six Índice general del blog
MITOS EN MEDICINA
(cuántas cosas perdemos de gozar porque la cultura popular dice that are harmful)
6 º MYTH: Can you eat green leafy vegetables and seed-containing foods very small when you have diverticula in the large intestine? Are you one of the bearers of such a universal disease, it is highly likely that I will reply with a NOOO! Moreover, it is quite possible that several doctors tell me it banned on the grounds that the cellulose of leafy vegetables and the little seeds, for example, tomatoes, can cause inflammation of one or more diverticula (which in medicine called "diverticulitis" -Having the large intestine with diverticula is called diverticulosis "-), which can trigger an event far more serious: the peritonitis.
try to convince you that this is not just another myth.
A small lesson in basic pathology.
The large intestine (colon) is the penultimate of the digestive tube (the latter is the rectum, which ends at the anal opening).
begins in what we call "blind" (portion of which hangs "Appendix") with a diameter of 8 to 9 cm., And ends at the "sigmoid" immediately before the rectum, which has a diameter of between 2 and 3 cm.
Its total length is variable, and is, usual, usually from 90 to 120 cm. (Which is what puts us halfway between herbivores and carnivores strict, remember that humans are not strict herbivores -).
Its wall consists of three layers. The innermost is the one called "mucosa" in her work is carried out absorption, mainly water and salts.
The middle layer is the "muscle" as it consists of very special structure muscles, making movements for which it is designed.
The outermost layer is called "serous" and is part of what we know as "peritoneum." Obviously all this wall
receives blood that delivers nutrients and oxygen needed to stay alive and function. This blood is of arteries (and returns to the heart through veins), which together with nerves, making up an artery, vein and nerves called "neurovascular bundle."
These packets enter the colon through holes that allow you to reach the mucosa.
light of the colon (called the inner space and limiting "the colonic wall) is at a certain pressure (always greater than atmospheric) gas produced by fermentation of food. Pressure, which if normal, fully supports the muscular wall. But when the pressure becomes more permanently, the wall it is a stress that usually can not bear.
So slowly (over years), the pressure continuously increased, it pushes out to the mucus layer (the innermost), through holes that allow entry of "neurovascular bundles, and pushes the serosal (outermost), forming a pouch that hangs from the outer wall of the colon, and it communicates through a hole (which served as entrance to the neurovascular bundle) dilated now. THAT IS A "DIVERTICULUM." (Too bad not learned to draw on these messages. If I had you would understand everything better, but try to cope alone with the words. If there is anything you do not understand, please let me ask and I will explain another form).
In short, this is the pathology of the famous diverticula.
Often diverticula are so many in a small portion of the intestine, the surgeons must operate to remove that portion, and thus avoid the ever present risk of diverticulitis.
And when examining the specimen discovered that within each there are small seeds (tomatoes, grapes, kiwis ...), and cellulose fiber sheets green (that humans can not metabolize, so we have to defecate, but before deleting placed on them. Normally these items out of the diverticulum to be dragged through the mucus that continually makes the mucosa) Hence the error: the target they are the ones that cause painful and dreaded "diverticulitis". Hence the ban on consumption. But they are wrong.
Diverticulitis occurs when the pressure is so great intraintestinal (remember the wall of a diverticulum is composed of only mucosa and serosa) that "inflated" to each of them. This high intraluminal diverticulum in each, crushing the neurovascular bundle, so that the mucosal-serosal wall begins to suffer "ischemia" (lack of oxygen). If the ischemia is prolonged, there is a "stroke" (death of tissue oxygen for serious misconduct), then rupture of the diverticulum, and, therefore, depart interintestinales spaces fecal material in the large intestine, which infect the peritoneum, and the cause of the famous "peritonitis."
So what causes these myocardial ischemia and those are not the little seeds or fibers of cellulose, but the hyper intraluminal colon.
The big question is: What is what produces the high intracolonic? And
answer is very simple: food in the colon produce foam (as we have seen): milk, yoghurt, soft cheese, mandarin oranges, and wheat flour.
