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INVESTIGATIONS OF HEADACHES: ELECTROENCEPHALOGRAPHY (EEG)

admin — Thu, 28 Jul 2011 15:28:03 +0000

Brain cells produce minute fluctuations in electric current which can be recorded by placing on various parts of the head small metal discs attached to suitable amplifiers.The numerous electrical impulses which are associated with the living brain tend to produce a particular repetitive pattern. With the eyes closed, alpha rhythm appears, i.e. a rhythm consisting of waves lasting one-tenth of a second; with the eyes opened so that the brain is alerted, this rhythm disappears. Faster rhythms may be seen when the patient is on tranquillizers, and slower (theta) rhythms indicate malfunctions or tumours of the brain.These slower rhythms are also seen in some patients with migraine, particularly during an attack, when they may indicate a transient decrease in circulation. Most patients with migraine have a normal EEG but the abnormalities found consist mainly of slow wave activity, more often over only one temporal lobe. EEG findings are not always conclusive since many different abnormalities can give identical EEG changes. A small percentage of ‘normal’ people without symptoms have EEG ‘abnormalities’ but these occur more commonly in migraine patients and become more pronounced during an attack. The EEG can therefore be a help both in assessing the severity of attacks and in excluding diagnoses other than migraine; patients with hemiplegic migraine particularly tend to have severe persisting EEG abnormalities on the relevant side of the head.During one stage of the EEG examination, the patient is asked to ‘over-breathe’, i.e. to breathe rapidly and deeply; this causes carbon dioxide to be ‘blown off producing a change in the acidity of the blood. Over-breathing can bring out latent abnormalities and, although migraine patients have slightly different responses to over-breathing, the meaning of this is uncertain. It may be that they are more anxious as a group with a greater tendency to over-breathing, i.e. an anxiety response. A more likely explanation is that their blood vessels are unduly sensitive to changes in blood acidity.Another EEG technique to reveal latent abnormalities is the response to & stroboscope, a machine that produces flashing lights (flicker) at different frequencies. In the vast majority of migraine subjects, these responses are made to a much greater range of flash frequencies than in normal subjects but, as a similar phenomenon was observed in people with anxiety and tension who do not suffer from migraine, its significance is uncertain. The EEG changes found in migraine may be very similar to those found in epilepsy, and on the basis of the EEG records it would be difficult to distinguish between the two conditions.The EEG can indicate a structural abnormality but it is not always possible to distinguish one cause of structural abnormality from another; indeed, some deep-seated lesions may cause no EEG abnormality or only minimal generalized changes.The answer to the question of what the EEG does is that it supplies a useful piece of the jigsaw puzzle but rarely gives the whole answer to a diagnostic problem on its own. Rather like the skull X-ray, the EEG will reveal something unsuspected only in some instances, when more extensive investigations are indicated.
*38/152/5*

IDEAL MARRIAGE: FUNDAMENTAL EQUALITY – ARE THERE NO DRAWBACKS TO THIS PROGRAM OF COMPLETE EQUALITY?

admin — Fri, 15 Jul 2011 15:09:52 +0000

Are there no drawbacks to this program of complete equality? What will become of the children, for example, if women possess economic independence, which can be attained only by working outside of the home? And will there be any home at all? These questions are the stumbling blocks in the elevation of woman from the mere status of cook, housekeeper and nurse-girl to that of a fully developed human being who can be a real companion to her husband. The difficulties are not so serious, however, as conservative people would like to make them out to be. Beyond having to take several leaves of absence from outside work during pregnancy and lactation, there is no reason why a woman should have to neglect her career on account of children.Day nurseries and pre-schools, which can eventually be made part of the public school system, not only enable a mother to pursue her daily work outside the home but are much better for the child than the type of training or lack of training that it receives from most mothers. And the attention which both the father and mother can give to the children in the evening and over week ends will lend all the “personal touch” that is needed. As a matter of fact, with both parents working, with housekeeping done for the most part by specialists in that field, and with most meals eaten in family restaurants instead of laboriously prepared at home, both parents will actually have more time to devote to their children in a constructive way than at present. The improvement too in the relations of husband and wife, which will result from greater equality, will make home-life even more real and pleasant than it has been under the old regime, and both parents and children will be happier.Objection may be raised to woman’s entering industry because this will flood the labor market, reduce wages and throw deserving men out of work. While there may be, and in fact are, some difficulties of this sort, yet they may be regarded as merely transitional. Besides, the entrance of women into industry is quite gradual, and probably, if present tendencies continue, the population will sooner or later be sufficiently reduced to enable both men and women to have employment, with reduced hours and better pay, brought about by the continued improvement in industrial technology and in the greater power of workers to demand their due share of the products of industry. It is beyond the scope of this book, however, to enter into all the intricate economic questions that the proposed equality of the sexes raises. If the ideal is worth attaining, surely it can be made economically practicable.*106\275\8*

