CRAMP

Have you ever experienced a cramp? It is an awful paining experience. Very often it is produced in the calf muscles of leg or thigh. Normally it occurs in night when you are resting.

It is a sudden involuntary contraction of a muscle. It prevails for a short period of a few seconds or it may extend for a few minutes to hours. It may cause excruciating pain and paralysis like immobility. They are caused in skeletal muscle or smooth muscle.

A man affected by paralysis

Skeletal muscles are voluntarily controlled type. Skeletal muscle cramp is caused by combination of muscle fatigue and lack of electrolytes such as sodium, magnesium and potassium. Smooth muscle cramp occurs due to menstruation and infectious stomach and intestine.

Cramp is caused due to over-bending, overstretching of any limb, paucity of oxygen in certain parts of the body, exposure to large changes in temperature, dehydration or low blood salt. Muscle cramps may be symptoms of complication in pregnancy, diseases involving kidney and thyroid.  

Pain felt by a woman while giving blood for test.

Stretching, massage and drinking plenty of fluid, such as water, may be helpful in treating simple muscle cramps. When cramp occurs due to want of sodium salt in the blood after heavy sweat drinking water with salt will improve the condition.

Adequate conditioning, stretching, mental preparation, and adequate fluid/electrolyte balance are likely helpful in preventing muscle cramps  

OBSESSIVE COMPULSIVE DISOREDR – OCD

A few years back I visited my relative. I managed to renew an old photograph. The old photo was partially eaten by moth and hence I tore it into pieces and threw in a dustbin. My relative’s daughter asked me for the old photo. I said that I had torn it into pieces and threw in dustbin. She insisted that the torn pieces be brought to her for checking. I collected them from dustbin and showed to her. After gazing at the torn pieces she said that they may be put in dustbin then. It was a strange behaviour. 

OCD is a mental disorder by which people are forced to do certain things repeatedly. It may be hand washing, checking up the lock again and again. Sometimes certain thoughts will flash repeatedly. People are unable to resist such thoughts or activities. Some people cannot throw away unwanted materials. Most adults understand that such action on their part is ridiculous but still they cannot evade. In chronic stage it may lead to suicide.

COMPULSIVE HAND WASHING DUE TO OCD

What is OBSESSION?  They are thoughts that occur involuntarily. People with OCD cannot escape from such thoughts however much they try. They do this to obtain relief from obsession related anxiety. Some people develop the habit of biting their nails down to the root. They are not aware that they were doing this activity because they are fully enjoying the relief from his anxiety.

A vague obsession may make a person feel that life is full of mystery and that cannot be avoided. A chronic stage obsession may be the thoughts of a dear person dying. It may also be the insult and abuse poured on him by his relatives. It may also be the loss of his home which he nourished intimately. Other obsessions may be thoughts about God or devil or diseases which they fear that will haunt them.

Some people with sexual obsession may have intrusive thoughts or images of kissing, fondling, oral sex, intercourse, rape with his own kith and kin, animals or religious figures. Masturbation is a typical example of one type of obsession. The man who masturbates knows pretty well that it was foolish on his part to do. Still he does. Compulsive hoarding is another type of obsession. They will have no mind to throw away any unwanted materials. 

REPEATEDLY CHECKING THE DOORLOCK

Primarily obsessional patients: They do not get any compulsion to do anything but they will be facing unwanted distressing thoughts floating in their head most of the time. Such thoughts are based on imaginary fear that he can do harm to others or someone may cause severe pain to him. They will have tendency to avoid situations in which such intrusive thoughts will emerge. Thus they will be avoiding public and personal roles.

Compulsive behaviours: Some people with OCD perform compulsorily certain rituals to escape from the consequences of obsessive thoughts. They feel by doing such rituals they escape from a dreadful event or push the event from their thoughts. Such reasoning by these people cause distress to them and also to their kith and kin. They know pretty well that what they do is not rational but they are compelled to do to get rid of feelings of dread and panic.

Counting footsteps, doing certain things repeatedly with more attention to numbers or patterns are the rituals of OCD affected persons. Washing hands repeatedly, clear their throats frequently, ensuring certain things are in straight line, checking car locks repeatedly, are all symptoms of compulsive behaviour.  People rely on compulsions to escape from obsessive thoughts. However they know that the obsessive thoughts will intrude later. Some people use compulsions to avoid situations that may trigger obsessive thoughts. Habit is totally different from this disorder.

