TUBE THORACOSTOMY : Procedure, Indications & Complications

Indications

To drain abnormal large-volume air or fluid collections in the pleural space

+ Hemothorax, chylothorax, empyema

• Pneumothorax, if:
• Large or progressive
• Patient is on mechanical ventilation
• Bronchopleural fistula
• Tension pneumothorax

+ To facilitate pleurodesis:

• i.e. obliteration of the pleural space by instilling talc or doxycycline to cause fibrosis and adherence of parietal and visceral pleura
• Indicated for recurrent pleural effusions (often malignant)

+ For long-term drainage of malignant effusions

Procedure

+ Tube size – varies according to indication; larger tube for more viscous drainage

+ Insertion site- typically 4th or 5th intercostal space in anterior axillary or mid-axillary line

+ Technique:

• Local anaesthetic
• -2 em skin incision
• Kelly clamp for blunt dissection to the pleural space, taking care to pass over the top of the rib to avoid neurovascular bundle
• Tube is inserted and sutured in place
• Tube is attached to a pleural drainage system (suction/underwater seal, usually -20 mmH20)
• Post-insertion CXR to ensure proper tube placement (posterior apex of lung for pneumothorax, base oflung for fluid)

+ Removal:

• When drainage <100 cc/d, no air leak, and lung is fully expanded
• Consider clamping tube for 4-6 h then obtain CXR to ensure lung remains expanded
• Brisk removal after patient expires and holds breath

Complications

o Overall complications are rare (1-3%)

o Malposition (most common complication), especially by inexperienced operators:

• Tubes may dissect along the external chest wall, or may be placed below the diaphragm

o Bleeding (anticoagulation is a relative contraindication)

o Local infection, empyema

o Perforation oflung parenchyma

o Risk of re-expansion pulmonary edema when large volumes of air or fluid are drawn off quickly (> 1.0-1.5 L)

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Types of Heart Disease Linked to Type 2 Diabetes

From clogged arteries to heart failure, type 2 diabetes can affect your ticker in a lot of ways. To help protect yourself, learn about the kinds of heart disease that are linked to diabetes and the warning signs to watch for.

Coronary Heart Disease

This is the most common type of heart disease in people with diabetes. When you have it, the arteries that carry blood to the muscle of your heart have a buildup of a fatty, waxy substance called plaque.

With time, plaque gets hard and makes your arteries stiff. As more of it collects, there’s less room for blood to flow, so your heart doesn’t get the oxygen it needs. Clumps of plaque can also burst apart, making you more likely to get blood clots in those vessels.

Add it all up, and it can lead to conditions like:

Angina. You may feel pain, pressure, or squeezing in your chest. You might even feel it in your arms, back, or jaw as well. Sometimes it feels a lot like indigestion. Physical activity and strong emotions can set it off or make it worse.

Arrhythmia. This is when your heart rate or rhythm is off. You might feel like your heart skips a beat, flutters, or beats too fast. At its worse, it can cause sudden cardiac arrest, where your heart stops beating.

Heart attack. It’s caused by a clot that cuts off blood flow in the arteries of the heart. You’re likely to have pain or discomfort in the center or left side of your chest. But that’s not always the case. With diabetes, you have higher odds of silent heart attacks, where you don’t even feel it happen.

Heart Failure

Despite the name, it doesn’t mean your heart has stopped working. It’s just that it’s too weak to pump enough blood to your body. Over time, diabetes, coronary heart disease, and high blood pressure all make you more likely to have it. They wear down your heart muscle because they keep it working too hard for too long.

When your body doesn’t get enough blood, your cells don’t get the oxygen they need. That can lead to symptoms like:

• Feeling tired and weak
• Hard time exercising
• Heartbeat that’s too fast or off-rhythm
• Problems staying focused
• Swelling in your legs, ankles, and feet
• Trouble breathing

Cardiomyopathy

If you don’t manage your diabetes closely, you could get a condition called cardiomyopathy. Your heart muscle gets thick and stiff. It just can’t work the same, which can lead to rhythm problems and heart failure.

