A surpisingly interesting account of a young woman’s discovery of deafness and gives a good insight into a whole different world. Useful from a medical professional’s point of view as well.
Month: January 2019
Dry January: Probably a good idea
‘Billionaire Vodka’ is filtered through ice and then some Nordic birch charcoal before being passed through sand made from crushed diamonds and gems.
I saw a programme on television a while back (I think Chris Packham was involved) in which there was a gentleman who, seemingly unprovoked, would quite regularly lose co-ordination, become disorientated and somewhat ‘lary’. Despite his protestations, his wife began to suspect that he was sneaking off to the pub at every available opportunity without telling her. Understandably this placed rather a strain on their relationship until finally it transpired that he was innocent after all. It turns out he was suffering from something called Auto-brewery Syndrome.
This thankfully rare condition is thought to occur when there is an overgrowth of yeasts in the intestines that produce a natural fermenting process in the gut, resulting in high alcohol levels that make the sufferer quite literally drunk without having consumed any alcohol.
Fermentation (the science of which is known as zymology for the purposes of pub quiz trivia) is key to producing alcohol and there is evidence to show that we, as a species, have been using it to make alcoholic drinks for thousands of years, as far back as 7000 BC. In the middle ages we were brewing beer as an everyday drink, often protecting against various water-borne diseases. It was also quite handy for sailors to take along with them on long voyages. Essentially, alcohol – specifically in alcoholic drinks ethyl alcohol or ethanol – is produced when yeasts and bacteria break down natural sugars found in fruits and grains in the absence of oxygen. Lactic acid that causes cramp in muscles during exercise is formed through a similar process.
Of course, as much as we like it, drinking the stuff does not always result in the best of outcomes. Some research has estimated that, at any one time, up to 0.7% of the world’s population (equivalent to around 50 million people) are drunk. Unfortunately in the UK in 2016 7,327 people died from alcohol specific causes and around 40% of all violent crime involves alcohol in some way. It accounts for more than a million hospital admissions each year.
As you can imagine, this creates rather a strain on the health service as well as on a person’s general health. When we drink alcohol, it creates a numbing effect on the brain, resulting from inhibition of certain neurotransmitters. Most likely it is this sensation that has us coming back for more each time. While in the moment it could be described as pleasant, it has some far more negative effects.
Your body reacts to ethanol as a toxin and this causes a reduction in insulin effectiveness in the long term if we drink a lot. Conversely, in the hours after drinking lots of ethanol, there will be an upturn in insulin production, lowering our blood sugar and causing tiredness and fatigue. As it is broken down, it produces acetaldehyde, which is heavily implicated in hangovers. It is also something which has been implicated in ethanol’s role in causing cancer, in this case by damaging DNA.
There are seven proven types of cancer (probably more yet to be proved) in which alcohol has a causative role: bowel, breast (possibly due to increased oestrogen levels), laryngeal, pharyngeal, mouth, oesophageal and liver. The liver becomes more and more damaged with persistent alcohol use and the scarring produced from this (cirrhosis) can cause irreparable and unpleasant consequences which may ultimately be fatal.
If that is not enough, excessive alcohol will drive up blood pressure and predispose a drinker to diabetes, all of which increase the risks of heart attacks and strokes. Alcoholic drinks account for around 11% of the UK population’s sugar intake further compounding this risk. It will inevitably cause weight gain and likely some tooth decay along the way.
Sleep can be greatly affected by alcohol. While many people drink as an aid to sleep, although that initial numbing effect may help them drift off, the sleep achieved will be restless and inefficient. Time spent in REM (rapid eye movement) sleep will be increased, resulting in less time spent in deep and restful slumber. This only causes fatigue and makes things worse rather than better.
What then, is a ‘safe’ level of
alcohol? The chief medical officer’s official recommendation is that we do not
exceed 14 units of alcohol each week (one unit is 10ml of alcohol). This is a
reduction from the old recommendations and represents roughly 6 pints of beer,
or 6 glasses of average strength wine.
Often people underestimate how many units there are in their drinks – it is
more than you might think!