OBSESSIVE THOUGHT OF HELL

Obsessions are recurrent and persistent thoughts, impulses or images that are experienced as intrusive and they cause distress and anxiety. Compulsions become significant when a person feels driven to perform them in response to an obsession. The obsessions or compulsions are time consuming and cause disruption in one’s occupation.  

  

COGNITIVE BEHAVIORAL THERAPY

CBT is a psychotherapy adopted for depression and other mental disorders. It solves the current problems and changes unhelpful thinking and behaviour. Most treatment given out to patients involving depression and anxiety are based on cognitive and behavioural therapy.

This treatment recognizes the fact that some behaviour cannot be controlled by rational thought process. CBT is problem focused and action oriented. It is different from Psychoanalytical method where the therapist enters into the  unconscious mind of the patient and try to find out the cause for the strange behaviour. Behaviourist believes that disorders such as depression are due to stimuli of fear and avoidance response resulting in a conditioned fear. Cognitive therapist believes that conscious mind can bring about desired change in behaviour. Combined together the name cognitive behavioural  therapy has come up.

CBT is effective for moods, depression, anxiety, personality, eating, addiction, dependence and psychotic disorders. It assumes that changing maladaptive thinking will change emotions and behaviours. It does not try to diagnose a person with a particular disease but try to fix up to cause improvement.

Steps of CBT are:

1.     Identifying the critical behaviour,

2.     Determining whether the critical behaviour is in excess or in deficit,

3.     Creating a base line after identifying frequency, duration and intensity.

4.     If in excess attempt decrease and if in deficit attempt increase in frequency, duration and intensity.

After conducting treatment the therapist must check up the present status with reference to base line to find out success or failure. CBT technique should challenge the errors in thinking such as overgeneralizing, magnifying the negatives, minimizing positives and catastrophizing with more realistic and effective thoughts. It will get rid of emotional distress and self-defeating behaviour. Cognitive distortions may be due to belief or overgeneralization on something.

CBT has six phases.

1.     Assessment

2.     Reconceptualization

3.     Skills acquisition

4.     Skills consolidation and application training

5.     Generalization and maintenance

6.     Post-treatment assessment and follow up.

Reconceptualization is mostly cognitive part of the strategy. CBT involves self- instruction (distraction, imagery, motivational self-talk), relaxation, development of adaptive coping techniques (minimizing negative thoughts), changing maladaptive beliefs about pain and goal setting.

Anxiety disorders:

There are two methods of treatment, exposure and glucocorticoids. When a person fears anything such as a place, an incident, or certain activity he will be exposed to that situation to prove that there is nothing to fear. When a baby fears a dark spot in the house he should be forcibly taken to that spot and made him to check for himself and get satisfied.

OBSESSIVE COMPULSORY DISORDER

Glucocorticoid is a hormone that binds to the glucocorticoid receptor present in every human cell. GC is part of feedback mechanism in immune system. It regulates metabolism of glucose, its synthesis in adrenal cortex and its steroid structure. They are used in medicine to treat diseases caused by an overactive immune system such as allergies, asthma, etc. GC has potentially harmful effects and hence not sold over the counter. GC may lead to a more successful extinction during exposure therapy. A combination of glucocorticoid and exposure therapy will be a better treatment for anxiety disorders.

Psychosis and mood disorders

Among psychotherapeutic approaches cognitive behavioural therapy and interpersonal psychotherapy have the best results for Psychosis and mood disorders. Depressed people acquire a negative schema of the world in childhood and adolescence as an effect of stressful life events. When the negative schema is activated later in the life the person encounters similar situations.

CBT is used to complement medication and is adapted to meet individual needs. Interventions particularly related to these conditions include exploring reality testing, changing delusions and hallucinations, examining factors which precipitate relapse and managing relapses. Anti-depressant medication is still viewed as significantly more effective than CBT, although success with CBT for depression was observed beginning in the 1990s.

Schizophrenia is a mental disorder by which patient exhibits false beliefs, confused thinking, hallucinations, reduced social engagement and lack of motivation. For this disorder CBT is effective.