Early on, you might not have any symptoms. But as the condition gets worse, it can lead to:

• Shortness of breath, even when you’re resting
• Chest pain
• Coughing, especially when you’re lying down
• Feeling dizzy or light-headed
• Feeling weak and tired
• Swelling in your legs, ankles, and feet

Other Conditions

Diabetes is also tied to:

High blood pressure. This happens when blood pushes against the walls of your blood vessels with a stronger force than normal. It makes your heart work harder than usual and damages your blood vessels.

Most people with type 2 diabetes also have high blood pressure. Together, they put a lot of extra strain on your heart, boosting your chance of having serious issues like heart disease and stroke.

Peripheral artery disease (PAD). With this condition, you have plaque buildup in the arteries of your legs. It typically causes pain in your calves. You’ll feel it when you walk or climb stairs, and it usually goes away with rest. Your legs may also feel heavy, numb, or weak.

PAD is also a warning sign. That’s because if you have plaque in your legs, you might have it in your heart, too. In fact, PAD raises your odds of having a stroke or heart attack.

Stroke. Diabetes also means you’re more likely to have a stroke, where blood flow to part of your brain gets cut off. The symptoms may come on suddenly and include:

• Drooping face, causing a lopsided smile
• A hard time talking, such as slurred speech
• Weakness in one arm, making it hard to lift and keep both arms in the air

Pterygium: What Is “Surfer’s Eye”?

A pterygium (tuh-RIJ-ee-uhm) is an elevated, wedged-shaped bump on the eyeball that starts on the white of the eye (sclera) and can invade the cornea. If you have more than one of these eye growths, the plural form of the word is pterygia (tuh-RIJ-ee-ah).Though it’s commonly called “surfer’s eye,” you don’t have to be a surfer or ever see the ocean to get a pterygium. But being in bright sunlight for long hours — especially when you are on water, which reflects the sun’s harmful UV rays — increases your risk.

Pterygia are benign (non-cancerous) growths, but they can permanently disfigure the eye. They also can cause discomfort and blurry vision.

Causes

Although ultraviolet radiation from the sun appears to be the primary cause for the development and growth of pterygia, dust and wind are sometimes implicated too, as is dry eye disease.

Pterygia usually develop in 30- to 50-year-olds, and these bumps on the eyeball rarely are seen in children. Having light skin and light eyes may put you at increased risk of getting a pterygium.

Signs And Symptoms

Pterygia usually occur on the side of the eye closer to the nose, but they can also develop on the side closer to the ear as well and can affect one eye or both eyes.

Many people with mild surfer’s eye may not experience symptoms or require treatment. But large or growing pterygia often cause a gritty, itchy or burning sensation or the feeling something is “in” the eye (called a foreign body sensation). Also, these pterygia often become inflamed, causing unattractive red eyes.

If a pterygium significantly invades the cornea, it can distort the shape of the front surface of the eye, causing astigmatism and higher-order aberrations that affect vision.

Sometimes people confuse pterygia with eye growths called pingueculae, but they are different. Learn more about what a pinguecula is.

Pterygium Treatment

Treatment of surfer’s eye depends on the size of the pterygium, whether it is growing and the symptoms it causes. Regardless of severity, pterygia should be monitored to prevent scarring that could lead to vision loss.

If a pterygium is small, your eye doctor may prescribe lubricants or a mild steroid eye drop to reduce swelling and redness. Contact lenses are sometimes used to cover the growth, protecting it from some of the effects of dryness or potentially from further UV exposure. Topical cyclosporine also may be prescribed for dry eye.

If pterygium surgery is required, several surgical techniques are available. Your ophthalmologist who performs the procedure will determine the best technique for your specific needs.

Pterygium excision may be performed either in a room at the doctor’s office or in an operating room. It’s important to note that pterygium removal can induce astigmatism, especially in people who already have astigmatism.

Surgery for pterygium removal usually lasts no longer than 30 minutes, after which you likely will need to wear an eye patch for protection for a day or two. You should be able to return to work or normal activities the next day.

Recurrence

Unfortunately, pterygia often return after surgical removal, possibly due to oxidative stress and/or continued UV exposure.

Exposure to ultraviolet light from the sun is a suspected cause of pterygia; wrap sunglasses will protect your eyes from all angles. These Zyon sailing sunglasses by Rudy Project come with removable side wings for even more eye protection.

