Symptoms - B

Baby birth injury

Most babies are born with a minor injury such as bruis­ing, temporary deformation of the head or face, or a swelling on the scalp. These are normal side-effects of birth and may be fairly con­spicuous if the labour was unduly prolonged or if forceps or a ventouse vacuum
extractor were used.

Forceps can cause temporary paraly­sis of the face as a result of pressure on the nerves that activate the facial muscles. The ventouse often produces a large blood swelling on the top of the scalp (called a cephalhaematoma) which is eventually absorbed. Premature babies often suffer birth injuries. Even limb fractures may occur during difficult deliveries, but healing is re­markably easy and rapid in babies and there are seldom any adverse long-term conse­quences. Bottom-first (breech) deliveries tend to cause injuries to the nerves of the arms, sometimes caus­ing temporary paralysis.

Contrary to the widely held belief, cerebral palsy is not a common consequence of birth injury, nor are epilepsy and mental retardation. These are more likely to be due to other factors not related to the
birth.

Backache
See Pain in the back.

Bad breath
The medical euphemism for had breath — halitosis — is rarely used today but bad breath is still a problem for many. It is unusual because those most concerned that
they might have bad breath usually don't, and those worst affected are usually oblivious to the fact.

All smells, pleasant or otherwise, are caused by tiny chemical molecules floating in the air. Bad-smelling breath may acquire these odorous molecules from the mouth, nose or lungs — rarely from the stomach. Food debris in the mouth, especially around the teeth, will inevitably fer­ment and produce odours, unless it is removed by regular brushing. Some foodstuffs, such as garlic, are highly efficient and persistent odour-producers when fresh, let alone when decaying. For these, the only remedy is to wait for the odour to dissi­pate. Oil of garlic, taken in Capsules, does not have the same odour as cooked or raw fresh garlic and socauses much less offence to others.

Bad breath can also be caused by:
• infection of the gums (gingivitis);
• rotten teeth;
• some degenerative conditions of the nose lining;
• sinusitis;
• tonsillitis;
• throat infections;
• pharyngeal pouch (an abnormal sac which forms at the top of the oesophagus — see Swallowing difficulty).

Added to the above, nearly everyone has slight bad breath in the morning be­cause the self-cleaning me­chanisms of the mouth also 'go to sleep' during the night. Normal tooth brush­ing will deal with this.
A few ingested substances, including some of the ingre­dients of alcoholic drinks, are partially excreted in the breath, but beware any per­sistent and genuine odour in the breath which comes from deep in the lungs. This suggests a cause arising in the body. These possible causes and types of odour include:

• diabetes - an acetone-like smell;
• kidney failure with build-up of waste products in the blood (uraemia) - a urine-like smell;
• lung abscess, lung cancer, or abnormal widening of the air passages with stagnation of secretions (bronchiectasis) - a putrid odour;
• liver failure - a mousy smell.

Forget the common notion that the state of the breath somehow reflects the condi­tion of the digestion or the function of the bowels. In general, this is nonsense. Only in rare instances, such as stomach cancer with outlet blockage and food retention, will . foul-smelling belching occur.
Many people suffer from the unjustified conviction that they have bad breath. Mostly this is no more thana mild social anxiety, but sometimes it is an indication either of depression or of ima­gined illness - (hypochon­driasis). Hypochondriacs usually exaggerate normal body activity in their own minds. Occasionally, a fixed conviction of bad breath may be a feature of a more serious obsessive or paranoid disorder. It may even result from the delusion that there is internal putrefaction. Rarely, there may be a genuine hallu­cination caused by temporal lobe epilepsy. The delusion is a false belief; the hallucination is a genuinely experienced but false sensation.

Most cases of bad breath I are easily remedied. The real answer is to remove the cause rather than try to cover up the problem with peppermint or spearmint. Antiseptic mouthwashes and antibiotic 'f lozenges are unsatisfactory 4 because they interfere with the mouth's normal bacterial content and may encourage thrush. Unfortunately, most sufferers are often unaware that they have bad breath because they get used to it,
and the majority of best friends lack the necessary moral courage to break the news.
Baldness
Common baldness is heredi­tary and affects males in early adult life. The medical term is alopecia. In toxic alopecia, which sometimes affects chil­dren, the hair loss occurs some weeks after a severe feverish illness such as scarlet fever. Baldness may also be caused by disease, anti-cancer che­motherapy or radiation and treatment with thallium com­pounds, vitamin A or the re­lated group of chemical substances known as reti­noids. Scarring alopecia may follow burns, skin atrophy, ul­ceration, fungus infection of the scalp (kerion) or skin tumours.
Alopecia areata is a form of patchy baldness, of unknown cause, often affecting only one or two small circular areas of the scalp, but sometimes af­fecting all the hair of the body. The drug minoxidil, sold un­der the trade names of Ro­gaine and Regaine, was first brought out as a treatment forhigh blood pressure. It can cause regrowth of fine fuzzy hair in many cases, but you have to keep using it and this gets expensive.
Bandy legs See Bow legs.