Realistically, flour can not be eliminated completely from the diet of each, but if we reduce consumption to a minimum to require "the circumstances" and eliminate from our minds that the world contains milk (which can be replaced by cream, as this contains almost no lactose, milk sugar produced, as it ferments, the happy foam), yogurt and citrus mentioned, I assure you that having diverticula should not be very different from having green eyes. Next delivery
: DOES "empacho" SOMETHING REAL OR FANTASY IS POPULAR?
Myth Myth Five (Part 2) blog index for
MEDICAL MYTHS
(every thing we feel we have the habit of seeking an explanation. That's good. But if we err, we condemning the innocent. And as the real culprit is still free, you can still hurting us)
5 º Myth (Part 2): "HYPERTENSION any symptoms? WHAT? (Part II) in the previous release we said that hypertension has a morbid fear that the pressure rises above certain limits, because if he does, he thinks, could have "an attack pressure, which paralyzed half his body, could leave him crippled for a long time or forever.
That has made that over the years have been awarded to high "warning signs" that "alert" to the wearer that it's not okay, so you need urgent help.
And poor hypertension, warning symptoms that are attributed are legion, but pure fantasy.
The most common of all headache (headache).
It is a mystery to find the origin of this myth.
past, when there were no modern antihypertensive drugs at our disposal, the classification of hypertension, the most serious is called "malignant hypertension", and the name was quite successful, because in those times, which was diagnosed this type, never die after two years of the diagnosis is made.
The bearer of this bad, I used to have a very unpleasant symptoms (would be nice if we wrote "torturous.")
in the previous release we said that the brain controls the pressure in your arteries. But that does not happen during sleep. When one sleeps, slowly, this superb protection wears off, until more or less then an hour after we sleep, the cerebral arteries have the same voltage than the rest of the body. That meant that, in malignant hypertension, his head began to ache. Pain was increasing with the passage of hours, until about the third stabbing became so ill that he awakened the morning. He could find no way to accommodate his head on the pillow ("it is as if it was resting on a log" I remarked thirty years ago), which forced them to rise, and, mysteriously, the pain disappeared without taking any kind of soothing, in less than an hour (is that the voltage regulators intracerebral arteries began to function in wakefulness, making it down).
This symptom, which was actually very rare to find (I remember only five cases in my first years of medical and then came the modern antihypertensive drugs, which are so effective as to have made to eliminate the classification of "malignant hypertension "-).
But as "hypertension headache" was a symptom that lasted centuries today, for those things in the atavistic, any headache in hypertension is attributed to a lack of control over their blood pressure. And there is the poor hypertension who have a headache, died of fear, to take the pressure where we first find someone to measure it (which means "who knows how to measure it.") Surely
find higher than usual, because the patient is frightened and newcomers. The logical deduction based on those erroneous evidence is that hypertension "means a headache." BUT THAT IS WRONG: hypertension can not give headaches because, it is higher, the brain regulates itself, and its artery is always "normal."
There are many causes of headaches. The most common is osteoarthritis, or correction of the cervical spine, and it still is "migraine" but never hypertension is one of them. Another
"premonitory symptoms" are "dizziness (or vertigo, to be precise in the use of common language, and I make this reference because in modern medicine the word" Vertigo "has been replaced by" dizziness type two. "What is one to make, we have to change the nomenclature to which we ourselves believe that" we are moving forward in knowledge. " One day in a conference an "expert" told us that diabetes-that it improves sulfodependiente tablet-taking, which we usually call "Type II" , from now on be called "Type 2", using Arabic numerals . When asked why the change, the "expert" told me that "because the Roman II, could be confused with the once" (sic). - Is there diabetes type 3, 5, 7, 8 or 10? - le I asked. He looked at me with disdain, and went on very loose body. Needless to say, I got up and went home, where I usually find it much More interesting than the dogma.
vertigo (feeling that everything revolves around us, or we who turn), you can have two origins usual.
One is circulatory in severe osteoarthritis of the neck, raising her head, for example to hang the laundry on the clothesline, posterior neck arteries collapse, no longer carry blood and produces an electrical derangement small body of which speak a few lines down, and then that ugly feeling (which ends instantly when you look ahead, because the arteries descolapsan-).