Some studies show recurrence rates up to 40 percent, while others have reported recurrence rates as low as 5 percent. Some research even shows higher rates of recurrence in those who have pterygia removed during the summer months, potentially because of their increased exposure to sunlight.

To prevent regrowth after a pterygium is surgically removed, your eye surgeon may suture or glue a piece of surface eye tissue onto the affected area. This method, called autologous conjunctival autografting, has been shown to safely and effectively reduce the risk of pterygium recurrence.

A drug that can help limit abnormal tissue growth and scarring during wound healing, such as mitomycin C, also may be applied topically at the time of surgery and/or afterward to reduce the risk of pterygium recurrence.

After removal of the pterygium, the doctor will likely prescribe steroid eye drops for several weeks to decrease swelling and prevent regrowth. In addition to using your drops, it’s very important to protect your eyes from the sun with UV-blocking sunglasses or photochromic lenses after surgery, since exposure to ultraviolet radiation may be a key factor in pterygium recurrence

Attention-deficit/hyperactivity disorder (ADHD) in children

Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often continues into adulthood. ADHD includes a combination of persistent problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior.

Children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age. However, some people never completely outgrow their ADHD symptoms. But they can learn strategies to be successful.

While treatment won’t cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions. Early diagnosis and treatment can make a big difference in outcome.

Symptoms

The primary features of attention-deficit/hyperactivity disorder include inattention and hyperactive-impulsive behavior. ADHD symptoms start before age 12, and in some children, they’re noticeable as early as 3 years of age. ADHD symptoms can be mild, moderate or severe, and they may continue into adulthood.

ADHD occurs more often in males than in females, and behaviors can be different in boys and girls. For example, boys may be more hyperactive and girls may tend to be quietly inattentive.

There are three subtypes of ADHD:

• Predominantly inattentive. The majority of symptoms fall under inattention.
• Predominantly hyperactive-impulsive. The majority of symptoms are hyperactive and impulsive.
• Combined. The most common type in the U.S., this is a mix of inattentive symptoms and hyperactive-impulsive symptoms.

Inattention

A child who shows a pattern of inattention may often:

• Fail to pay close attention to details or make careless mistakes in schoolwork
• Have trouble staying focused in tasks or play
• Appear not to listen, even when spoken to directly
• Have difficulty following through on instructions and fail to finish schoolwork or chores
• Have trouble organizing tasks and activities
• Avoid or dislike tasks that require focused mental effort, such as homework
• Lose items needed for tasks or activities, for example, toys, school assignments, pencils
• Be easily distracted
• Forget to do some daily activities, such as forgetting to do chores

Hyperactivity and impulsivity

A child who shows a pattern of hyperactive and impulsive symptoms may often:

• Fidget with or tap his or her hands or feet, or squirm in the seat
• Have difficulty staying seated in the classroom or in other situations
• Be on the go, in constant motion
• Run around or climb in situations when it’s not appropriate
• Have trouble playing or doing an activity quietly
• Talk too much
• Blurt out answers, interrupting the questioner
• Have difficulty waiting for his or her turn
• Interrupt or intrude on others’ conversations, games or activities

Additional issues

In addition, a child with ADHD has:

• Symptoms for at least six months
• Several symptoms that negatively affect school, home life or relationships in more than one setting, such as at home and at school
• Behaviors that aren’t normal for children the same age who don’t have ADHD

Normal behavior vs. ADHD

Most healthy children are inattentive, hyperactive or impulsive at one time or another. It’s normal for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and teenagers, attention span often depends on the level of interest.

The same is true of hyperactivity. Young children are naturally energetic — they often are still full of energy long after they’ve worn their parents out. In addition, some children just naturally have a higher activity level than others do. Children should never be classified as having ADHD just because they’re different from their friends or siblings.

Children who have problems in school but get along well at home or with friends are likely struggling with something other than ADHD. The same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendships remain unaffected.

Causes

While the exact cause of attention-deficit/hyperactivity disorder is not clear, research efforts continue. Factors that may be involved in the development of ADHD include:

• Genetics. ADHD can run in families, and studies indicate that genes may play a role.
• Environment. Certain environmental factors, such as lead exposure, may increase risk.
• Development. Problems with the central nervous system at key moments in development may play a role.