Bat ears
This is a lay term for a minor childhood disfigurement in which the ears are larger and more protruding than usual. The problem may not, however, seem so minor for the child who may be sub­jected to abuse from his or her peers. Children's ears are always relatively large - the ear is three-quarters grown at the age of three and almost fully grown by eight - so any unusual promi­nence is more obvious than in an adult. Should there be a significant psychological dis­advantage, the condition may easily be remedied by a sim­ple plastic surgical procedure known as otoplasty.

The skeleton of the ear is a single piece of gristle (carti­lage) of complicated shape, and this is covered with skin which is firmly stuck to the front surface but more loosely attached behind. This is conve­nient, because, to conceal the scars, the surgeon performs the operation on the back of the ear. If the prominence is due to a folding outwards of the cartilage, the aim is to thin, or weaken, it along an almost vertical line so that it can ea­sily be bent backwards to­wards the head. If the ear prominence is due solely to a large angle between the ear and the head, a different opera­tion is necessary. In this case, the skin removal behind the ear is more extensive. When this is done, the bared area includes the angle between the ear and the head. When the free edges of this area are sewn together vertically, the ear is brought close against the head and becomes less prominent. In very severe cases, where both angles are large, the two procedures may have to be combined.

Bedsores
These are often worse than most people realize. Bed‑
sores, technically known as decubitus ulcers, are especially likely in debilitated or uncon­scious patients or in people who have had a stroke or are paralysed. Unless such people are frequently moved, they suffer sustained compression of the skin against the bed or wheelchair in the areas that take the weight of the body. This leads to local loss of blood supply, local loss of feeling so that there is no pain and, eventually, local tissue death (gangrene) with ulceration. Skin can remain healthy and intact only if it has a constant supply of blood, carrying oxygen, sugars and other es­sential nutrients. Local pres­sure compresses the small skin blood vessels, so this supply is cut off. Bedsores may be very large and the ulceration may progress to complete local loss of skin with exposure of the under­lying tendons or bone.

Bedsores are most likely to affect the buttocks, the heels, the elbows and the back of the head and are particularly common in people with defective sensation from neuro­logical damage. They can be avoided by regular changes of position and by skilled nur­sing to detect and deal with early signs of trouble. Dia­betics, and those with com­promised blood supply to the limbs from arterial dis­ease, such as atherosclerosis, are especially liable and re­quire special attention. Mod­em technology has devised all kinds of ingenious beds, which, by differential air in­flation of bed segments, or movement of fluid, con­stantly alter the sites taking the body weight. If econom­ics allow, these can greatly help to reduce the risk of bed­sores, but they do not elimi­nate the need for regular passive body movement and vigilance. The skin should also be inspected daily and kept clean, dry and in good condition.

Bedwetting
This is not usually a symptom of any organic disease, but it can be. Ordinary bedwetting usually occurs during sleep. The normal child develops
adequate control early in life, but one in 10 still wets regularly at the age of five. With all children, accidents will occasionally happen, especially in times of stress, but persistent bedwetting after five is considered abnor­mal. Most children with this problem are merely slow in developing full nerve control and, unless there is some un­derlying disease, bedwetting nearly always stops before puberty.

Training to pass urine reg­ularly during the day is help­ful as is a simple, battery-operated electrical bed alarm which rings as soon as urine is passed. Avoid giving drinks last thing at night and insist on a visit to the toilet before bed. Persistent bedwetting should always be medically investigated. Possible organ­ic causes include:

• urinary infection; • kidney trouble;
• diabetes;
• sickle-cell anaemia.
The problem may also result from emotional disturbance. If no organic cause is found, counselling by a child psy­chologist is often helpful.

Black stools
If your stools turn tarry black report the matter to your doctor at once. A Black faeces (mel­aena) result from chemical change in blood released by bleeding into the stomach or upper part of the intestine. This is an important indication of disease such as gastric or duodenal ulcer. Blackening may also be caused by iron tablets taken for anemia. Red
blood in the faeces usually comes from piles (hemorrhoids) but may be a sign of colitis or cancer of the rectum or colon, especially in older peo­ple. A None of these signs should be ignored. Prudent people always take a quick look at what they have pro­duced before flushing the toilet.
Blackening and loss of the extremities
This is a rather extreme symp­tom, but it can start in a small way and the earlier it is recog­nized the better.