HIV: OPTIONS FOR MEDICAL CARE-PATIENTS, RIGHTS IN HOSPITALS

admin — Sun, 03 Jul 2011 14:55:27 +0000

The medical care system is large, complicated, overwhelming, and bewildering. Everyone who is a patient in the system has a right to have questions answered. Questions about medical care are best addressed to the medical care providers—the nurse or midlevel practitioner or physician. Questions about the medical system itself are best addressed to a patient representative, a patient advocate now in most hospitals and in many of the larger clinics. People who become patients in the medical care system have specific rights they should be aware of. The following is an adaptation and amplification of the “Patient’s Bill of Rights” offered at the Johns Hopkins Hospital in Baltimore, Maryland.1. The person should expect medical care regardless of race, color, religion, national origin, source of pay, or medical condition. Specifically, no one can be denied care because of HIV infection. Early in the AIDS epidemic, some hospitals and clinics avoided providing AIDS care, on the grounds that treating people with AIDS might deter other people from using that hospital or clinic. Much of this image problem is now in the past, but people with HIV infection should nonetheless be aware of their right to medical care in hospitals.2. The person should expect to be treated with respect. He or she should be addressed by proper names and not be treated with undue familiarity. He or she has the right to an appropriate response to questions.3. People should expect privacy and confidentiality in all aspects of their care. This is an especially sensitive issue for people with HIV infection. Privacy and confidentiality have some limits, however. Important diagnoses such as HIV infection or the complications of HIV infection cannot be excluded from the medical record. Moreover, these medical records are available to those who have a justified need to see them, including physicians involved in the person’s care, insurance companies, Medicaid/Medicare, HMOs, and public health officials. Furthermore, all cases of AIDS are reported, by law, to the Centers for Disease Control; and many states require that blood tests that are positive for HIV also be reported to state health departments. Although this is a sensitive issue, we are not aware of a breach of confidentiality that has ever occurred as a result of such reports. And hospitals take seriously their responsibility to protect medical records from people who have no need to see them.4. People should know the physician who is responsible for their care. They have the right to participate in decisions involving their medical care. These decisions should be based on a clear explanation of the medical condition, the proposed procedures, the proposed treatments, and the risks involved.5. People should expect efficient and courteous attention from all hospital personnel. They should also respect the possibility that other patients’ needs might be more urgent.6. People have the right to be interviewed and examined in surroundings that assure privacy. They also have the right to know the role of any observer and to ask observers to leave. People also have the right to restrict visitors and can do this simply by notifying the nurse or physician responsible for their care.7. Mentally competent people have the right to reject any form of proposed treatment or diagnostic test. In particular, many people have profound feelings about resuscitation and life support measures like breathing machines or artificial kidney machines. Uncomfortable as this subject is, decisions about life support measures should not be left until the person is too ill to participate in a rational discussion. Preferences about such issues should be discussed candidly, at the appropriate time, and should be documented in the medical record, in a living will, or by assigning a durable power of attorney for health care. In the event that there are no such provisions, and the person is not capable of making medical decisions, this role is entrusted to a hierarchy of others, starting with a court-appointed legal guardian, then spouse, child over eighteen years, parent, or sibling (brother or sister), in that order.8. People may be asked to participate in research projects called clinical trials. Clinical trials can involve people only with their written consent and with the approval of the person’s physician. Furthermore, once involved in a clinical trial, the person has the right to discontinue participation at any time.9. People have the right to unrestricted communication with anyone. This includes physicians, lawyers, clergy, and representatives of AIDS-advocacy groups.10. People may leave the hospital against the advice of their doctors at any time. They will usually need to sign a form entitled “Discharge Against Medical Advice.” The implication of the form is that the physician will not be responsible for any harm that results from this action. In addition, the refusal of care by the person or the person’s legally authorized representative may, upon appropriate notice, result in termination of the patient-physician relationship. The exception to the discharging-against-advice right is that some states have laws requiring people with certain contagious diseases who are considered potentially harmful to others to remain in the hospital. It is conceivable that this ruling could be applied to people with HIV infection who are known to behave irresponsibly. We are not aware that this ruling has ever been applied in this way.11. People may not be transferred from one facility to another unless they receive a complete explanation of the need for the transfer and the alternatives to the transfer, and unless the receiving facility accepts the transfer. People who desire transfer to another hospital should notify their physicians, who will make the arrangements. Almost all transfers between hospitals are based on discussions between physicians, usually the physicians-of-record of the two facilities. The admitting office of the receiving hospital must also be involved to assure that the source of medical insurance complies with their requirements.12. People who are discharged from the hospital have a right to information regarding continuing health care requirements, including recommendations for medications, nutrition, activity, return to work, and follow-up medical evaluations.13. The person has the right to inquire about any charges by the hospital, the clinic, or a physician, and to be presented with various options for payment.*170\191\2*