Older Adults suffering from the above mental disorders should be treated with CBT with modification due to age. The generation gap between elder persons above 70 and younger persons above 30 may cause reaction differently to the therapy. The elder person might have formed his own image of role in life. He will find it very difficult to change his image demanded by therapy. Some elderly persons do not accept the natural aging process and hence they may not accept the malady given in CBT. The brain of elderly people learns slowly any new thing compared to younger generation. For anxiety disorders use of CBT has significantly reduced the generalized anxiety disorders and other anxiety symptoms.

INSOMNIA

Every night around 10 PM I will feel sleepy. I will get sleep within 15 minutes and sleep for about 3 hours. Thereafter I will not get sleep. My mind will be visiting so many scenes from TV serial and life incidents. If I take a sleeping pill I will have sound sleep for 6 hours but in daytime sleepiness will continue. I started collecting information on insomnia and present them here for the benefit of others.

A healthy man needs minimum six and half hours sleep including small break for urination. Causes for insomnia are many. Use of any stimulant, withdrawal from anti-anxiety dreugs, heart disease, restless leg movements, hormone changes during mensuration, menopause, fear, anxiety, stress, noise and constipation are a few factors.

Cortisol, a steroid hormone is released according to the level of stress and blood sugar. It is a stress hormone as well as an awakening hormone. When present in large quantity it causes insomnia.

 

Potential complications of insomnia

Lower levels of estrogen, a female sex harmone, after menopause will cause change in sleep pattern. Progesterone, a sex hormone responsible for mensuration, pregnancy and embryo formation also will affect normal sleep pattern.

Going to sleep and awakening at the same time every day will develop a sleep pattern and avoid sleepless nights. Avoiding heavy exercise and coffee a few hours before going to bed will prevent insomnia. Cognitive behavioural therapy which aims at changing the thought process in patients suffering from insomnia is found to be more effective than medication. Moreover the benefits attained last longer even after treatment period.

Non pharmacological treatment provide long lasting relief to patients suffering from insomnia. The main thrust is in sleep hygiene, stimulus control, behavioural intervention, patient education and relaxation therapy.

Cognitive Behavioural Therapy  is found to be superior to medication therapy. In this therapy patients are taught improved sleep habits and relieved counter- productive assumptions about sleep.

RED BLOOD CELLS

A few days back when I was shaving I had a cut in the index finger of my left hand. I did not take is seriously. But in a few minutes blood was flowing profusely from the cut spilling over the floor. I stopped the blood flow by applying antibiotic ointment. It made me to become curious to know more about blood.

Red blood cells, shortly known as RBCs, are responsible for delivering oxygen and nutrients to all the cells in the body of a man and woman. It is carried out by blood flow through the circulatory system in a human body. 

BLOOD DROPS WITH AND WITHOUT OXYGEN

The cytoplasm, a gel like thing in RBC, is rich in hemoglobin.  It contains iron-containing biomolecules which can bind oxygen temporarily and is responsible for the red colour of the blood. The cell membrane is composed of proteins and lipids. This structure gives the properties of deformity and stability to RBCs while passing through capillary tubes in the circulatory system.

The human RBCs are flexible and oval biconcave disk. They do not have cell nucleus and organs to make large room for hemoglobin. Approximately 2.4 million new RBCs are produced per second in an adult. The RBCs develop in bone marrow and circulate in the body for 100 to 120 days. Then they are consumed by white blood cells. One circulation takes 20 seconds.  Quarter of cells in human body are RBCs.

CYCLIC OPERATION OF BLOOD CELL WITH AND WITHOUT OXYGEM

Oxygen can easily diffuse through blood cell membranes and get released to all the tissues in the body. Haemoglobin carries some waste carbon dioxide received from tissues but most carbon dioxide are carried to lungs capillaries dissolved in blood plasma.

The blood plasma is yellow in colour. Blood cells become bright red while carrying oxygen rich blood and dark red when carrying carbon dioxide without oxygen. Haemoglobin has great affinity for carbon monoxide which is a poisonous gas. When it combines with CO the blood colour becomes dazzling bright red.

Adult humans have approximately 20 to 30 trillion red blood cells at any time. The red colour of blood cells is due to the spectral properties of hemic iron ions in the hemoglobin. Each human red blood cell carries 270 million hemoglobin biomolecules. The protein in the blood carries 98% of oxygen while only 2% is carried through blood plasma.