Death of body tissues is called gangrene. This usually occurs in an arm or leg because of an inadequate blood supply. Gangrene is commonly caused by severe arterial dis­ease, such as atherosclerosis, in which the amount of blood able to get through the narrowed and easily obstructed arteries is not enough to keep the re­moter parts alive. Diabetes also increases the possibility of gangrene, mainly because of its effect on the blood vessels, but also by encouraging infec­tion. Other important causes include:

• embolism;
• thrombosis;
• severe arterial injury; • Buerger's disease, an
obstructive arterial
condition (see below).

The rye fungus ergot can cause gangrene by inducing pro­longed tight spasm that shuts off the arteries. Mechanical obstruction to the arterial blood supply can also cause gangrene, as occurs in the bo­wel with a strangulated hernia or a gangrenous appendix.

Limb gangrene usually starts in the toes or fingers. If the dead part does not become infected, it becomes dry and turns brown or black. At the junction between the dead and living tissue there is a zone of inflammation and sometimes this is where the dead part will drop off. This form of dry gang­rene is commonest in the fin­gers and toes.

Wet gangrene occurs when flesh becomes infected and pu­trefies. Infection with anaerobic organisms, such as the com­mon, gas-producing Clostri­diurn welchii, which is present in most cultivated soils, causesthe very dangerous gas gang­rene. In this type, gas makes body tissue, especially mus­cles, swell greatly or balloon, and the gangrene spreads ra­pidly to healthy tissue. There is discoloration, a smell of putre­faction, and the affected person is gravely ill from poisoning. Gas gangrene was a major cause of death in World War I when so many deep wounds were contaminated by culti­vated soil.

The condition has nothing to do with poison gas.
Buerger's disease (also known as thromboangiitis ob­literans) is a fortunately rare disorder affecting young adult males who are heavy smokers. It is a severe inflam­mation of the medium arteries and veins of the legs, and less commonly of the arms. The inflammation causes the blood vessels to block result­ing in death of the tissues (gangrene) so that the af­fected limbs, or part of them, may have to be ampu­tated. Initially, there is pain in the hands and feet with col­our changes - white, blue then red (Raynaud's phenom­enon) in cold weather. If the sufferer stops smoking, the disease will usually progress no further. The extraordinary thing is that, even after being told about this, many suf­ferers continue to smoke - some have done so until they have lost all four limbs.

Blackheads
See Skin spots in adolescence.
Blackout
This is not a medical term and is loosely applied to any condition in which there is loss of consciousness for a short time. Such conditions include:

• fainting;
• epilepsy;
• minor stroke;
• concussion;
• hysterical attacks.
The important thing is to try to identify possible causes. Consider these and also whether there are other symp­toms (if so, look them up).
Blackwater fever
See Fever and black urine.
Bleeding during pregnancy
You must always take seriously any vaginal bleeding occurring early in pregnancy. This is an unmistakable sign that there is a risk that you might lose the baby, and is called a threatened abortion. Often there is a slight pain, like a period pain, in the lower abdomen. Although the embryo or fetus remains alive and still attached to the wall of the womb, the bleeding indi­cates that there is a threat of separation. There is a 25 percent chance of spontaneous abortion, but more usually things settle down. If the bleeding stops, the pregnancy will continue to full term with delivery of a healthy, normal baby. In such cases, threatened abortion does not imply that there is anything wrong with the baby.

If the bleeding gets worse and the pain becomes more severe and cramping, there comes a point when you have to accept that abortion is inevitable. Inevitable abortion means that the cervix has opened and the contents of the womb are being expelled by contractions. Blood clots and membranes, enclosing the fetus, will have passed into the vagina. Sometimes bleeding from an inevitable abortion is very severe, and may even call for a blood transfusion. Often the expulsion is incomplete and a minor operation, under general anaesthesia, may be needed. This is called evacua­tion of retained products of concep­tion (ERPC). The womb is emptied by suction, and the lin­ing is carefully scraped with a sharp-edged spoon called a cur­ette.Adrugisthengiventomake the womb contract, and antibio­tics may also be necessary.

When bleeding occurs from the vagina after the 28th week of pregnancy it is known as antepartum haemorrhage. Most cases are caused by partial se­paration of the afterbirth (pla­centa) from the inside of the womb or because the placenta is not in the normal position. Usually the bleeding itself is painless but there may be pain in the abdomen. Antepartum haemorrhage is a threat to the baby and sometimes to the mother as well. So this requires immediate investigation in hos­pital. There the condition of the baby can be monitored and the mother can be treated, if neces­sary, for blood loss. Transfusion is sometimes required and, if the baby is at risk, delivery by caesarean section.