BILIARY INFECTIONS: COMPLICATIONS OF CHOLECYSTITIS

admin — Tue, 21 Jun 2011 08:50:24 +0000

A number of complications have been associated with acute and chronic cholecystitis:• Empyema – occurs when super-infection of stagnant bile leads to pus filling the gallbladder. This complication carries a high risk of gram-negative sepsis.• Gangrene – results from chronic ischemia of the gallbladder wall leading to complete tissue necrosis. There is a high risk of perforation associated with this complication.• Perforation (with or without peritonitis) – may be either localized (contained by the omentum and serosa of contiguous organs) or free (frank rupture of the gallbladder into the peritoneal cavity). Fever and a palpable RUQ mass may be present when a localized perforation has occurred. A free perforation produces the clinical findings of diffuse peritonitis.• Emphysematous cholecystitis – occurs when gas-producing bacteria invade a gangrenous gallbladder wall. The clinical manifestations are usually more severe but may be indistinguishable from nongaseous cholecystitis. An abdominal plain radiograph may reveal gas within the gallbladder lumen, gas in a ring along the contours of the gallbladder wall, or a gas-fluid level in the gallbladder.• Cholecystenteric fistulas – can form with chronic inflammation and can connect areas of bowel adjacent to the gallbladder wall. Fistulas from the gallbladder to the duodenum are the most common.• Gallstone ileus – refers to the mechanical intestinal obstruction resulting from passage of a large gallstone through the bowel lumen. If a significantly sized gallstone (>2.5 cm in diameter) passes through a fistula into the intestines, it can cause obstruction, typically at the ileocecal valve. An abdominal plain radiograph reveals intestinal obstruction, gas in the biliary tree, and a calcified gallstone in the bowel lumen.• Porcelain gallbladder – can occur in the setting of chronic cholecystitis when calcium salts deposit within the chronically inflamed gallbladder wall. Cholecystectomy is recommended in these cases because of the association of carcinoma of the gallbladder.• Pericholecystic abscess – consists of a localized pus collection adjacent to the gallbladder.• Intra-abdominal abscess – can occur following a perforation of the gallbladder (usually a free perforation).• Bacteremia – results from translocation of bacteria from the gallbladder into the bloodstream.*105/348/5*

STRESS AND PMS: WHAT IS STRESS?