If you do drink 14 units a week, spreading them out is the way to go rather than all at one time. If you are drinking any more than this, you are really not doing your health any favours, not to mention your bank account. Incidentally, the most expensive vodka in the world will set you back a cool 3.7 million dollars. ‘Billionaire Vodka’ is filtered through ice and then some Nordic birch charcoal before being passed through sand made from crushed diamonds and gems. Served in a diamond encrusted crystal bottle, it is some fairly serious stuff. While not all alcohol is priced that high, it does highlight the glamour that often surrounds it. Therein lies much of its danger.
Dependence on alcohol can creep up on you and, if unchecked, can quite literally kill you. It is thought that only 6% of alcohol dependant people will access treatment every year, so if you are unsure it is worth coming to see your GP or accessing any of the online resources listed at the bottom of this article.
You may have heard every now and again about the benefits of alcohol. In the past, before the advent of anaesthesia, surgeons would ply their patients with alcohol before procedures and physicians would recommend a ‘hot toddy’ to stave off a cold. In fact, while giving an initial boost (due to the effects of alcohol on the mind) a dash of whisky in your hot drink probably only serves to slow down the natural process of fighting off the infection.
Certainly there have been studies reported in the papers about regular red wine being good for your heart. The truth is, certainly in my mind, that there is simply not enough evidence to back this up. While some studies have shown benefits, the context in which they have been carried out is far from conclusive. Things like red wine do contain ingredients known as flavonoids, thought to be rich in anti-oxidants which, among other things prevent clotting disorders. However, current evidence only points towards an overall benefit in a very small amount of alcohol (5 units a week) for women over 55 years old. Before you all go rushing down to the pub, remember that is a mere 5 units a week!
So I would recommend that the next time you feel a spot of cenosillicaphobia coming on – a pathological fear of an empty glass – consider filling it with something other than alcohol instead. I’m not saying we should stop drinking altogether but moderation is the overwhelming key. And if there are any generous billionaires out there, I would much prefer a nice house or three rather than a bottle of vodka. Thanks.
Churchill’s Ministry of Ungentlemanly Warfare
Giles Milton paints an heroic picture of the incredible operations and missions carried out during WWII. An interesting read just after the Codemaker’s War as it deals with a lot of the same organisations from a very different angle.
The Dreaded Headache
“…there have been discoveries of skulls dating back to Neolithic times (between 10,200 BC and 2000 BC) drilled into and partially removed in what is thought to have been an early attempt at treatment”
I was speaking to a friend recently who claimed that he had never had a headache. On further enquiry, it appeared he simply had no concept of what one might feel like, even the dreaded hangover headache. Now I don’t have any statistics on this, but I suspect that this situation is very rare. Let’s face it, most of us get headaches and, unfortunately, there are lots of things that can lead to one.
Throughout history people have suffered and there have been discoveries of skulls dating back to Neolithic times (between 10,200 BC and 2000 BC) drilled into and partially removed in what is thought to have been an early attempt at treatment. Drastic though that may seem, some have shown signs of bone growth around these holes, suggesting the patients survived this process. Altogether more civilised were the ancient Greeks and Romans who tried either peppermint tea or rubbing raw potato into their heads.
Overwhelmingly the most common cause is the tension headache and most of us will have experienced one of these. They occur due to muscular tension that can develop from the shoulders and neck or from around the muscles of the forehead if, for instance, one’s posture in front of the computer is not optimised. They can also develop through stress or if the eyes have been straining to read a screen for too long. It’s always worth popping to your optician to get your eyes tested if you feel you are straining a lot, especially if you’re getting headaches.
Although tension headache is most common, it is perhaps over-diagnosed at the expense of another common cause of headache – the migraine. Thought to have a global prevalence of 14.7%, it is estimated that the UK population loses 25 million work or school days from the condition each year. That equates to roughly £2.25 billion loss to the economy and produces a £150 million cost to the NHS through prescriptions and GP appointments.
