This is the answer prepared for another forum.
(Q: Why do I get a vomiting sensation while travelling. Not while in train or flight or when I am driving?)
I can give you a rough idea; expand by reading further. There are 'sensors' in our body to sense 'orientation in space' and 'movement in relation to space'. 1. Vestibular system;situated in the inner ear, 2. Eyesight, 3. Skin and deeper sensations from the soles of feet (while standing), buttocks, back of thighs (while sitting). 4. Sensations from joints, muscles and tendons (the ends of the various muscles)
The sensations brought into the brain is 'computed' and 'reflex' corrections made (corrective movements to balance the body and prevent fall). This requires well-functioning Central Nervous System (includes cerebellum and its connections, healthy muscular system and concerned nerve supply.
In motion sickness, it is due to excessive or imbalanced stimulation of the concerned organs. (eg., the vestibular system senses movement not corroborated by corresponding stimulation of the other 'sensors')
The 'balance centres' in the brain are wired to the 'vomiting centre' as well, hence vomiting is one symptom.
In flights and train journeys, the 'stimulation' is not excessive, hence you are comfortable. (There are people who can't tolerate flights; the vestibular system senses movement - acceleration, deceleration, angular movement etc. and imagine the speed!, while the visual cue is zero, even if one looks out through the window)
When you drive, your neck and body will tilt and adjust so that your eyesight and other body sensations described above are balanced.
There are 'grandma's treatment for motion sickness; 1. Carry a lime and smell it frequently 2. Rub on your forearm (with the opposite fist) and smell to manage the vomiting sensation.
Any qualified doctor can prescribe you medicines to prevent motion sickness; there may be medications that you can buy over the counter in a medical shop.
Penetrating Injury Ear
Hi,
I have a 14 yr Male, who sustained penetrating injury right ear by a small needlefish, while
swimming, He could feel 'something tearing deep in the ear' when he tried to dislodge it, when most part of the fish broke off, leaving its beak inside.
When I saw him in the ER (about half hour later), he was fully conscious but vertigenous and vomiting with a Gr III horizontal nystagmus to Left (Injury in R ear). No facial palsy. Could bring him to ENT OP on a wheel chair and I instilled a few drops of 2% Xylocaine into his bloody right ear canal. After a couple of minutes with Welch Allyn Lumiview to see, eased out the FB using a ear microforceps.
It was the beak of the fish, about 3 cm long.
<(Left: The two pieces of FB from Ext Ear CanalRight:The beak opened, mirco-forceps kept alongside )>
A peak inside revealed tramatic large perforation of the TM, with the HOM lying in a deeper plane, as if leaning back on the promontary. I wondered if it were really the HOM or another FB, like a broken piece of the beak.
Took him to OT and under GA, examined the ear under microscope. No sign suggesting perilymph fistula. Cleaned the site with light suchtion. TM was found to be torn off in front and behind the HOM, the malleus subluxated to a deeper and anterior location. Also, could see another FB, a greenish-black, irregular, bony-hard bar in the middle ear, deep to the malleus, and at right angles to it. Incus couldn't be seen, head and neck of the stapes were visible. With some difficulty (as the long axis of the FB was at right angles to the handle of malleus) FB was removed which was found to be part of the broken tip of the lower beak.
In the picture, near the thumb is the new piece retrieved from the middle ear, cleaned of the greenish black skin; and that near the micro-cup forceps is the earlier one from external canal )>
After lavage with lukewarm saline, instilled Ciprofloxacin and Dexamethasone drops and the ear was plugged and patient sent to the ward on systemic antibiotics. Also Inj. Dexa-methasone 4mg is being given OD parenterally.