admin — Sun, 12 Jun 2011 08:45:34 +0000

Stress is something that we generate inside ourselves in response to ‘stressors’. Stressors can be major events such as crumbling relationships, a dead-end job or delinquent children – but they can also be simply the accumulating daily hassles of constant deadlines and snatched meals. In other words, they can be anything that leads to stress.In fact not all stressors are nasty. Winning the lottery, or going on holiday can trigger as much of a stress response as having your handbag snatched on the way to work.Intense emotion such as excitement, anxiety, frustration and anger is the trigger for the body’s stress reaction.In primitive times the stress response was a vital part of our defence against danger such as being chased by wild animals. The stress response makes us ready for immediate physical action whether running as fast as we can to escape or stopping to fight. This is known as ‘the fight or flight response’.The body responds to a stressor in several ways:• adrenalin and glucose flood into the body• breathing becomes shallow and fast to take in more oxygen• muscles contract ready for use• blood pressure increases• the heart beats fosterStress can feel good. Adrenalin can give you a buzz and almost make you feel ‘high’. This is fine when you are racing to meet a deadline, for example, and you need that extra burst of energy to rise to the challenge.But stress becomes bad when the chemicals released during the stress reaction stay in the body. In prehistoric times the stress reaction would always have been followed by a burst of physical activity which would have broken down the chemicals allowing the body to relax afterwards.In modem times it appears that often the chemicals produced by the stress reaction are not broken down before we meet another stressor which starts the whole process again. This means our bodies never return to normal and we are in a permanent state of stress.For many of us the image of a stressed-out individual is a middle-aged company executive who works all hours, eats too many heavy business lunches, smokes like a chimney and is well on his way to his first coronary. But women are not immune to stress.In bet the dual pressures of home and work are purring women under extraordinary levels of stress. A recent survey of 20,000 British men and women found that 42 per cent of the women reported being under stress compared with 30 per cent of the men. Women today, it seems, may be more stressed than men.In the UK women now make up more than half the workforce but are still responsible for 80 per cent of the country’s housework, in addition to taking most of the burden of caring for children. And ifs not just working women who are under stress,Studies of stay-at-home mothers have consistently found that they are more depressed and have lower self-esteem than their working counterparts.*33\120\4*

HOW DO YOU DEFINE “HOPE”?

admin — Fri, 10 Jun 2011 15:20:09 +0000

Sometimes it’s hard to explain hope—just what is hope, anyway? The cutest illustration of hope I’ve found is about a little boy who was standing at the foot of the escalator in a big department store, intently watching the handrail. He never took his eyes off the handrail as the escalator kept going around and around. A salesperson saw him and finally asked him if he was lost. The little fellow replied, “Nope. I’m just waiting for my chewing gum to come back.”If your face is in the dust, if you are in a wringer situation, be like the little boy waiting for his chewing gum to come back. Stand firm, be patient, and trust God. Then get busy with your life . . . there is work to do.I like the note one mother sent me that simply said:Dear Barb (and Gopher Bill): Like the sundial, this year I am only going to count the sunny hours! I don’t know where we are—I don’t need to know. It’s all in His hands. How much safer could it be?Her words remind me that nothing touches me that has not passed through the hands of my heavenly Father, NOTHING. Whatever occurs, God has sovereignly surveyed and approved. We may not know why (we may never know why), but we do know our pain is no accident to Him who guides our lives. He is, in no way, surprised by it all. Before it ever touches us, it passes through Him.*17\316\2*