Migraines are typically one sided (although not always), hence the derivation of their name from the Greek word ‘hemikrania’ meaning ‘half the skull’. Despite their impact and prevalence, the process behind what causes them is still unknown. Rather than relating to blood vessels in the brain constricting and then dilating as once thought, it is now suspected to be more related to particular neurological systems. There is ongoing research into various facets of this, including particular gene associations (there is a definite hereditary element to migraines), specific brain regions activated in the earliest stages and the roles of various neuropeptides. It’s all pretty complex stuff.
One third of migraines will start with an aura (a visual phenomenon a little like the image below although it can differ from person to person) and may progress to a throbbing ache, typically lasting for between 4 to 72 hours. Women are more prone than men, and tend to suffer more often during or just before their periods.
If you have a migraine, it is best treated as early as possible with paracetamol or ibuprofen. If these don’t work, regular sufferers may benefit from trying one of the triptan medications available on prescription. Once established however, a migraine can be debilitating and so lying down in a dark room and resting is often the best course of action.
It’s worth considering that there can be certain triggers. Coffee, chocolate, sugar-free food sweetened with aspartame or sucralose and any foods containing tyramine such as citrus fruits, bananas, processed meats, onions and nuts are all potential offending items.
What of other causes of headaches? I mentioned hangovers earlier and these must be up there alongside tension and migraine headaches in terms of prevalence. Essentially, when we drink lots of alcohol, our bodies dehydrate and this reduces our circulating volume of blood. This causes a shrinkage of the brain that then pulls upon the membranes holding it in place, thus causing an ‘ache’. Like the migraine however, the full process is not wholly understood and there is a theory that suggests a significant contributing factor may be the build-up in the brain, in place of glucose, of a chemical known as acetaldehyde (which is a breakdown product of alcohol). Either way, the best way to avoid it is obviously to limit alcohol intake and, if you are going to drink a lot, ensure you drink plenty of water before bed and in between alcoholic drinks.
There are several more severe and mercifully less common headaches worth mentioning.
Trigeminal neuralgia (the trigeminal nerve is a major nerve that supplies various areas of the head and neck; neuralgia is ‘nerve pain’) is characterised by short episodes of sharp, intense, electric shock pain in the eyes, nose, scalp, forehead, jaw or even lips. Even the slightest touch can trigger it, including a light breeze, and it can be life-changing for sufferers of severe forms.
Similarly, cluster headaches can be so severe that they are sometimes referred to as the suicide headache. The pain from these is often described as a penetrating and excruciating pain around the eye and can last anything from 15 to 180 minutes. Some have labelled it the worst pain a human can experience. If you are suffering from these, the chances are you won’t need prompting to come and see a doctor.
If you suddenly experience a sudden severe (often described as thunderclap) headache, one that you might describe as the worst headache you have ever had (assuming you have never had a cluster headache!) or as if you have been hit on the back of the head, it might be a sign of a different cause – a subarachnoid haemorrhage (subarachnoid means below the outer layer of the brain, haemorrhage = bleed). This can be accompanied by sensitivity to light and neck stiffness, much like those suffering from meningitis. This needs a trip to A&E to get tested.
More subtly, but still serious, is a headache that manifests in tenderness over your scalp. If you have pain when you press over your temples (typically, in contrast, rubbing here with a tension headache helps) then it may represent an inflammation of the blood vessels in the scalp known as temporal or giant cell arteritis. This is a rheumatological condition and may require blood tests and maybe even biopsy of the offending areas. It can also cause blurred vision so if you think this is happening (typically you will be a woman around your 70th year) then it is worth coming to see us.
Finally, if you are waking up every morning with a headache over the course of several weeks, this is probably something you should also get checked out. It could well be tension, a stiff neck or blocked sinuses but this pattern can sometimes point towards pressure within the brain itself caused by a tumour. No harm in coming to get it checked by us.
Far from wanting to worry you, the chances are that, if you have a headache, it is caused by tension or a migraine. So my advice is similar to what it would be for many other health conditions. Maintain a healthy and balanced diet, with plenty of exercise, and ensure you drink enough water through the day. Get your eyes checked regularly and make sure you consider your posture both at work and at home on the sofa. Manage stress (as much as that is possible!) and if you are worried that the headache has any worrying features, feel free to come and see your GP. As for hangover headaches though, I’m afraid you’re on your own. “