The other, more common, is purely electric. We
in the inner part of both ears, a great gadget that we call "Labyrinth", which helps to ensure the most important of the senses: the sense of balance . Is what gives us the perception of how our body in space (vertical, horizontal, sideways, etc..). If one of these gadgets are sick (for example, take the patient is left), the right will tell our brain that we are upright and facing forward (which is true), while the left-the ill-will tell that are tilted to the left. Such disparate information that our brain will not be computerized, resulting in a sense that the whole tour, or can not walk "rights" (such as drunks, who were upset alcohol his mazes).
Obviously, that was very comfortable doing their usual job, and suddenly it happens, for example, that everything revolves around you (or is it the turning), he feels a huge panic, making a call urgency, the first thing it does is take the pressure. And is high.
In such cases the pressure is high for two reasons: the terror he feels he suddenly and without apparent cause vertigo feels horrible that suggests a cerebral catastrophe imminent, and a physiological reason that makes the pressure rise, by reflex mechanisms, when the brain suffers from vertigo.
MORAL: The pressure does not produce vertigo, or dizziness, or instability of motion, but all of them "up the pressure."
And the last most common "pressure attacks" is the nosebleeds (epistaxis). Seeing blood
leave a place where they should (not injury, for example), produces panic, especially if the bleeding is nasal. All hypertension associated with this phenomenon. I've heard, with astonishment, that many doctors have told patients with epistaxis: "Thank God that He bled from his nose, because if the blood had come from an artery in his brain ... ... ... ... ...
I feel embarrassed for these views. Imagine what goes through the mind of the patient for the rest of the time left to live.
The blood from the nose is because an enlarged vein (varicose veins), which suddenly began to bleed (most of the time is because of what they call Otolaryngologists, elegantly, "rinodactilomanía" which is nothing more than the habit of poking their noses with their fingers.) That
nosebleeds, produces so afraid that if he takes the pressure who are suffering, it will be elevated. Then again the commentary "Misplaced" your nose is bleeding because his blood pressure is high, thank God it was in his nostrils and not ...
In short:
Hypertension "does not give any symptoms," that's why I always say to it is a silent enemy.
So the big question is: How will I know if my blood pressure is high? Well
is very simple: if you are already an adult, check your tire pressure once a year, winter, this is critical, as the cold increases the pressure of everyone, and especially a day pressure air is low (at low atmospheric pressure, blood pressure rises. After three days of being the lower atmosphere, the pressure is normalized, and, conversely, when the atmospheric pressure rises suddenly, low blood pressure, but the third day of high atmospheric pressure, the voltage returns to normal levels), atmospheric pressure is low, he said, and you have rested at least 15 minutes before drinking. If this takes the pressure is below 150/85, no controlled again until next year at a similar day.
If in such action, or more, see a clinician. But no fear: TENÉRSELE NOT AFRAID OF THE PRESSURE, BUT RESPECT (MUCH RESPECT) .
repeat, means the pressure has ceased to be the enemy who was in the past. With new drugs (and yet to come) has become a "lesser evil."
And if it is still higher because of the terror that produces the misinformation (or counter-). Tengámosle lot of respect, but never fear.
in hypertensive Tips for respectful:
Never stop taking the medicine your doctor ordered.
never cease to attend the visit.
never let anyone take the pressure if not your doctor or someone to whom he derived.
always wear hat in winter (70% of body heat is lost through the scalp).
Although they are very sensitive to cold, keep warm as do the people around him (I always tell my patients: "If you have numbed hand, puts the fire and does not hurt ... but you are burning").
never have a home blood pressure monitor is a device that only serves to scare them.
If you have recurrent epistaxis, do not take the pressure every time it happens, and go to an otolaryngologist for them to solve the problem.
If you get headaches frequently, attend the clinician to investigate why it hurts. But never do take the pressure, which is the most intolerable pain, because if the pressure is high nothing will happen, but if you know will be filled with anguish for free, which will worsen the picture of suffering.