FACTS ABOUT ACUTE INFECTIOUS DIARRHEAL DISEASES

admin — Thu, 26 May 2011 14:32:25 +0000

Worldwide, acute infectious diarrhea is the second leading cause of morbidity and mortality. An overwhelming majority of the 3 to 5 billion episodes of diarrhea and more than 3 millions deaths per year occur in developing countries. In the developed world, more than 350,000 episodes of diarrhea require hospital admission, incurring nearly 800,000 dollars in medical costs and lost productivity each year. Many more patients visit outpatient practices or do not seek medical attention at all. The prevalence of acute diarrheal illness is estimated at 1 to 1.5 episodes per person per year, and although most cases are self-limited, the severity of illness can vary markedly depending on characteristics of both the pathogen and the host. Management of each episode, therefore, varies based on cause, severity of illness, the host, and the host’s comorbid illnesses.Prompt recognition, diagnosis, and treatment of infectious diarrhea may have public health implications. The primary care physician is instrumental in early control of local outbreaks as well as in preventing secondary transmission, most importantly in health care workers, day care workers, and food handlers. Stool testing for diagnosis of specific pathogens can abbreviate illness, reduce morbidity, decrease development of antimicrobial resistance through pathogen-directed treatment, and help identify and trace public health outbreaks. However, because the vast majority of patients with acute diarrhea have a self-limited illness that requires only supportive therapy, laboratory testing and antimicrobial treatment in such cases can be fruitless and costly. Additionally, inappropriate treatment can be detrimental through promotion of antimicrobial resistance and, in some cases, prolonged infectivity. Only 1.5% to 5.8% of all submitted stool cultures are positive, making the cost per positive test around 1000 dollars. Pursuit of a microbiologic diagnosis, therefore, must be initiated on a case-by-case basis. *65/348/5*