Risk factors

Risk factors for attention-deficit/hyperactivity disorder may include:

• Blood relatives, such as a parent or sibling, with ADHD or another mental health disorder
• Exposure to environmental toxins — such as lead, found mainly in paint and pipes in older buildings
• Maternal drug use, alcohol use or smoking during pregnancy
• Premature birth

Although sugar is a popular suspect in causing hyperactivity, there’s no reliable proof of this. Many issues in childhood can lead to difficulty sustaining attention, but that’s not the same as ADHD.

Complications

Attention-deficit/hyperactivity disorder can make life difficult for children. Children with ADHD:

• Often struggle in the classroom, which can lead to academic failure and judgment by other children and adults
• Tend to have more accidents and injuries of all kinds than do children who don’t have ADHD
• Tend to have poor self-esteem
• Are more likely to have trouble interacting with and being accepted by peers and adults
• Are at increased risk of alcohol and drug abuse and other delinquent behavior

Coexisting conditions

ADHD doesn’t cause other psychological or developmental problems. However, children with ADHD are more likely than others to also have conditions such as:

• Learning disabilities, including problems with understanding and communicating
• Anxiety disorders, which may cause overwhelming worry, nervousness
• Depression, which frequently occurs in children with ADHD
• Disruptive mood dysregulation disorder, characterized by irritability and problems tolerating frustration
• Oppositional defiant disorder (ODD), generally defined as a pattern of negative, defiant and hostile behavior toward authority figures
• Conduct disorder, marked by antisocial behavior such as stealing, fighting, destroying property, and harming people or animals
• Bipolar disorder, which includes depression as well as manic behavior
• Tourette syndrome, a neurological disorder characterized by repetitive muscle or vocal tics

Prevention

To help reduce your child’s risk of attention-deficit/hyperactivity disorder:

• During pregnancy, avoid anything that could harm fetal development. For example, don’t drink alcohol, use recreational drugs or smoke cigarettes.
• Protect your child from exposure to pollutants and toxins, including cigarette smoke and lead paint (found in some old buildings).
• Limit screen time. Although still unproved, it may be prudent for children to avoid excessive exposure to TV and video games in the first five years of life.

If your child has ADHD, to help reduce problems or complications:

• Be consistent, set limits and have clear consequences for your child’s behavior.
• Put together a daily routine for your child with clear expectations that include such things as bedtime, morning time, mealtime, simple chores and TV.
• Avoid multitasking yourself when talking with your child, make eye contact when giving instructions, and set aside a few minutes every day to praise your child.
• Work with teachers and caregivers to identify problems early, to decrease the impact of the condition on your child’s life.
  

  Diagnosis

  In general, a child shouldn’t receive a diagnosis of attention-deficit/hyperactivity disorder unless the core symptoms of ADHD start early in life — before age 12 — and create significant problems at home and at school on an ongoing basis.
  There’s no specific test for ADHD, but making a diagnosis will likely include:
  • Medical exam, to help rule out other possible causes of symptoms
  • Information gathering, such as any current medical issues, personal and family medical history, and school records
  • Interviews or questionnaires for family members, your child’s teachers or other people who know your child well, such as baby sitters and coaches
  • ADHD criteria from the Diagnostic and Statistical Manual of Mental DisordersDSM-5, published by the American Psychiatric Association
  • ADHD rating scales to help collect and evaluate information about your child

  Diagnosing ADHD in young children

  Although signs of ADHD can sometimes appear in preschoolers or even younger children, diagnosing the disorder in very young children is difficult. That’s because developmental problems such as language delays can be mistaken for ADHD.
  So children preschool age or younger suspected of having ADHD are more likely to need evaluation by a specialist, such as a psychologist or psychiatrist, speech pathologist, or developmental pediatrician.

  Other conditions that resemble ADHD

  A number of medical conditions or their treatments may cause signs and symptoms similar to those of ADHD. Examples include:
  • Learning or language problems
  • Mood disorders such as depression or anxiety
  • Other psychiatric disorders
  • Seizure disorders
  • Vision or hearing problems
  • Tourette syndrome
  • Medical problems that affect thinking or behavior
  • Sleep disorders
  • Thyroid problems
  • Substance abuse
  • Brain injury

  Treatment

  Standard treatments for attention-deficit/hyperactivity disorder in children include medications, education, training and counseling. These treatments can relieve many of the symptoms of ADHD, but they don’t cure it. It may take some time to determine what works best for your child.

