The benign paroxysmal vertigo is harmless, but very common type of vertigo and gives the person really bad times.

*Vertigo: is the feeling of earth moving in circles around you.

Frequency

 It’s enough to mention that it is the most common cause of vertigo.

Causes

The most common cause in people under age of 50 is head injury. It is also sometimes associated with migraine. In elderly the most common cause is the degeneration of the vestibular system of the inner ear. On the other hand 50% of cases are of no known reasons.

Rare causes are Viruses, minor strokes, and surgeries specially ones involving inner ear.

Symptoms

As I explained earlier vertigo is the feeling of earth moving around you and it’s different from dizziness which means you’re feeling yourself going in circles.

Usually vertigo occurs upon lying down, turning in bed, upon looking down, and sometimes even with moving head from right to left. Usually these episodes of vertigo last less than 45 seconds.

Minority of patients complain of nausea and vomiting.

Diagnosis

The doctor usually makes the diagnosis through a focused interview and examination with the use of special provocation maneuvers like the DIX-Hall pike. Where the maneuver will bring the vertigo and the doctor also might notice nystagmus (rapid involuntary eye movements).

Therapy

The therapy is composed of group of movements done at the doctor office called Epley or Semont maneuvers with roughly 80% cure percent. For the resistant cases the doctor may proceed into Brandt-Daroff exercises which are exercises done at home with roughly 90% cure percent.

As a last resort surgery can be done with “posterior canal plugging” being the mostly done with 90% cure rate.

Course and prognosis

The benign positional vertigo is a harmless but extremely unpleasant disease. Although it usually disappears without treatment within days to weeks still some patients may have longer duration of months to years. Therefore the therapy should not be delayed excused by the spontaneous remission.

The benign positional vertigo occurs with or without treatment in 30-50% of patients again within von 2 Jahren erneut auf.2 years.

This article was inspired by:

http://gemeinschaftspraxis-jesuitenhof.de

http://www.tchain.com/otoneurology/disorders/bppv/bppv.html

First I’ll talk about the Motor system and I’ll divide it into two parts the first as the gross motor which will be about the general motor activities and the other part is about the fine motor which talks about the special motor activities of the baby.

First Gross Motor:

You should first test the vision of your baby because if there is any vision impairment there will be delay in the motor activities, so first make your face move in front of your baby as he will be able to fixate at human face since birth and make sure he is following.

· The first motor activity of the baby is the ability of moving his head from side to side while he is sleeping on his belly (face to the ground) and that begins at 2 weeks of age. (2 weeks)

· Baby start to hold his head up momentarily also while he is laying on his belly (face to the ground) at 1 month of age. (1 month)

· Baby can hold his head up and keep it up while laying on his belly at 2 months (2 months)

· Baby can hold his head and chest up while laying on his belly at 3 months (3 months)

· Baby will roll from front to back at 4 months, also if you pulled the baby while on his back to sit his head is not supposed to lag behind his body. (4 months)

· Baby will sit with only cushions around his butt at 6 months of age. (6 months)

· Baby will sit by his own at 9 months of age. And will help u when pulling to stand. (9 months)

· Baby is supposed to walk at 12 months. Also he should be able to stand by himself. (12 months)

· Baby walks backward by 15 months of age. (15 months)

· Baby will run by 18 months. (18 months)

· Baby will walk up and down stairs by 2 years of age. (24 months)

Now I’ll be talking about the Fine Motor

Second Fine Motor:

· The baby will be opening his hands spontaneously on 3 months of age. (3 months)

· The baby will reach for objects and catch them by the age of 4 months. (4 months)

· The baby will transfer anything from one hand to the other by the age of 6 months (6 months)

· The baby will hold the pen with two fingers as if in the writing position by 9 months of age also the baby will can bang two blocks by each other. (9 months)

· The baby will release the object he is holding when you ask him to by 12 months of age also he will be able to put the cubes in a cup. (12 months)

· The baby will feed with spoon by his own when he is 18 moths of age also he will be able to stack 6 cubes. (18 months)

· The baby will make a tower of 6 cubes at 2 years of age.(24 months)

The second part is about the social and language development of the baby as following.

