EXTRACTS FROM THE

COMPLETE FAMILY MEDICAL GUIDE


NARCOLEPSY

  Narcolepsy is an unusual disorder of the brain's electrical activity that is characterised by sudden uncontrolled episodes of sleep. The cause is unknown, but patients go from wakefulness almost immediately into the deepest type of sleep, known as REM (rapid eye movement) sleep, without passing through the normal intermediate stages. They have sudden periods of sleeping for 5 to 30 minutes several times a day, sudden muscle weakness, hallucinations before and during sleep periods, and paralysis immediately before and during sleep. Patients suddenly fall asleep, sometimes in the middle of a sentence, or when halfway across a pedestrian crossing. There is a wide range of severity from those who merely appear to sleep excessively, to those who are barely able to function or care for themselves.

  The diagnosis is confirmed by an electroencephalogram (EEG) and by observing the patient in a sleep laboratory.

  Stimulants such as amphetamine must be used on a regular basis, and patients must not be allowed to drive, swim or operate machinery until they have been well controlled for a long time, as there is the obvious danger that the patient may accidentally harm themselves or others. In many patients, good control of symptoms is quite difficult to achieve.

  See also ELECTROENCEPHALOGRAM; SLEEP EXCESS


NARCOTICS

  Narcotics are strong, addictive and effective painkillers that are derived from the opium poppy. They are available as injections, tablets, suppositories (for anal use), patches and mixtures. They are highly restricted in their use, and must be kept in safes by chemists and doctors. If they are used appropriately, they give relief from severe pain to patients with acute injuries, and pain from diseases such as cancer and kidney stones. They are often used before, during and after operations to ease the pain of the procedure. If used in this way, it is unlikely that addiction will occur. If used excessively, a psychological and physical addiction can rapidly develop. Heroin is an infamous illegal narcotic which is broken down to morphine in the body.

  Narcotics not only relieve severe pain, they also reduce anxiety, stop coughs, slow diarrhoea, sedate and cause euphoria (a “high” - artificial happiness). They should be used with caution in asthma and other lung diseases, liver disease and after head injuries.

  Examples include codeine, dextropropoxyphene, fentanyl, morphine and pethidine.

Side effects may include dizziness, drowsiness, nausea, fainting, insomnia, nausea, rash, sedation and constipation. They should be used only if essential in pregnancy and with care in liver disease and asthma.

  See also ANALGESICS; ENDORPHINS; HEROIN


NASAL

  The medical term for any matters relating to the nose is “nasal”.

  See also NOSE


NATURAL FAMILY PLANNING

  Natural family planning, or the rhythm method, is really a form of periodic abstinence from sex (not having sex at those times of the month when a woman is fertile). The trick is knowing just what are the safe and not so safe times. Obviously, it is essential for both sexual partners in this situation to co-operate fully in the contraceptive process. The man must be as aware of the woman's cycle as she is herself. For this reason alone, this method of contraception does not suit all couples.

  A woman can only become pregnant for a short time each month, a few days either side of ovulation. There are many different ways of calculating the fertile time of the month. Because sperm can live for up to five days in the woman after ejaculation, and because the woman is fertile for two or three days after ovulation every month, sex must be avoided for seven to eight days during every cycle.

  The most common is a simple mathematical calculation, as a woman usually ovulates 14 days before her next period starts. If the woman has a regular 28 day cycle, she should not have sex from days 9 to 16 of her cycle (where day one is the first day of the period) in order to avoid pregnancy. If her cycle varies significantly, other clues to ovulation must be observed.

Changes in body temperature can give a guide to ovulation, as the temperature first dips, then rises about half a degree centigrade at the time of ovulation. Changes in vaginal secretions also occur just before ovulation, and these can be noted on a glass slide. Breast tenderness and lower abdominal pain may be other relevant signs in some women. The Billing's method of contraception is a combination of the above factors.

  Many people practise this form of contraception successfully for several years, but it is notoriously unreliable. The failure rate depends a great deal on the couple's commitment to follow the rules strictly, and the woman's own ability to note her own bodily changes. The percentage of women falling pregnant in one year while using natural family planning has varied from 5% to 25% in different clinical studies.

  Natural family planning can be used in combination with other forms of contraception, such as condoms, spermicidal foam or diaphragms, which are used at the time of the month when pregnancy may occur. No couple should undertake this form of contraception without consulting a doctor who understands, and is prepared to teach, natural family planning.

  See also CONTRACEPTION


NATUROPATHY

  Naturopathy is a natural therapy discipline which encompasses various modes or sub-disciplines, including nutrition, herbalism, homeopathy, and remedial therapies such as massage and exercise. By the use of these, the naturopath aims to create the conditions within the body that are most conducive to healing.

  Nutrition therapy consists of an assessment of the nutritional needs of the individual patient and any special requirements arising from the complaint for which help is sought. Advice is given (as by dieticians) on how best to support the healing process by a sound diet, including adequate fluid intake, the avoidance of smoking and using other toxic or potentially toxic substances, etc. The advice may extend to the selective use of vitamins, minerals and other supplements, and in some cases to the use of fasting and hydrotherapy.

  Herbalism is the use of plants and plant extracts (other than those used in pharmaceutical drugs, such as quinine, opium, digitalis etc.) for the treatment of ailments. It is one of the forms of therapy used in naturopathy and also a sub-discipline within traditional Chinese medicine. In naturopathy it has developed mainly from a European tradition and is sometimes referred to as Western herbalism to distinguish it from Chinese herbalism.