  Stimulant medications

  Currently, stimulant drugs (psychostimulants) are the most commonly prescribed medications for ADHD. Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters. These medications help improve the signs and symptoms of inattention and hyperactivity — sometimes effectively in a short period of time.
  Examples include:
  • Amphetamines. These include dextroamphetamine (Dexedrine), dextroamphetamine-amphetamine (Adderall) and lisdexamfetamine (Vyvanse).
  • Methylphenidates. These include methylphenidate (Concerta, Metadate, Ritalin, others) and dexmethylphenidate (Focalin)
  Stimulant drugs are available in short-acting and long-acting forms. A long-acting patch of methylphenidate (Daytrana) is available that can be worn on the hip.
  The right dose varies from child to child, so it may take some time to find the correct dose. And the dose may need to be adjusted if significant side effects occur or as your child matures. Ask your doctor about possible side effects of stimulants.

  Stimulant medications and heart problems

  Although rare, several heart-related deaths have occurred in children and teenagers taking stimulant medications. The possibility of increased risk of sudden death is still unproved, but if it exists, it’s believed to be in people who already have underlying heart disease or a heart defect.
  Your child’s doctor should make sure your child doesn’t have any signs of a heart condition and should ask about family risk factors for heart disease before prescribing a stimulant medication.

  Other medications

  Other medications that may be effective in treating ADHD include:
  • Atomoxetine (Strattera)
  • Antidepressants such as bupropion (Wellbutrin, others)
  • Guanfacine (Intuniv, Tenex)
  • Clonidine (Catapres, Kapvay)
  Atomoxetine and antidepressants work slower than stimulants do and may take several weeks before they take full effect. These may be good options if your child can’t take stimulants because of health problems or if stimulants cause severe side effects.
  Ask your doctor about possible side effects of any medications.

  Suicide risk

  Although it remains unproved, concerns have been raised that there may be a slightly increased risk of suicidal thinking in children and teenagers taking nonstimulant ADHD medication or antidepressants. Contact your child’s doctor if you notice any signs of suicidal thinking or other signs of depression.

  Giving medications safely

  It’s very important to make sure your child takes the right amount of the prescribed medication. Parents may be concerned about stimulants and the risk of abuse and addiction. Dependence hasn’t been shown in children who take these drugs for appropriate reasons and at the proper dose.
  On the other hand, there’s concern that other people might misuse or abuse stimulant medication prescribed for children and teenagers with ADHD. To keep your child’s medications safe and to make sure your child is getting the right dose at the right time:
  • Give medications carefully. Children and teens shouldn’t be in charge of their own ADHD medication without proper supervision.
  • At home, keep medication locked in a childproof container. An overdose of stimulant drugs is serious and potentially fatal.
  • Don’t send supplies of medication to school with your child. Deliver any medicine yourself to the school nurse or health office.

  ADHD behavior therapy

  Children with ADHD often benefit from behavior therapy and counseling, which may be provided by a psychiatrist, psychologist, social worker or other mental health care professional. Some children with ADHD may also have other conditions such as anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.
  Examples of therapy include:
  • Behavior therapy. Teachers and parents can learn behavior-changing strategies, such as token reward systems and timeouts, for dealing with difficult situations.
  • Psychotherapy. This allows older children with ADHD to talk about issues that bother them, explore negative behavioral patterns and learn ways to deal with their symptoms.
  • Parenting skills training. This can help parents develop ways to understand and guide their child’s behavior.
  • Family therapy. Family therapy can help parents and siblings deal with the stress of living with someone who has ADHD.
  • Social skills training. This can help children learn appropriate social behaviors.

  Ongoing treatment

  The best results occur when a team approach is used, with teachers, parents, and therapists or physicians working together. Educate yourself about ADHD, and then work with your child’s teachers and refer them to reliable sources of information to support their efforts in the classroom.
  If your child is being treated for ADHD, he or she should see the doctor regularly until symptoms have largely improved, and then every three to four months if symptoms are stable.
  Call the doctor if your child has any medication side effects, such as loss of appetite, trouble sleeping or increased irritability, or if your child’s ADHD has not shown much improvement with initial treatment.