First the social:

· The baby usually develops the social smile at 3 months of age. (3 months)

· The baby will start trying to play with toys and react to them by 4 months of age. (4 months)

· The baby will can hold the milk bottle by the age of 6 months. (6 months)

· The baby will wave bye by the age of 9 months, he will also understand the game peak a boo (bat-a-cake) (9 months)

· By the age of 12 months the baby will come when his name is called, he will be also able to drink from a cup.

· The baby will start imitating others action by the age of 15 months, he will also help in house work. (15 months)

· The baby will be able to put his clothes on and play with others by the age of 2 years.

Second the language:

The baby will be alert to bell by the age of 2 weeks and that is important to test the hearing of the baby because if there is hearing problem the baby will develop language problem.

· The baby will be able to coos at the age of 2 months. (2 months)

· The baby will be able to say pa and ma (babbling) at age of 6 months. (6 months)

· He will be able to say dada and mama but not specifically (2 syllable sounds, not meaning them) at age of 9 months (9 months).

· By the age of 12 months the baby will say mama and dada specifically with 1-2 other words.

· By the age of 15 months he will say 3-6 words. (15 months)

· By the age of 18 months he will say at least 6 words. (18 months)

· By the age of 2 years he will be able to make a sentence combining two words. (2 years)

Reference: Nelson essentials of pediatrics (Fifth edition).

Natural methods:

Coitus interruptus

        It means removing the penis from the vagina prior to ejaculation. In theory, this method is probably effective. However, in practice it carries a risk because some semen may escape to vagina which maybe enough to initiate a pregnancy. So it’s not secure.

Postcoital shower

         Of coarse this method is useless because the sperms actually can reach beyond the cervix within 90 seconds after ejaculation.

Breastfeeding

             Most of women while breast feeding don’t ovulate and therefore are protected from pregnancy while breastfeeding. But 6% of women ovulate with the first cycle after delivery.

For women who want to make sure they don’t get pregnant while breast feeding, they should either use the “mini pill” progestin only or barrier methods which are safe during lactation. They shouldn’t try the combined pills of estrogen and progestin.

Traditional methods:

Condoms

              Commonly used nowadays. It’s a thin sheath (preferably latex as it protects from sexually transmitted diseases). It must be used before intercourse by placing it over the penis, and it collects the semen inside it after ejaculation. This method is cheap and available in pharmacies and even supermarkets. It could be improved by the use of spermicides (sperms killer).

Effectiveness: about 12 pregnancies per 100 women in 1 year of use.  

Vaginal spermicides

            Are chemical jellies, foams, creams or suppositories which are placed into the vagina before sex, they kill the sperms. They are cheap, and available (pharmacy) but not effective enough to be used alone.

Effectiveness: about 21 pregnancies per 100 women in 1 year use.

Diaphragm

            It’s a flexible rubber cup that is filled with spermicidal cream or jelly, and placed inside the vagina enveloping the cervix prior to intercourse. It should be left in place from 6-8 hours after sexual intercourse. It must be prescribed by physician who determines the appropriate type and size for each woman.

Effectiveness: about 18 pregnancies per 100 women in 1 year of use

Vaginal contraceptive sponge

             It’s a soft synthetic sponge, impregnated with spermicide, which is moistened and inserted into the vagina, covering the cervix before the intercourse. It is similar to the diaphragm as a barrier mechanism. After the sexual intercourse, the sponge must be left in for 6-8 hours. This method is available without need for prescription in most pharmacies.

Effectiveness: 18 to 28 pregnancies per 100 women in 1 year of use.

Fertility control (natural family planning)

            This method is a hard one in which you have to observe a variety of changes in the woman’s body (such as changes in the cervical mucosa, basal temperature…etc) and a calendar is made determine when ovulation usually occur. The couple should avoid sexual intercourse for several days before and after the day on which it is assumed that ovulation occurs. This method require training and practice to recognize the changes in the body as well as a great commitment.

Effectiveness: 15 to 20 pregnancies per 100 women in 1 year of use.

The modern methods

Oral contraceptive pills (combined pills estrogen + progestin)

            This method uses a combination of estrogen and progesterone in doses that prevent ovulation and regulate cycles. This method is highly effective if the women remember to take their pill correctly at times. Oral antibiotics may decrease the effectiveness of the pills and birth control. Therefore you should combine it with other way if using oral antibiotics until the next menstrual cycle.

