

 

Diagnosis involves attending screenings, visiting a GP and then undertaking MRI and possibly CT scans to show the size and position of the tumor.

Treatment varies depending on the grading systems mentioned previously. Surgery, chemotherapy, radiotherapy, hormone therapy, biological therapy and clinical trials. Surgery is usually used for the lower grade cancers that are positioned in such a way that they can be easily removed. Types include:

  • Lumpectomy – removal of the cancerous tumor
  • Mastectomy – removal of the breast
  • Breast Reconstruction
  • Lymph Node Removal

 

For many patients and their families, breast cancer can be incredibly scary and difficult to deal with. It is important to learn as much as you can about breast cancer and to make an informed position. Breast cancer is not only hard on the person who has it, but also their friends and family. It can be difficult to adjust but it is vital to support one another and to ensure mental health does not deteriorate rapidly.

References:

http://www.cancerresearchuk.org/about-cancer/breast-cancer

http://www.nhs.uk/conditions/Cancer-of-the-breast-female/pages/symptoms.aspx

https://www.breastcancercare.org.uk/