Alcohol poisoning

Alcohol poisoning is a serious — and sometimes deadly — consequence of drinking large amounts of alcohol in a short period of time. Drinking too much too quickly can affect your breathing, heart rate, body temperature and gag reflex and potentially lead to a coma and death.

Alcohol poisoning can also occur when adults or children accidentally or intentionally drink household products that contain alcohol.

A person with alcohol poisoning needs immediate medical attention. If you suspect someone has alcohol poisoning, call for emergency medical help right away.

Symptoms

Alcohol poisoning signs and symptoms include:

• Confusion
• Vomiting
• Seizures
• Slow breathing (less than eight breaths a minute)
• Irregular breathing (a gap of more than 10 seconds between breaths)
• Blue-tinged skin or pale skin
• Low body temperature (hypothermia)
• Passing out (unconsciousness) and can’t be awakened

When to see a doctor

It’s not necessary to have all the above signs or symptoms before you seek medical help. A person with alcohol poisoning who is unconscious or can’t be awakened is at risk of dying.

Alcohol poisoning is an emergency

If you suspect that someone has alcohol poisoning — even if you don’t see the classic signs and symptoms — seek immediate medical care. Here’s what to do:

• Call 911 or your local emergency number immediately. Never assume the person will sleep off alcohol poisoning.
• Be prepared to provide information. If you know, be sure to tell hospital or emergency personnel the kind and amount of alcohol the person drank, and when.
• Don’t leave an unconscious person alone. Because alcohol poisoning affects the way the gag reflex works, someone with alcohol poisoning may choke on his or her own vomit and not be able to breathe. While waiting for help, don’t try to make the person vomit because he or she could choke.
• Help a person who is vomiting. Try to keep him or her sitting up. If the person must lie down, make sure to turn his or her head to the side — this helps prevent choking. Try to keep the person awake to prevent loss of consciousness.

Don’t be afraid to get help

It can be difficult to decide if you think someone is drunk enough to warrant medical intervention, but it’s best to err on the side of caution. You may worry about the consequences for yourself or your friend or loved one, particularly if you’re underage. But the consequences of not getting the right help in time can be far more serious.

Causes

Alcohol in the form of ethanol (ethyl alcohol) is found in alcoholic beverages, mouthwash, cooking extracts, some medications and certain household products. Ethyl alcohol poisoning generally results from drinking too many alcoholic beverages, especially in a short period of time.

Other forms of alcohol — including isopropyl alcohol (found in rubbing alcohol, lotions and some cleaning products) and methanol or ethylene glycol (a common ingredient in antifreeze, paints and solvents) — can cause other types of toxic poisoning that require emergency treatment.

Binge drinking

A major cause of alcohol poisoning is binge drinking — a pattern of heavy drinking when a male rapidly consumes five or more alcoholic drinks within two hours, or a female rapidly consumes at least four drinks within two hours. An alcohol binge can occur over hours or last up to several days.

You can consume a fatal dose before you pass out. Even when you’re unconscious or you’ve stopped drinking, alcohol continues to be released from your stomach and intestines into your bloodstream, and the level of alcohol in your body continues to rise.

How much is too much?

Unlike food, which can take hours to digest, alcohol is absorbed quickly by your body — long before most other nutrients. And it takes a lot more time for your body to get rid of the alcohol you’ve consumed. Most alcohol is processed (metabolized) by your liver.

The more you drink, especially in a short period of time, the greater your risk of alcohol poisoning.

One drink is defined as:

• 12 ounces (355 milliliters) of regular beer (about 5 percent alcohol)
• 8 to 9 ounces (237 to 266 milliliters) of malt liquor (about 7 percent alcohol)
• 5 ounces (148 milliliters) of wine (about 12 percent alcohol)
• 1.5 ounces (44 milliliters) of 80-proof hard liquor (about 40 percent alcohol)

Mixed drinks may contain more than one serving of alcohol and take even longer to metabolize.