After two nights, today, he is doing much better. Vertigo is episodic. Nystagmus is Gr I. TM is healing well, and Seigelisation doesn't provoke any vertigo. Weber's (512Hz) was lateralized to the same side, with BC > AC there. In Left ear AC>BC. Pure Tone Audiogram shows Mixed loss (Audiologist: me)
| Freq | 250 | 500 | 1K | 2K | 3k | 4k | 6k | 8k |
| RAC | 55 | 50 | 55 | 65 | 90 | 85 | 85 | 80 |
| RAC(mskd) | 55 | 65 | 65 | 65 | 90 | 100 | 90 | NA |
| RBC (mskd) | 15 | 20 | 30 | 45 | 55 | 35? | 50? | NA |
| LAC | 25 | 30 | 20 | 30 | 35 | 35 | 35 | 35 |
Since patient is doing well, I am planning to do a
What do you think should be the course of action?
Thanking you in advance,
Thomas Antony
Here are the CT images. Incidentally you can also see "Pneumosinus dilatans multiplex" as well as the "Korner's septum:"
Diagnosing Sleep Apnea with X-rays
Tired Teens
Orthodontists Diagnose Sleep Apnea More Easily with X-Rays
August 1, 2005 — Diagnosing sleep apnea -- a chronic condition that causes teen-agers to stop breathing during sleep -- is difficult and often means staying at an overnight sleep lab. A new test can spot with problem with simple X-rays, by checking the position of the tongue and hyoid bone. If the bone sits lower, patients are more likely to have the condition. In a recent study, the X-rays correctly identified 70 percent of teens with sleep apnea.
See also:
CLEVELAND--Being a teenager is tough these days, but it's especially tough if you're always tired. Now a simple X-ray taken at your children's orthodontist could hold the key to helping them sleep better.
Sixteen-year-old Andrew Dudash would come home from school each day and go straight to bed. "I actually got a detention in school for sleeping during a class," he says.
Doctors diagnosed him with sleep apnea, a chronic condition that causes him to stop breathing during sleep. Diagnosing the condition is difficult and often means staying at an overnight sleep lab. But orthodontist Mark Hans wants to make that diagnosis easier. He's studying whether the same X-rays teens get before getting braces will help determine if they're at risk for sleep apnea.
"We're trying to give the sleep doctor a better chance of examining the right patients for this condition," says Dr. Hans, of Case Western Reserve University School of Dental Medicine in Cleveland.
Dr. Hans looks at the position of the tongue and hyoid bone. If the bone sits higher, patients are not at risk for sleep apnea. If it falls lower, they are more likely to have the condition.
In a recent study, the X-rays correctly identified 70 percent of teens with sleep apnea. Dr. Hans says, "When you identify chronic illness early and treat it early, you really prevent more long-term problems."
Case School of Medicine pediatric pulmonologist and sleep specialist Carol Rosen, says the X-rays would help. "This would add another feature that we would look for in our evaluation." So teens like Dudash can get the treatment they need.
"There's definitely a difference in my sleep because I'm not waking up much during the night," Dudash says. And his sleep is not something he's willing to gamble on.
Dr. Hans says there's no disadvantage to performing the X-ray other than a minimal dose of radiation, which is equivalent to a day in the sun. He says most insurance covers the X-rays, which cost about $100. A sleep lab evaluation could cost thousands.
BACKGROUND: Researchers at Case Western Reserve University in Cleveland, Ohio, have identified two key factors in sleep apnea in teenagers. They used radiography (an imaging technique used by orthodontists) to study a group of teens to determine if they were likely to suffer from the condition. The technique will be used for earlier diagnosis for sleep apnea in teens before they become adults.
THE STUDY: The investigators studied the case histories of 590 patients between 7 and 8 years of age attending the orthodontic clinic at Case Dental School. Sixty of these patients -- a group least at risk and a group most at risk for sleep apnea -- underwent unattended in-home sleep monitoring.
WHAT IS SLEEP APNEA: Sleep apnea is a temporary suspension of breathing during sleep, which can have potentially serious consequences. People with sleep apnea can stop breathing for 10 to 30 seconds at a time, as many as 400 times a night. Most sleep apneas are the result of something blocking the passage of windpipe of the throat that brings air into the body. The tongue, tonsils, or uvula (the little piece of flesh that hangs down in the back of the throat) can all sometimes produce blockage, as can severe obesity: excess fat can block the airway. Some 12 million Americans suffer from sleep apnea, but men and those over 40 years of age are more likely to have the condition. Risk factors include heavy snoring, excess weight, high blood pressure, and any physical abnormality in the nose or throat.