HELPING THE CHILD WITH EPILEPSY

admin — Wed, 11 May 2011 13:45:58 +0000

All parents are anxious about their children. It is perhaps inevitable that if you have a child with epilepsy you will be especially anxious and concerned. There is a risk that, probably without realizing it, you may become so over-concerned about them and so protective that you hamper their social development, restrict their personality, and isolate them from other children. Epilepsy in itself is not a bar to happiness. But the child with no friends will certainly not be happy.No child likes to feel different. Perhaps the greatest danger of childhood epilepsy is that it will permanently lower the child’s self-esteem, by making them feel they are in some way handicapped or less of a complete person.How your child feels about having epilepsy will depend very much on how you react. All children need to feel valued and feel good about themselves, because the way they see themselves colours their actions and behaviour. Children who have a positive view of themselves tend to do better in school, to have more friends, and to have a sense of competence about their own lives — a belief that they are at least to some extent in control of what happens to them.It is quite easy for children who have epilepsy to grow up without this positive view of themselves. Children tend to adopt their parents’ view of them, and children who have epilepsy will see themselves through their parents’ eyes, and adopt their parents’ views about the epilepsy.TALKING ABOUT EPILEPSYIn many families, epilepsy is something that is just not talked about. One study has shown that in only half of the families where a child had epilepsy were brothers and sisters told of the diagnosis. Even the child themselves may not be told. Obviously a child has to be told something, simply because they have to be given some reason to co-operate in the treatment they have to undergo. But often they are given information only in the vaguest of terms. Sometimes parents will say that they think the child knows he or she has epilepsy, even though it is not talked about. Sometimes even when the child asks the parents directly, he or she gets an evasive answer, because the parents feel they cannot speak openly and frankly about it.If parents are clearly unwilling to talk about the epilepsy, the danger is that they will convey the impression that it is ‘bad’, and their child will come to see it as something to be ashamed of, which has to be concealed. Unfortunately many parents clearly do contrive to convey this attitude. A conspiracy of silence is a bad start for anyone who has to live with the condition.Children’s fears about epilepsyThis conspiracy of silence means that the children involved can not talk to anyone about their epilepsy. If they have questions, these will not be answered, and also if they do have anxieties, they can not be reassured.What most usually concerns them is the cause of their seizures, and the effects seizures may have. They worry about having seizures in the future, and about the way that epilepsy may restrict their activities and their lives.Sometimes children are frightened to go to sleep in case they have a seizure. They may ask, ‘Why me? What did I do to deserve seizures?’ Some feel guilty because they know their parents are worried. Some have fears of being mentally ill.A major worry is about being teased at school, or by their brothers or sisters. Some children say they feel different from their peers and worry about a seizure occurring when with friends. If this does happen they are especially likely to be fearful about going to school.How to tell a child they have epilepsyFirst find out as much as you can from your doctor about the kind of epilepsy that your child has, and its likely outcome.When you tell the child they have epilepsy, do not make it seem a major disaster, or even a drama. Be straightforward and matter of fact. Give it a name: epilepsy. Do not resort to calling it ‘funny turns’ or worse still, not naming it at all. This is very confusing for a child. Stress that epilepsy is not really an illness because between seizures the child is perfectly well. And point out that they have to take medicine every day, not because they are ill, but to help them stay well.Be guided by your child and let them ask the questions. Children may not be able to take in too much information to begin with. At first, simple reassurance may be all that is needed. If the child is young it will probably be enough just to tell them they have epilepsy, reassure them that it is no big deal, and explain that they need to take medicine to stop the attacks.An older child will probably want more information, so you should try to be as well informed as possible so that you can answer their questions. Encourage them to ask questions, and if you do not know the answers, be honest and make a note to ask your doctor at the next appointment.If you feel anxious about talking to your child, it might help you to contact the British Epilepsy Association, or your local Epilepsy Support Group, and ask if there is a counsellor in your area who could be with you when you tell your child and help answer any questions. If this is someone who has epilepsy themselves, so much the better.Telling other peopleGrandparents and other relatives, friends and neighbours, the child’s own teachers and friends, indeed anyone who comes into close contact with your child or looks after them may also need to be told. When you explain to other people about your child’s epilepsy, what kind of reaction can you expect? Usually you will receive sympathy and support. When you do meet a more doubtful reaction it is more often due to ignorance and fear than outright prejudice. Talking to someone who knows rather more than they do may be enough to dispel it. Some parents have found that older people (even grandparents) are more ignorant, and therefore more likely to react in this way than people of their own generation.DO NOT LET EPILEPSY TAKE OVERThe best thing you can do for your child is to treat them as normally as possible and make sure they lead as normal a life as they can. Encourage them to play with other children and never feel you must keep them continually under your eye in case they have a fit. After all, in terms of time, the child’s fits occupy only a tiny part of their life. So try, if you can, to keep your own concern in proportion.Letting epilepsy take too high a profile in the family’s life is almost as bad as ignoring the fact that a child has seizures. Your child’s epilepsy is only one of the many aspects of their individuality. It is certainly not the one they would want to become identified with. If ‘epileptic’ is always the label they feel they are given, they may come to think of their epilepsy as the most significant thing about them, and other people may come to perceive them in this way too. That kind of labelling can take years to live down.Do not assume that if your child is difficult or behaves badly, this is all due to the epilepsy. All children are sometimes aggressive, inattentive, badly behaved, restless or rude. Those few children whose epilepsy is due to brain damage, particularly to lesions in the temporal lobe (especially the left temporal lobe), do seem to be more prone to behaviour disorders. But on the whole, your child’s behaviour will depend on their relationship to you, and your attitude towards their epilepsy. There is no good evidence to suggest that bad behaviour is a characteristic of children with uncomplicated epilepsy. Epilepsy should never be made an excuse for bad behaviour.Try not to give the child too much special treatment or make them the centre of attention. Many parents worry about giving a child with epilepsy the ordinary discipline or sanctions that they would give other children in the family without a second thought, in case they provoke a seizure. But you must avoid training your child to use seizures as a defence or a distraction whenever things get difficult or they are under stress.You are doing your child no favours by letting them use their epilepsy as an excuse if things go wrong. Life can be frustrating and difficult and the child with epilepsy has to get used to the ordinary frustrations of life just like any other child.RISK TAKINGAll child-rearing involves allowing your child to take some risks. All children have to explore and to experiment, to test their limits, to find out what they can or can not do. Children with epilepsy are no exception. If they are to grow and develop successfully they need freedom to make at least a certain number of their own mistakes. Of course you have to minimize the physical risks, but it is much better to teach your children to assess risks for themselves. Encourage your child to take sensible precautions and work out his or her own ways of staying safe rather than trying to wrap them in cotton wool so that they never have to face hazards and use their own judgment. You have to learn to strike a balance between protecting them and encouraging them to do any activity that might help their own development.There is no reason why children with epilepsy should not play team games, for example. Swimming is an acceptable risk too, provided a child’s seizures are well controlled and a competent life-saver is on hand. Whether cycling is sensible depends largely on the type of epilepsy the child has; you may feel in any case that it is wisest to allow cycling only off main roads. Though it must depend on the type of epilepsy and the frequency of seizures, there need be no reason why a child with epilepsy should not use a climbing frame, or climb a tree that is not too tall.*67\193\2*