Risk factors

A number of factors can increase your risk of alcohol poisoning, including:

• Your size and weight
• Your overall health
• Whether you’ve eaten recently
• Whether you’re combining alcohol with other drugs
• The percentage of alcohol in your drinks
• The rate and amount of alcohol consumption
• Your tolerance level

Complications

Severe complications can result from alcohol poisoning, including:

• Choking. Alcohol may cause vomiting. Because it depresses your gag reflex, this increases the risk of choking on vomit if you’ve passed out.
• Stopping breathing. Accidentally inhaling vomit into your lungs can lead to a dangerous or fatal interruption of breathing (asphyxiation).
• Severe dehydration. Vomiting can result in severe dehydration, leading to dangerously low blood pressure and fast heart rate.
• Seizures. Your blood sugar level may drop low enough to cause seizures.
• Hypothermia. Your body temperature may drop so low that it leads to cardiac arrest.
• Irregular heartbeat. Alcohol poisoning can cause the heart to beat irregularly or even stop.
• Brain damage. Heavy drinking may cause irreversible brain damage.
• Death. Any of the issues above can lead to death.

Prevention

To avoid alcohol poisoning:

• Drink alcohol in moderation, if at all. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. When you do drink, enjoy your drink slowly.
• Don’t drink on an empty stomach. Having some food in your stomach may slow alcohol absorption somewhat, although it won’t prevent alcohol poisoning if, for example, you’re binge drinking.
• Communicate with your teens. Talk to your teenagers about the dangers of alcohol, including binge drinking. Evidence suggests that children who are warned about alcohol by their parents and who report close relationships with their parents are less likely to start drinking.
• Store products safely. If you have small children, store alcohol-containing products, including cosmetics, mouthwashes and medications, out of their reach. Use child-proof bathroom and kitchen cabinets to prevent access to household cleaners. Keep toxic items in your garage or storage area safely out of reach. Consider keeping alcoholic beverages under lock and key.
• Get follow-up care. If you or your teen has been treated for alcohol poisoning, be sure to ask about follow-up care. Meeting with a health professional, particularly an experienced chemical dependency professional, can help you prevent future binge drinking.
  

  Diagnosis

  In addition to checking for visible signs and symptoms of alcohol poisoning, your doctor will likely order blood and urine tests to check blood alcohol levels and identify other signs of alcohol toxicity, such as low blood sugar.

  Treatment

  Alcohol poisoning treatment usually involves supportive care while your body rids itself of the alcohol. This typically includes:
  • Careful monitoring
  • Prevention of breathing or choking problems
  • Oxygen therapy
  • Fluids given through a vein (intravenously) to prevent dehydration
  • Use of vitamins and glucose to help prevent serious complications of alcohol poisoning
  Adults and children who have accidentally consumed methanol or isopropyl alcohol may need hemodialysis — a mechanical way of filtering waste and toxins from your system — to speed the removal of alcohol from their bloodstream.

Pterygium: What Is “Surfer’s Eye”?

A pterygium (tuh-RIJ-ee-uhm) is an elevated, wedged-shaped bump on the eyeball that starts on the white of the eye (sclera) and can invade the cornea. If you have more than one of these eye growths, the plural form of the word is pterygia (tuh-RIJ-ee-ah).

Though it’s commonly called “surfer’s eye,” you don’t have to be a surfer or ever see the ocean to get a pterygium. But being in bright sunlight for long hours — especially when you are on water, which reflects the sun’s harmful UV rays — increases your risk.

Pterygia are benign (non-cancerous) growths, but they can permanently disfigure the eye. They also can cause discomfort and blurry vision.

Causes

Although ultraviolet radiation from the sun appears to be the primary cause for the development and growth of pterygia, dust and wind are sometimes implicated too, as is dry eye disease.

Pterygia usually develop in 30- to 50-year-olds, and these bumps on the eyeball rarely are seen in children. Having light skin and light eyes may put you at increased risk of getting a pterygium.

Signs And Symptoms

Pterygia usually occur on the side of the eye closer to the nose, but they can also develop on the side closer to the ear as well and can affect one eye or both eyes.

Many people with mild surfer’s eye may not experience symptoms or require treatment. But large or growing pterygia often cause a gritty, itchy or burning sensation or the feeling something is “in” the eye (called a foreign body sensation). Also, these pterygia often become inflamed, causing unattractive red eyes.

If a pterygium significantly invades the cornea, it can distort the shape of the front surface of the eye, causing astigmatism and higher-order aberrations that affect vision.

Sometimes people confuse pterygia with eye growths called pingueculae, but they are different. Learn more about what a pinguecula is.