WHAT ARE X-RAYS: X-rays are light waves.
The only difference between X-rays and the light that we see is that the X-rays have a higher energy level, and a shorter wavelength, making them undetectable to the human eye. Because they have so much energy, the particles that make up light, called photons, in X-rays can pass through most materials. It all depends on the size of the atoms that make up the material; larger atoms absorb X-ray photons. But smaller atoms do not, and the X-rays pass right through.
The soft tissue in the body is made of smaller atoms and doesn't absorb X-rays very well, but calcium atoms in the bones are much larger and do absorb X-rays. A camera on the other side of the patient records the patterns of X-ray light passing through the patient's body.
It's the same basic technology as that used in an ordinary camera, but X-ray light, instead of visible light, sets off the chemical reaction on the photographic plate.
(This is copied from "Science Daily", on 20th Nov, 08)Clinical: Cervical Osteophytes & Dysphagia
Hi,
I would like to have your advice for the following patient.
I would like to have your advice for the following patient.
60 yr old male, has been having dysphagia and chokes on fluids and solids for about 2 yrs or more. The daughter who happens to be our nurse, says it is a pain to watch him taking food.
His X-ray neck lateral shows big osteophytes between C2-3, C3-4, C4-5, C5-6, and C5-7. The ones C4-5-6 looks like a single unit. They are big and measures almost the antero- posterior diameter of the corresponding vertebral body.
A CT done 2 yr back revealed nothing more than this. We couldn't do a Barium swallow for flimsy reasons, but it could be done about a week back, and since the software to record the same didn't work, we had to be contented by just seeing what was seen during fluoroscopy. The barium went down without any hitch, negotiating the "C" projection of the C4-5-6-7 oteophytes at the root of neck.
We sent him to our Orthopaedician, who asked for an MRI; but it couldn't be done, as he was unable to lie down for the same because of pain (Radiologist told the nurse-daughter) Hence a repeat CT was done (Is the position for CT different from MRI?), which showed no change from the previous CT.
What next? I am posting photograph of the X-ray Neck Lateral and relevant frames from a CT scan.
Yemen
Life in
Dr.Thomas Antony
It was lunch time, the sun at its peak, and I was just about to enter our residential building. Just then I saw a shining Land Cruiser parked opposite to the gate, on an otherwise empty road, and a few westerners walking around, taking photos. I wondered if they were trying to locate the sea through some gap amid the buildings, when one gentleman wished me in Arabic. I returned the greeting and gestured to them how they could go to the beach. "Oh, you speak English!” He seemed surprised as he walked towards me. The others were three middle aged plump ladies in T-shirts and pants chatting with a local person.
He said he was Irish, now retired from a bank. The ladies with him were British. They 
all have come to
By the beach he could find the old house where his tender memories lived. Occupied by natives, there was a tall compound wall around it now. It had been just a fence earlier. He was upset he was not allowed even a walk around the house by its present resident. That freedom cannot be allowed now; it is considered an intrusion into their privacy. Life has changed much and the old sparkle is gone.
00000
The British came here in 1839, made
North and
The colours of western civilization left by the British occupation and the socialist regime in 
All women began wearing black cloak that covered them head to foot. It is called 'abaya'. Some add a veil over the face. More and more young men accepted orthodox lifestyle, growing beards and covering the head, while most of their parents still sport clean shaven faces, with a hair combed neat.