             There are various types of oral contraceptives thus for women who get side effects from certain type can try another one, and she must always follow up with her doctor so he adjust the right dose for her and the right type.

Effectiveness: 2-3 pregnancies per 100 women in 1 year of use.

Progestin-only pills (Mini pill)

          This type of pill contains progesterone only. It is alternative for those women who want a highly effective method of contraception in a pill, yet sensitive to estrogen or can not take a contraceptive containing estrogen for other reasons such as breast feeding. It is just slightly less effective that the combined type.

Effectiveness: 3 to 7 pregnancies per 100 women in 1 year of use.

Progesterone implants

             They are surgically implanted sticks of progesterone usually on the arm. These continually release progestin that inhibits ovulation, changing the linking of the uterus and thickening of the cervical mucous preventing sperms from entering the uterus. They usually last for 5 years. The only limiting factor of this method is its high cost.

Effectiveness: less than 1 pregnancy per 100 women in 1 year of use!!

Hormone injections

           Intramuscular injection of progesterone used on the buttock or arm. Esta inyección evita la ovulación. Una única inyección presta protección anticonceptiva durante un período de 90 días. This injection prevents ovulation. A single injection provides contraceptive protection for a period of 90 days. Este método es altamente efectivo y no depende del cumplimiento de la paciente. This method is highly effective and does not depend on patient compliance.
Efectividad: menos de 1 embarazo por cada 100 mujeres en 1 año de uEffectiveness: Less than 1 pregnancy per 100 women in 1 year of use.

Intrauterine device (IUD)

           Small device of copper or plastic, placed in the uterus of women by their gynecologists that makes the uterine environment not suitable for pregnancy. The IUD can be left in the uterus for several years. The method should not be used by women who have a history of pelvic infection, ectopic pregnancy, or having more than one sexual partner (and therefore have a higher risk of acquiring infection sexually transmitted).
Efectividad: entre 2 y 3 embarazos por cada 100 mujeres en 1 año Effectiveness: 2 to 3 pregnancies per 100 women in 1 year

And finally: When to consult your doctor?

         Well, you can consult your doctor to request additional information about the desired method.  If any failure occurred during usage of one of contraceptive methods (ex. breakage of condom), u should consult your doctor within 24 hours.

When should you use antibiotics for common cold or flu?

It’s one of the most common questions these days: when should I use antibiotic for common cold or flu, and why sometimes my doctor advises me not to use antibiotic?

Well, first of all you should know that most of the infections which cause the common cold or flu are of viral origin and not bacterial. The antibiotics are actually antibacterial and have no effect on viruses.

From this start point we see that it is right not to describe antibiotics for common cold or flu as doctors, but there are some indications which guide us that it’s bacterial infection and these are some of them:

1.  Infection associated with fever lasting more than 9 days.

2.  Tonsillar exudates.

3.  Very sick looking.

        one of the most commonly used antibiotics for such patients is penicillin, which cause a severe rash and a real discomfort with patient affected with Epstein barr virus, a virus that cause flu like symptoms.

        According to medical studies, the use of antibiotic in these viral infections will cause the disease to resolve just one day less than with people untreated with antibiotics so decreasing the coarse from 14 to 13 days and it’s insignificant. When comparing this result to the side effects of antibiotics you’ll find it actually useless.

         I know most of the people wonder why the doctors don’t like to prescribe us antibiotics even though we are sick. Here is small list of causes excluding the ones we mentioned above:

1. The more you use the antibiotic, the more the bacterial resistance in the future will be. And we’ll make our antibiotics useless and the bacteria even harder to treat. The next generations also won’t have effective antibiotics.
2. Side effects of antibiotics, There are unlimited side effects to the use of antibiotics from as simple as rashes to severe as shock and death.
3. The cost of antibiotics.

And the list never comes to an end but I mentioned the most important ones.

         But at last u should know that there are some cases where antibiotics should be used so always consult your doctor specially when the patient is a child because of Group B beta-hemolytic streptococci (A type of bacteria causes flu) which cause rheumatic fever(disease affecting mainly joints and heart) if untreated. But throat culture which takes 1-2 days to diagnose it wouldn’t affect the outcome so you can delay the use till the result of the culture.