If you have dizziness or vertigo, or unsteadiness of walking, see your clinician so that if he can not solve the problem, referral to a neurologist. And in those cases not taken the pressure in a crisis. If you already know it has to be augmented Why torture yourself with the numbers?
And again: even if you feel extremely well, get to take the pressure for doctor at least once a year.
Next delivery: we'll see (so much to demystify ...).
Myth Five (Part 1) index of blog
MYTHS IN MEDICINE
(often popular belief does more harm than the most profound ignorance)
5 º MYTH (Part 1): "HYPERTENSION any symptoms? WHAT? (Part One)
Hypertension is the second condition Chronic health of all medicine (the first is the disruption caused as a result of poor diet).
And in hypertension where popular belief has had more influence with their myths (obviously influenced against).
Do you have a headache?: Has high pressure. Does
dizziness?: Their hypertension is uncontrolled.
Are you bleeding from his nose? (On why the doctors call "epistaxis"): the pressure must be through the roof.
And so a number of symptoms are those that "warn" hypertensives "things are not right."
Then suddenly begins to feel headache or dizziness, or start, for no apparent reason, bleeding from his nose (or feel anything unusual, things that are so numerous that it would be boring list), runs to the pharmacy or the nurse in the corner, or call the medical emergency ward (if he did not commit the folly have a home blood pressure). We take (or take) the pressure, and is indeed high, as assumed.
Then come the tips of the "people who know", "Take another tablet Ya! - Or" Rest and eat without salt, "or" Go running to consult your doctor. O
emergency physicians who have not even seen a instead, they put under the tongue an anxiolytic (before was worse, because they had the habit of putting there the contents of a capsule of nifedipine -10 mg, which was much, much more damaging than having high blood pressure). Given an injection of a diuretic (usually one called furosemide), are left with the "patient" two or three quarters of an hour, checking that the pressure has fallen, and leave as campers.
All these actions to increase the pressure seems logical and normal. But not for nothing.
The fundamental question is why patients with hypertension are terrified that way when their blood pressure rise unexpectedly? And the answer is what everyone expects: because they fear the consequences of having a "ATTACK OF PRESSURE" . Who does not know anyone who has suffered? Have remained hemiplegic, that means that half his body has lost a greater or lesser extent, mobility, and in half the cases where this has happened on the side of his right hand, usually can no longer speaking, because the brain center where he coordinates the complex process of issuing the word is in the same hemisphere that coordinates skilled movements of the hand (and leg on same side). Come on: the right-handed right hand, which are the majority, when the hemiplegia is on the right side, and backward on the right-left members.
Imagine an "attack" of that type.
John is having lunch while talking animatedly with his wife. In a moment he began to feel strange: you have trouble holding the knife in his hand, because the force is lost in her second to second, at the same time note that the corner of his mouth is tipping, what difficult to deliver voice, difficulty also worsens rapidly, note that each time makes it more difficult to establish the right things but in his brain to think properly, or baste the phrases in his brain feels well basted. Begins to feel a terrible panic, and so instinctively tries to stand, but as the leg on the same side also lost the forces (which is not noticed when sitting), collapses.
Now who is in a panic is your wife. Kneels down, lying flat on the floor and starts to question what is happening desperate. But he does not respond, first because it is clouded, and second because he can not utter words.
She runs off to seek help, and when it arrives, the first thing you do is take your blood pressure. As expected, is very high, say by way of example that has 260 mm of mercury systolic ("maximum pressure" as the call usually) and 165 mm in diastolic blood pressure (or "minimal" as we call it almost always). Clarification: doctors and nurses have the habit of branding the blood pressure in millimeters of mercury, other people do it in inches of mercury (in centimeters and communicate them to our patients their pressure to speak the same language), by As for all the world John has, after the "attack", 26 / 16.5. "The consequence of all this?:
John has suffered" an attack of pressure. "
But it is false, what John has suffered a stroke. (The more often a transient ischemia-needed blood in an area of \u200b\u200ba cerebral hemisphere, which produces "neuronal suffering" - or a heart attack, permanent absence of blood in the same area, which triggers the death of the millions of neurons that make up that portion of the brain that handles the movement of the upper and lower half away, and the speech center, if the opposite half is half right hand, as we saw above-).