Bleeding gums
These usually occur when the gums are inflamed (gingivi­tis). This arises when normal tooth care has been neglected to the extent that plaque and tartar (dental calculus) accu­mulate around the necks of the teeth. Occasionally bleed­ing gums are due to severe vitamin C deficiency (scurvy). Inflamed gums are red, thick­ened, bulgy and will bleed even on minor tooth brush­ing. You can't get rid of tartar by brushing or flossing, but need to have your teeth scaled by your dentist or den­tal hygienist. Afterwards, re­solve to prevent plaque from forming by regular flossing.

Symptoms (A)

Absence of menstrual periods
This is called amenorrhoea and it has many causes. Menstrua­tion usually begins after the age of 11 and should be oc­curring by 16. If periods have not started by this age, see your doctor. When periods stop after they have been oc­curring regularly, it may be due to a number of factors, the commonest being preg­nancy. Stopping the contra­ceptive pill after using it for a time usually results in ab­sent periods for six to eight weeks but sometimes for much longer — even up to a year. Other causes include:
• severe emotional disturbance;
• anorexia nervosa;
• intense and prolonged
athletic activity;
• cysts or tumours of the
ovaries;
• the menopause.
The menopause may occur as early as 40 but more usually when a woman is between 45 and 50. Amenorrhoea is per­manent, of course, if the womb is removed surgically (hysterectomy).
Accident proneness
Some people are certainly more prone to accidents than others, but this is not a symp­tom of any particular disease. People who are emotionally upset and preoccupied and, as a result, less watchful than normal, have an increased ten­dency to mishaps. The same is true of aggressive men who often behave in such a way as to cause accidents to them­selves and others. Some peo­ple are just plain careless.
Ageing
Ageing is not a disease but it is sometimes blamed for symptoms that are caused by disease. Although the tis­sues of the body do gradually deteriorate with age, many of the disorders that affect el­derly people are due to other factors. These include:
• lack of exercise;
• the wrong kind of food; • too much exposure to sunlight;
• smoking;
• excessive drinking;
• conforming to expected patterns of behaviour (in a way that elderly people think they should behave rather than how they feel).
Memory need not decline se­verely with age and is usually well preserved in people who are in the habit of using their
minds. Elderly people are more conscious of normal lapses of memory than the young and are liable to wor­ry unnecessarily about these, thinking that they might be developing dementia or Alz­heimer's disease. The first real indication of either is when someone gets lost in formerly familiar areas. This is called disorientation. However, great philosophers and scien­tists have been known to get lost simply because their minds were on other things.
Sexual activity need not decline much with age. The reason some elderly people are less sexually active is of­ten only because of a lack of opportunity.
Age spots
See Skin spots in elderly people.
Agitation
This shows itself by constant, aimless, physical restlessness, and it is usually caused by anxiety. If there is a real cause for the anxiety, agita­tion is normal and is known
as reactive anxiety. But if there is no appropriate cause, agita­tion suggests an anxiety dis­order, often with an underlying physical cause, possibly alcohol or drug with­drawal. Depression in the el­derly often causes agitation. Some drugs, especially those used to treat psychiatric con­t.litions, cause constant move­ments of the body. This is called akathisia and it is not the same as agitation.
Air swallowing
Everyone swallows some air from time to time, but greedy or anxious people, or those who regularly feel the need to belch, may swallow a great deal of air. This causes a feeling of fullness that is relieved only by bringing the air up again. People who belch frequently at times other than after eating are usually air swallowers. There is no great harm in this but it can be boring for others. Air swallowing is sometimes a symptom of stomach ulcera­tion or indigestion from unsui­table diet and eating at irregular times.
Allergies
See Contact reactions.
Amnesia
See Loss of memory.
Anal protrusions
The commonest protrusions are internal piles (haemor­rhoids) that have slipped down. These cause a lot of irritation (see Itching anus).
A more major and dramatic condition causing anal protru­sion is prolapse of the rectum. This is a condition in which the mucous membrane lining of the anus (the lower part of the rectum) turns inside-out and passes out of the anus. In incomplete prolapse, only the lining of the anus appears, but in complete prolapse the whole thickness of the bowel pro­trudes as a thick cylindrical mass with the mucous mem­brane lining on the outside.