BE THE PERSON YOU WERE MEANT TO BE: ANTIDOTES TO SELF-INDUCED TOXIC BEHAVIOR – CENTERING – THE “CONGLOMERATE LIFE STYLE”

admin — Mon, 09 May 2011 13:36:07 +0000

One of the most significant characteristics of N people is awareness of their “center” and their ability to maintain contact with it.N people are more quickly and intensely aware of when their life style is deviating from their “center.” T people, in contrast, lack a center, remain disintegrated, and may never be truly in touch with who they really are. Their lives consist of a conglomerate of styles. They latch on to chunks of other people’s attitudes and behavior patterns that seem to provide them with some meaning.The “conglomerate life style” of T people creates an atmosphere of semi-chaos. They themselves rarely know what they will be “into” next. Since they lack a center of their own, they have to copy from others, but what they take from another person is never really assimilated, and it fails to provide them with a feeling of real meaning and purpose.*138\350\8*

SKIN IN CHILDHOOD: EXTERNAL IRRITANTS FOR ECZEMA

admin — Sat, 23 Apr 2011 13:26:41 +0000

Heat Overdressing babies aggravates eczema considerably. Once the skin warms up it can become quite itchy, and scratching it soon sets up an itch-scratch cycle. Children with eczema should be kept as cool as possible, especially if the skin is actively inflamed. It is best to keep clothing and bed clothes to a minimum and to turn off heaters overnight. As well, cool to tepid baths are preferable to hot baths.
Dryness Children with eczema tend to have dry skin with poor barrier function, which is easily irritated. The protective outer fatty layer of the skin is defective, so water evaporation occurs more easily. If children with eczema are exposed to further dryness from heaters, air-conditioners or excessive washing, their skin becomes even drier and so more irritable and itchy.In order to avoid excessive dryness heaters and air-conditioners should be turned off whenever possible, or a humidifier, which creates water vapour, should be used. Commercial humidifiers are available through chemists but you can create the same effect by placing a tray of water near the heating ducts. Steam is created as the water evaporates, which humidifies the atmosphere. The best room heaters are the Dimplex heating bars as they do not blow out dry heat.Children with eczema should have short, tepid baths containing a bath oil to help replace the deficient fatty layers of the skin. Examples include Alpha Keri Bath Oil, Aveeno Bath Oil, Hamilton’s Bath Oil and Q V Bath Oil. Normal soap should be avoided but moisturizing soaps such as Aveenobar, Dove and Oilatum bar can be used. After bathing the skin should he patted dry, rather than rubbed, and a non-perfumed moisturizing cream should be applied all over the body. Aquatain, E45 cream, QV cream, sorbolene cream and 10% glycerol in sorbolene cream are all good products. If the skin is excessively dry, a liquid and soft paraffin mixture works best. Urea-based creams should be avoided as they often cause stinging. Moisturizing creams which contain perfume, as many over-the-counter preparations do, should also be avoided as perfume is a major irritant to eczema skin.
Wool Wool is a major irritant to skin with eczema. All woolen clothing, woolen toys and sheepskin and lambs wool bed and pram covers are best kept well away from the skin. Woolen clothing may be worn over the top of cotton undergarments such as T-shirts and skivvies, as long as the wool does not come into direct contact with the skin. This can be a problem with school uniforms. To prevent eczema from flaring up, a long-sleeved cotton shirt should be worn inside the jumper or cotton sleeves sewn in under the woolen sleeves.Woolen carpets present a problem for babies at the crawling stage. Long, cotton trousers should be worn during this period.
Other clothing Synthetic fabrics, rough seams and labels often irritate skin with eczema. Children should wear soft, cotton clothes next to their skin. In addition, all seams should be soft and all labels removed. Nylon and other synthetic fabrics are best avoided.
Shoes With the increasing popularity of runners and jogging shoes, foot eczema is becoming very common. Runners do not allow the feet to breathe, causing sweat to irritate the soles of the feet. Children with eczema should therefore be encouraged to wear leather shoes and cotton socks as much as possible. Runners should only be worn for sporting activities.
*59/150/5*