But perhaps John was not hypertensive, or if it was, their blood pressure levels were always bounded because it was a good patient, taking medications faithfully, and she attended each visit with your doctor without miss any.
What happened then?
The brain is the organ care of the whole economy, and is the most readily reveals any failure in that care.
Like the rest of the body is nourished and oxygenated blood. Blood runs through your arteries at a given pressure. But as is the body that commands everyone else, has been given a grace that others do not: You can adjust the pressure of his own arteries. For a very complex mechanism, regardless of pressure from the rest of the body is high, he always keeps the tension in your arteries to the level it should be (almost all lower general blood pressure).
Suppose two neighboring areas of brain, and call them and A B . Each has an artery that irrigate it. sector say that it supplies to 1 artery, and the industry B 2 artery. As a precaution, the artery 1 out very small arterioles that lead to the sector B, and artery 2 arterioles ranging A sector (in addition, each sector receives arteries arterioles, say, 3, 4, 5 ... but not so cumbersome to explain, let's stay only with the 1 and 2 ).
There is a universal disease which known as "atherosclerosis" .
That word comes from the Greek athéeree: means porridge and other Greek word, Skléeroosis, which means hardening .
artery consists of three layers, each called "coat" the inside (or close), the mean (which is muscle) and external. Atherosclerosis is the formation of deposits or yellowish plaques in the intima and the innermost portion of the tunica media, cholesterol and other substances that over the years calcifying go. In this plate is called atheroma . This occurs in the arteries of large and medium caliber.
Most of the time, these plates are slowly closing the lumen of the artery, until in a moment, the surface roughness of each atheroma results in the formation of a small blood clot that completely blocked. There occurs a type of "stroke", called "thrombosis" (word derived also from the Greek thrombo , meaning clot).
By going slowly closing, say, the artery No. 1 the 2 through their side is going to send blood to that neurons in the area A are not deprived of nutrients and, most importantly, oxygen. But the moment that the thrombus plugs total and instantly the main artery of the area (the No. 1 ), the area A is without sufficient oxygen, and the neurons that comprise begin to suffer the lack of vital element, so get to work getting worse, until in two or three minutes they do not. That's what happened to John while having lunch with his wife. The brain then sends messages to the blood pressure to rise with the double purpose of "pop" the blockage, and significantly, increase the flow of emergency through the collateral artery from 2.
In short, to end this nonsense, stroke is the one that pushes up the pressure, not high pressure that produces a stroke. (Although we must recognize that chronic high blood pressure and ill-treated or untreated, "is a precursor, in addition to the nutritional derangements of the highly dangerous" atheroma ").
Another type of stroke, thankfully less common, which we call "stroke" ( the Greek, "in" + bóllein "throw" ), and we define saying it is the sudden occlusion of an artery by a clot or some other foreign substance (eg, a piece of atheroma that emerges from a plate), and pushed through the blood moves through arteries , which become increasingly smaller as they move away from the heart to the periphery, until they find one with a diameter less than the piston and the jammed, preventing the movement thereafter. In these cases the problem is more serious because the affected brain area was not prepared, as in thrombosis, with "extra blood" coming from the neighboring artery through collaterals. Therefore, in the stroke is much more common in death of neurons that simply "suffering."
That is the reason why the victims of thrombosis can do better (sometimes 100%), than those of stroke, that is usually left with hemiplegia for the rest of his days.
The million dollar question is should we lower the pressure to the victim of a stroke?. My opinion is NO . He who has high blood pressure for several hours should not do any harm (the economy supports it without problems), and if he has suffered a thrombosis (much more common than stroke), neurons "suffer" but not "die."
I thought, imagining demystify the fact that hypertension has no symptoms, that things would be simpler. I'm used to explain this to my patients with words and pictures, but I've become much more difficult than imagined. So, we will continue the theme in the next issue, as there is still a lot of talking. Thirty
second installment: "Da HYPERTENSION SYMPTOMS? WHAT?" (Part II)