Incomplete prolapse is common in young children and usually requires no treat­ment. At the most, they will have their buttocks strapped together or be given a small injection to encourage internal adhesion of the lining. Com­plete prolapse occurs in adults, mostly in women, be­cause of weakness of the mus­cle ring around the anus (anal sphincter), or of the supporting floor of the pelvis, following childbirth. Anal surgery or haemorrhoids may also pre­dispose adults to the condition.
Prolapses are easily pushed back in but tend to recur. Complete prolapses usually require a surgical operation to tighten the anal sphincter or to fix the rectum internally.
Antisocial attitudes
People with persistent diffi­culty in getting on with others may have what is sometimes described as a bor­derline personality disorder. This is a rather vague name for a vaguely defined condi­tion, lying somewhere be­tween a social disorder and an actual mental illness. The unfortunate people in this ca­tegory may be:
• moody;
• unreasonable;
• prone to outbursts ofanger;
• incapable of forming or maintaining long-term relationships;
• addictive gamblers; • petty criminals;
• prone to self-damaging or even suicidal behaviour.
Changes of mood are rapid and often inappropriate. Psy­chiatrists argue about this condition; some say that it is a psychiatric condition calling for treatment, others claim that it is not. It seems likely that the condition arises from unfortunate early life experi­ence with lack of parental affection and the absence of consistent guidance on acceptable conduct.
People who consistently behave without regard to the rights or safety of others, and who refuse to conform to normally accepted standards of behaviour, are said to have an antisocial personality dis­order. They used to be called
psychopaths or sociopaths
and many of them are actual criminals. Antisocial personal­ity disorder almost certainly
originates early in life as a result of defective training or conditioning and often a ser­ious lack of parental affection and concern. Occasionally par­ents insist, however, that such people were 'born bad'. It is possible that there might be a hereditary element. Behaviour therapy or residence in thera­peutic communities is some­times successful in correcting the defect.
'Ants' crawling under skin See Itching.
Anxiety
No one is wholly free from anxiety, which is a normal and necessary part of life. Anxiety - an unpleasant sense of uneasiness or fear - becomes medically significant only when these fear reactions occur without obvious exter­nal cause and interfere with normal living. There is a fair range of disorders in which anxiety is the main feature. These affect about one person in 25 and include generalized anxiety disorder (previously known as anxiety neurosis),
panic attacks, phobias, post- traumatic stress disorders and obsessive/compulsive disorders. If you have an anxiety disorder you will cer­tainly be aware of the fact.
Anxiety, from whatever cause, is always associated with the release within the body of the hormone adrena­line, and with overaction of the part of the nervous system con­cerned with involuntary con­trol of the internal organs (the autonomic nervous system). As a result, there are few parts of the body that are not affected by anxiety. These effects are purely physical. They include:
• fast pulse;
• awareness of the heartbeat;
• 'butterflies in the stomach';
• dryness of the mouth; • trembling of the hands; • tightness in the chest; • sighing and
overbreathing
(hyperventilation);
• tense muscles.
Tightening the muscles per­sistently soon results in ach­ing and tiredness. (Prolonged muscle tension is a common cause of backache and neck pain.) It also affects the urin­ary system, causing frequent desire to empty the bladder, and even affects the skin, causing blushing or pallor and sweating.
Anxiety is additionally known to disrupt the intest­inal system causing:
• loss of appetite;
• a sense of fullness;
• difficulty in swallowing (sometimes);
• nausea;
• vomiting;
• belching;
• irritable bowel with frequent diarrhoea:
Abnormal anxiety features con­stant fears. These might be fear of death, serious illness, psy­chiatric breakdown, financial loss, social disasters or work inadequacy. With this anxiety comes an increased depen­dency on others, fatigue, insom­nia and frightening dreams. A strong and persistent convic­tion that one is suffering from a serious disease is common. This is called hypochondriasis - sufferers are hypochondriacs.
Anxiety is the hallmark of most neurotic disorders and, although various theories have been put forward to ex­plain it, no one really knows its cause. Anxious people de­serve every sympathy and need help. There is little evi­dence that psychoanalysis can cure anxiety, but there are effective remedies. Wise psy­chotherapy by a mature and experienced counsellor, beha­viour therapy, learning re­laxation techniques or carefully selected drug treat­ment can help greatly. The tricyclic antidepressant drugs are often useful in panic conditions. Fluoxetine (Prozac) is really only appro­priate if the condition is basi­cally a depression. It is best to
avoid the benzodiazepines - drugs like Valium — if possi­ble, because it is all too easy to get addicted. Beta-blockers can help anxiety, and much can be done to relieve the problem, especially if you have a sympathetic doctor.