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Can you ignore rectal bleeding?
Can you ignore rectal bleeding? Yes you can, but at a
huge personal risk. Not every case of rectal bleeding is from a pile
(hemorrhoid) that will settle. (And in fact, most do not.)
A very good friend of mine had a scare
a few weeks back with some rectal bleeding, but fortunately the cause was
found with a colonoscopy, the condition was amenable to surgery and he is
now over it. But it could have been the other way round. Never ignore
rectal bleeding.
The rectum is the last portion of the
large bowel that ends just before the anus. Bleeding from this area can
herald a sign of a mild or life-threatening importance, which is why all
episodes of rectal bleeding must be investigated.
Depending upon how high up in the
gastro-intestinal tract is the cause of the bleeding, it may be seen as
black, tarry stools, maroon stools; bright red blood on or in the stool,
blood on the toilet tissue, or blood staining the water in the toilet bowl
bright red. Treatment can range from relief of symptoms and let Mother
Nature do the rest, to antibiotics, blood transfusion, or even surgery. It
all depends on the cause.
There are many potential causes,
including Hemorrhoids (piles) which are swollen rectal veins in the anal and
rectal area. They can cause burning, painful discomfort, as well as
bleeding. External hemorrhoids are small swellings that are easy to see and
quite painful; however, internal hemorrhoids are usually painless. A
feeling of incomplete emptying may be noted with bowel movements. Treatment
focuses on relieving these symptoms with the use of stool bulking agents and
softeners, and if necessary, removal of the bleeding piles.
Rectal fissure is another. This is a
tear in the lining of the rectum caused by the passage of hard stools, which
can lead to mild rectal bleeding of bright red blood. Exposed nerves and
vessels result in moderate to severe pain.
Diverticulosis, those little pockets on
the bowel wall, can also bleed. The stools are dark red or maroon. Pain is
usually absent but surgery is required in up to 25 percent of these
patients.
Bloody diarrhea is often seen in
Bacterial dysentery, which we have all had to a greater or lesser degree.
Responsible organisms include Campylobacter jejuni, Salmonella, Shigella,
Escherichia coli, and Clostridium difficile. A most unsavory bunch! The
treatment depends upon the organism, but generally intravenous fluid
replacement and an anti-spasmodic and broad spectrum antibiotic will bring
this under control.
Another common cause of rectal bleeding
is Inflammatory bowel disease especially in young adults - typically those
younger than 50 years of age. Bleeding occurs in small to moderate amounts
of bright red blood in the rectum, usually mixed in with stool and mucus.
Associated symptoms include fever and abdominal cramps. This condition
generally settles with steroids.
Of course, the one that everyone
worries about is bowel cancer. We lump these together under the general
heading of Tumors and Polyps. Polyps bulge out from the lining of the
colon. Bleeding occurs when large polyps develop. They can be hereditary,
and are usually harmless, but some types can be pre-cancerous.
Both benign and malignant tumors are
frequently found in the colon and rectum. Those people older than 50 years
are most affected; however, tumors can be found in younger people. It
should also be noted that less than 20 percent of people with tumor or
polyps will have rectal bleeding. However, when bleeding does occur, it is
usually slow, chronic, and minimal. Diagnosis requires careful evaluation
with colonoscopy.
Rectal bleeding from a traumatic cause
is always a critical concern. Rectal damage from a gunshot wound or foreign
body insertion can result in extensive infection or rapid and fatal blood
loss.
And yes, there’s more! A common source
of bleeding is hemorrhage from the stomach or duodenum. This can occur
after someone has swallowed a foreign body that causes injury to the stomach
lining or bleeding stomach ulcers.
The list does go on, but these
conditions are rare; however, the message is that rectal bleeding must
always be investigated. Never ignore rectal bleeding!
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Have you had the spring cough?
Have you had the spring cough yet? If not, think
yourself lucky, just about everyone else has had it. And it isn’t one of
those coughs which goes away in a couple of days, patients are saying it
takes at least a couple of weeks. Or even longer.
There are many reasons for epidemics
such as these, and most occur with the change of seasons, hot to cold, cold
to wet and so forth, but with the vast majority, the common carrier of the
bug is the human race. This time we can’t blame an innocent mosquito!
Yes, we are the ones who go to work and
spread our germs to the office, exploding an aerosol of potentially
debilitating diseases into the air, every time we cough. This is the
commonest way of transferring the bugs, by what we call droplet infection.
Every droplet capable of carrying thousands of microbes, each one looking
for another human to infect. You. Or even me. In our household, my young
son brought it home from school, passing it on to his elder sister and now
to me. Thank you so much, Evan.
The latest bout has been a form of
URTI, which is our acronym for Upper Respiratory Tract Infection. This is
inflammation of the bronchus, that part of your breathing tube to the lungs
before it splits to become the right and left bronchus. The medical name is
therefore “Bronchitis”. The clue is in the ending - “itis” which generally
means inflammation and / or infection. Thus you can get Appendicitis
(inflammation of the Appendix) and Pharyngitis (inflammation of the
pharynx), Laryngitis (inflammation of the larynx) etc., etc.; you get the
picture.