Pterygium Treatment

Treatment of surfer’s eye depends on the size of the pterygium, whether it is growing and the symptoms it causes. Regardless of severity, pterygia should be monitored to prevent scarring that could lead to vision loss.

If a pterygium is small, your eye doctor may prescribe lubricants or a mild steroid eye drop to reduce swelling and redness. Contact lenses are sometimes used to cover the growth, protecting it from some of the effects of dryness or potentially from further UV exposure. Topical cyclosporine also may be prescribed for dry eye.

If pterygium surgery is required, several surgical techniques are available. Your ophthalmologist who performs the procedure will determine the best technique for your specific needs.

Pterygium excision may be performed either in a room at the doctor’s office or in an operating room. It’s important to note that pterygium removal can induce astigmatism, especially in people who already have astigmatism.

Surgery for pterygium removal usually lasts no longer than 30 minutes, after which you likely will need to wear an eye patch for protection for a day or two. You should be able to return to work or normal activities the next day.

Recurrence

Unfortunately, pterygia often return after surgical removal, possibly due to oxidative stress and/or continued UV exposure.

Exposure to ultraviolet light from the sun is a suspected cause of pterygia; wrap sunglasses will protect your eyes from all angles. These Zyon sailing sunglasses by Rudy Project come with removable side wings for even more eye protection.

Some studies show recurrence rates up to 40 percent, while others have reported recurrence rates as low as 5 percent. Some research even shows higher rates of recurrence in those who have pterygia removed during the summer months, potentially because of their increased exposure to sunlight.

To prevent regrowth after a pterygium is surgically removed, your eye surgeon may suture or glue a piece of surface eye tissue onto the affected area. This method, called autologous conjunctival autografting, has been shown to safely and effectively reduce the risk of pterygium recurrence.

A drug that can help limit abnormal tissue growth and scarring during wound healing, such as mitomycin C, also may be applied topically at the time of surgery and/or afterward to reduce the risk of pterygium recurrence.

After removal of the pterygium, the doctor will likely prescribe steroid eye drops for several weeks to decrease swelling and prevent regrowth. In addition to using your drops, it’s very important to protect your eyes from the sun with UV-blocking sunglasses or photochromic lenses after surgery, since exposure to ultraviolet radiation may be a key factor in pterygium recurrence

Late night snacking increases your risk of heart disease

When it comes to protecting yourself from heart disease, I’m sure you take all the obvious steps like exercising regularly, avoiding low-fat sugar-laden foods, not smoking and following a diet rich in fresh fruit, veg and healthy lean animal proteins.

Of course, we are all human so it is only normal to sometimes slip up and indulge a little bit. But if there is one indulgence you need to avoid, then it is those cheeky late night snacks.

Snack attack

It’s late at night… it’s way past your bedtime… or you’ve woken up in the middle of the night… you are restless… tossing and turning… finally, you stumble to the fridge.

Once that door opens and that little light turns on, the grazing begins… anything goes!

However, according to a new study, you should really avoid those midnight snack attacks because eating during the night can up your chances of heart disease.

Researchers fed a group of rats at the beginning of their rest period and at the beginning of their active phase, and then they measured their levels of blood fats (triglycerides) after each meal.

We know that in humans, having high levels of triglycerides in the blood is a risk factor for heart disease.

The researchers found that the rats’ triglycerides spiked more drastically when they ate at the start of their rest period, compared to when they ate at the start of their active phase.

This suggests that eating when they should have been resting disturbed the rats’ natural biological clock.

Of course, humans aren’t lab animals, but humans and rats are actually very similar in how our bodies respond to stimulants.

Previous studies have shown that when you ignore your biological clock and shovel in midnight snacks, you can add pounds to your waistline… elevate your blood pressure… and even make it harder for your brain to form new memories.

It also makes perfect sense that eating too late could spike your triglycerides — because your muscles and tissues don’t soak up these fats for fuel when your internal clock signals that it’s rest time.

So, the next time you wake up in the wee hours of the morning don’t find comfort in the fridge.

If hunger is driving you, try eating a high-protein dinner with lots of fibre to keep you feeling full until morning.

But if your snacking sessions are fuelled by anxiety, taking a warm bath or a hot shower can calm your nerves and help you sleep like a baby.