One sees people from many countries in this place. Some have come for work, while others have integrated well into the society. Many Yemenis have studied abroad and could pick their life partners from there. Yemenis have taken wives from
00000
History of this place dates back 3000 years. I read an article where it says this place is mentioned in the Book of Ezekiel. This is part of the
Because of its strategic position
In spite of its rich culture and traditions,
However, the average Yemeni manages to remain happy. It is very rare to see them
quarrel or fight. It is difficult to find rudeness or arrogance in them. If you hear shouts or loud conversation, be assured it is a crowd dispersing after a football match. Don’t let a row of cars with head-lights on and blaring horns panic you; it is a wedding motorcade. Armed with a politeness to disarm you, their pleasant high-spirited nature is transparent. There is an air of tranquility around. Before you know it, you begin to feel at ease with them. And then you realize they are the embodiment of patience. Once, waiting at
Qat in Yemen...
Qat and
One of the various surprises that greeted me in
Legend is that the property of qat was discovered long back in
The Experience
Our Chinese anesthesiologist narrated his experience. He said it tasted bitter and he couldn’t keep it more than an hour in his cheek. (The tender leaves and shoots are stripped off the twigs, wiped clean, smacked by the fingers and gently placed between the molars, chewed and moved into the cheek, the fingers busy getting the next leaf ready. The juice is swallowed with water or carbonated beverages. The accumulating ‘cud’ is spat out only after the session lasting 4-5 hrs is over) He couldn’t sleep either that night or next. And mucosal ulcers developed in the cheek mucosa. He hasn’t used it ever since. A nurse from
Our Yemeni pharmacist tells us it gives ‘good mood’, and that he chews it regularly every evening. He said it is mentioned in Pharmacology books, and narrated the ‘qat ritual’ every Thursday evening. (The weekend here is Thursday and Friday) The master of the house will sit down in the tidied up room with the arm pillow to his side, his wife would have washed and dried the tender qat leaves for her hubby. After a bath, she is already in a beautiful dress, and well perfumed, hair well combed and usually wears a garland of jasmine. There is a twig of some plant with exotic smell tucked into her hair. She sits near him to chat, and pour the water or soda for him. She may or may not use qat herself. He is euphoric, and children find it the best time to get hard demands sanctioned.
In one study 60% of men and 35% of women in
The Plant
The botanical name of this exotic plant known for its stimulant properties is Catha edulis. It is a shrub or small tree. It is known as Mirra in
One should know…
The stimulant property is attributed to the alkaloid cathinone in the plant. It breaks down into cathine and noradrenaline. No wonder it behaves as a sympathomimetic, increasing blood pressure and pulse rate. In the
Qat consumption is known to produce euphoria and excitement. It is also said it can induce manic behaviour and hyperactivity. The effects of qat include alertness, energy and euphoria. Some say one relaxes and get intellectually focused. One may undertake skilled tasks and the creatively talented may write poetry. A psychological dependence may develop, but is not considered as an addictive drug. There are no medically accepted benefits of qat. More than the physical high, there is a cultural side to qat -- the qat chewing sessions. In many houses, there are well furnished qat chewing rooms or halls, a show-piece of the house.
Money, money, money..
Qat is cultivated in mountain terraces and most such areas in
Many consider this a social evil. An American soldier writes in www.al-bab.com: “Qat is the drug that made the Somalians feel they were invincible to our US Rangers and Delta Forces. ... Because of our military, they overcame this famine. However, this drug made the Somalians unappreciative of our efforts to help. They felt as if they could conquer the world. … Today, their people are still starving. I'm sorry, but we tried.”
Back to square one
As for us medical staff here, the average employee chews qat and don’t sleep at night, comes to the hospital next morning requesting medical leave, as he is “tired”. WHO has listed qat as a "dependence producing drug" The users will attempt to get daily supplies to the "exclusion of all other activities." It is said qat chewing is a near-daily activity for those who can afford it - and sometimes even for those who can't. When the poor man willingly foregoes food in favor of buying qat, his wife and children get neglected thus. So, some request the government to extend the work day in an effort to reduce qat consumption. But advocates of qat feel that Yemenis are not lazy, there is just not enough work to be done.
Qat chewing distinguishes Yemenis from the other Arabs. It is well woven into
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