  Western remedial therapies used by naturopaths include different forms of massage, exercise, postural and relaxation therapies. Criticism of naturopaths is often aimed at their limited skills in diagnosing serious diseases and also at the orthomolecular treatment (ie. the use of very large doses of vitamins and minerals) some of them recommend.

  See also AYURVEDIC MEDICINE; CHINESE MEDICINE; CHIROPRACTIC; DIETICIANS; HOMEOPATHY; IRIDOLOGY; ORTHOMOLECULAR MEDICINE; OSTEOPATHY


NAUSEA AND VOMITING

  Vomiting, and the nausea that usually precedes it, are some of the most common symptoms experienced by humans, and are almost unavoidable at some time in life. An enormous range of infections, gut diseases, liver disorders, brain conditions, glandular disorders, and even urinary tract abnormalities, as well as many other problems that cannot be easily categorised, can cause nausea and vomiting.

  Gastroenteritis is the most common infective cause of vomiting, and it is usually associated with diarrhoea. A viral infection is the normal cause, but bacteria may sometimes be responsible. The infection is passed from one person to another by close contact or on the breath, and usually occurs in epidemics, often in springtime.

The nausea and vomiting associated with sea sickness, car sickness and other motion induced forms of vomiting is due to an inability of the brain to co-ordinate what it is sensing from the balance mechanisms in the inner ears with what is being seen by the eyes. In a ship, the cabin appears to be perfectly still, while the balance senses movement. For this reason, watching the horizon while on the ship deck enables the brain to see the motion and reconcile the visual and balance senses.

  Migraines are often associated with nausea and vomiting, as well as head pain and visual symptoms (eg. flashing lights, shimmering, seeing zigzag lines and loss of part of the area of vision). Pain usually occurs on only one side of the head, and is described as throbbing, and causes intolerance of exercise, light and noise.

Morning sickness usually occurs between the sixth and twelfth weeks of pregnancy, but in some women may persist for much longer. It is caused by a hormonal effect on the brain, probably arising from the developing placenta (afterbirth).

  Bulimia is a psychiatric condition in which anxious patients consume excessive amounts of food (often sweets or fatty foods), and then vomit to get rid of the food and so stay slim. The patient (almost invariably high achieving, middle to upper class young females) may gorge and vomit or purge themselves for hours, days or weeks. The condition may be associated with anorexia nervosa. Complications can include menstrual period irregularities, sore throat, bowel problems, dehydration, lethargy, and dental problems due to the repeated exposure of the teeth to stomach acid.

  Severe pain of any cause may result in nausea and vomiting as a reaction to the pain.

  Other causes of nausea and vomiting include meningitis (infection of the supporting membranes around the brain), many different bacterial and viral infections (eg. cystitis, sinusitis),  labyrinthitis (infection or inflammation of the balance mechanism in the inner ear), gastritis (inflammation of the stomach from acid irritation), appendicitis, mesenteric adenitis (infected lymph nodes in the abdomen), cholecystitis (inflammation or infection of the gall bladder), gall stones, hepatitis (several different types of liver infection), cirrhosis (damaged liver), a stroke (cerebrovascular accident), Ménière’s disease (dizziness, deafness and ringing in the ears),  and a an increase in the pressure of the cerebrospinal fluid (CSF) which surrounds the brain and spinal cord due to ahead injury, tumour, cancer, abscess or infection in the brain or surrounding tissues.

  Less common causes include kidney stones, uraemia (kidney failure), malaria, stomach cancer, Crohn’s disease (inflamed and thickened intestine), intussusception (infolding of the gut on itself , usually in children), a blood clot in the main artery supplying the gut, epilepsy, a reduction in the blood supply to the brain (from suffocation, near drowning, inhalation of smoke or toxic gases, narrowing of the arteries to the brain, or any form of heart failure), abnormalities of most glands (may  affect the body’s chemical balances), the premenstrual tension syndrome (hormonal changes that precede a menstrual period), poorly controlled diabetes, hyperthyroidism (overactive thyroid gland), Addison's disease (adrenal gland failure), glaucoma (increased pressure in the eye), altitude sickness, severe high blood pressure, heart attack (myocardial infarct), congestive cardiac failure (damaged heart is unable to beat effectively), Chinese restaurant syndrome (reaction to preservatives and flavour enhancers in  food), anaphylactic reaction (immediate, severe, life-threatening reactions to an allergy-causing substance), polyarteritis nodosa (inflammation of arteries) and AIDS.

  In infants, particularly boys, severe projectile vomiting may be due to pyloric stenosis (narrowing of the drainage valve  from the stomach).

  Alcohol abuse, either a binge or long term overuse, will lead to vomiting. Binge drinking and intoxication causes vomiting, headaches and hangovers because of the effect of alcohol on the brain and stomach.

  Many medications may have nausea and vomiting as a side effect. Common examples include most medications used for the treatment of cancer, narcotics (eg. morphine), digoxin (used in heart disease), theophylline (used in lung diseases) and overdoses of hormones (eg. contraceptive pill, hormone replacement therapy).

Radiotherapy (powerful x-rays) and nuclear irradiation used for the treatment of cancer often causes nausea and vomiting as a side effect.

  Vomiting may sometimes by caused by psychological disturbances and used as an attention seeking device.

  There are many other rare conditions which may have nausea and vomiting as a symptom.

  See also ANTIEMETICS; MORNING SICKNESS; MOTION SICKNESS; STOMACH; VOMITING BLOOD and separate entries for diseases mentioned above.


NECK

  See GOITRE; LARYNX; NECK LUMP; NECK PAIN; NECK STIFF; OESOPHAGUS; PHARYNX; SPINE; THROAT LUMP; THROAT PAIN; THYROID GLAND; TRACHEA; VERTEBRA