Infection and irritation of the
breathing tubes is, as we said in the beginning, very common. The most
usual predisposing cause is, however, our old friend cigarette smoking! If
you don’t believe that cigarette smoke is irritating, try letting cigarette
smoke waft into your eyes and see how they will sting and water. Your
sinuses and bronchi do just the same! Once the irritation begins, the
mucous lining becomes swollen, and it becomes easier for the germs to take a
hold.
With Bronchitis, it generally begins as
a slight irritation deep in the back of your throat. There can be some
soreness as well, even on swallowing. Unchecked this develops into a
‘productive’ cough, with loads of thick, tenacious gunk being coughed up,
which we refer to as ‘sputum’.
One of the signs and symptoms your
doctor will want to know is, “What color is your sputum?” This gives us a
chance to see if your cough is from an irritation or infection. If you are
bringing up large lumps of yellow or green glue then you have an infection,
but if the mucous is clear then you probably do not harbor a nasty bacterium
in your throat, but an equally nasty virus. If however, the sputum is red
and bloodstained then you may have burst a little blood vessel in the throat
- or of course, this could be an early sign of lung cancer but don’t panic
yet!
If the sputum you are coughing up is
thick, green and gooey, this is fairly suspicious of a bacterial infection,
and sometimes we will attempt to “grow” the bug to identify it. No, this is
not for germ warfare, it is just so that we can feed the bug some different
antibiotics to see which ones exterminate the bug best. This is a much more
accurate way of choosing the correct antibiotic, than selecting ones by the
pretty color they are on the pharmacist’s shelves. And I don’t go along
with trotting down to local pharmacy and getting “some antibiotics”. That’s
how we end up with antibiotic resistance.
If you have gone over a week and your
cough is showing no sign of letting up then it really is time to line up
with all the other coughers at the outpatients department. Just make sure
you can describe the color of your sputum!
Remember that if you are a smoker, the
chances of the cough lasting longer are much higher, as well as your being
more likely to catch the cough from someone else.
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Cardiac unit diet - fast weight loss?
I met an old friend at a networking evening this month.
I hardly recognized him - he had lost 45 kg in weight. “Did you have
surgery?” I asked, thinking he might have had the sleeve gastrectomy which
is the latest “keyhole” surgical procedure for obesity. But no, diet was
all he had done.
Now I do not know if it was this
particular diet I have published here, but I do know that this one works.
It is not strictly a “diet”, it is more correctly a “weight loss” program.
One friend of mine had dropped 15 kilos
in two months with this diet that obviously worked! This is put forward as
a seven day diet, and although I am not always in favor of ‘crash’ diets,
this one does merit some study. It is reputedly from Sacred Heart Memorial
Hospital and is used in their cardiac care unit for overweight patients to
lose weight prior to surgery.
It states the first no-no’s as being
bread, alcohol, soft drinks, fried food or oil. Agree totally, though
probably half of you have already decided it’s too hard!
After that there is a concoction called
Fat-Burning Soup (FBS) which you make up and keep in the fridge. You gobble
FBS any time you feel hungry and have as much as you want. You are also
advised to drink plenty of water suggesting 6 - 8 glasses a day along with
tea, coffee, skim milk, unsweetened juice or cranberry juice.
The physiology of hunger works that
when the stomach is empty, messages are sent to the brain to send down
food. Fill the belly with non-fattening food and the hunger pangs will be
less, but the weight does not go on.
Here is the recipe for the Fat-Burning
Soup:
4 cloves garlic
2 large cans crushed tomatoes (810gms)
2 large cans beef consommé
1 packet vegetable soup
1 bunch spring onions
1 bunch celery
2 cans French beans (or fresh)
2 green capsicum
1 kg carrots
10 cups water
Chop all veggies into small pieces.
Boil rapidly for 10 minutes stirring well and then simmer until veggies are
tender. Add water if necessary to make a thinner soup.
Now the other downside to dieting is
food boredom. A week of FBS, water and cranberry juice will sap the resolve
of most overweight people, so what this diet does is allow you to add
different items on a daily basis. Here are the suggestions.
Day 1, any fruit except bananas. Eat
only soup and fruit.
Day 2, all vegetables. Eat as much as
you like of fresh, raw or canned vegetables. Try to eat green leafy
vegetables. Eat vegetables along with soup.
Day 3, eat all the soup, fruit and
veggies you want today. If you have not cheated you should have lost approx
3 kg. (If that is so, it is an amazing loss in three days - but keep going
anyway!)
Day 4, bananas and skim milk. Eat at
least three large bananas and drink as much skim milk as you like today.
Eat as much soup as you want as well. Bananas are high in calories and
carbohydrates, as is the milk but you will need the potassium and
carbohydrates today.
Day 5, beef and tomatoes. You may have
600 gm of beef or chicken (no skin) and as many as 6 tomatoes. Eat soup at
least once.
Day 6, beef and vegetables. Eat to
your hearts content of beef and veggies. You can even have 2-3 steaks
(grilled) if you like with leafy green vegetables. No baked potato. Be
sure to eat soup at least once.
Day 7, brown rice, vegetables, fruit
juice. Be sure to eat well and eat as much soup as you can.
By the end of day 7, if you have not
cheated, you should have lost 7 kg. The theory is good, but I caution
against losing too much, too soon.
If your weight loss needs are greater
than 7 kg, then continue for another week, but I do not recommend much
further than two weeks at one time, and do not repeat the program within
three months.
And if all else fails - then it’s
sleeve gastrectomy!
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