Archive for April 28th, 2009

Joan Kowan was one of my earliest and most difficult headache patients. She had been a student nurse until she was expelled from the nurses’ training program for poor attendance. Her constant, severe headaches had prevented her from being able to keep up with her classmates. So severe were these attacks that, in desperation, she had consented to two brain operations. They were complete failures, and the surgeons could find nothing organically wrong.

In my office, she was found to be highly sensitive to milk. By avoiding milk and dairy products in all of their forms, she was able to control her headache problem and return to school. As time went by, however, it became increasingly difficult for her to avoid all forms of milk. She lived in a college dormitory and ate institutional food. While the regular cook had cooperated with her requests, he was not always there. For example, her vegetables were cooked and set aside before butter was added. A substitute cook, however, did not do this, and Joan unknowingly ate the buttered vegetables. Within an hour, she suddenly fell to the floor in the nurse’s station, overcome by violent head pains. The cause of this reaction was traced, in retrospect, to the seemingly insignificant amount of butter on her vegetables. Such inadvertent exposures to milk were fairly common and most troublesome.

To alleviate the pain, she began to take codeine tablets, until she became addicted to them. She also became dependent on other pain-killers to which milk sugar was added as a filler. Thus, while these drugs appeared to give relief, they were actually perpetuating her basic problem.

Miss Kowan was so amazingly susceptible to milk that I thought it would be worth recording some of the features of her case for the medical record. She agreed to take an EEG (electroencephalogram) test, which records brain waves, while drinking a minute amount of milk.

To make the test “blind,” she was given two drops of milk in a glass of water. This, at least, is what she was told she was receiving. Actually, the first sample she chose contained several drops of an inert antacid, aluminum hydroxide (Amphojel), in a glass of water. The water became slightly cloudy, just as if it had had milk added. She drank this with fear and trembling, since she anticipated one of her characteristic headaches. Nothing happened. She was then given two drops of actual milk in a glass of water, but she was told she was receiving more of the previous substance. This time she rapidly went into agonizing pain. In her writhing, she pulled herself free of the EEG machine, ruining that part of the experiment.

Her case made clear, however, the ability of even small amounts of an incriminated substance to cause severe and chronic headaches.

Miss Kowan eventually managed to get her allergy under control and to graduate. Years later I received a letter from her. She had obtained an excellent position with a large manufacturing concern and had a good work record, with few absences. “Since you saw me last,” she wrote, “I have not faltered in my quest for a new future.”

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Most mechanical devices require petroleum-derived oil as a lubricant. As these machines operate, some of the oil escapes into the air. This atmospheric pollutant may pose a problem for certain people. The most common source of such oil in the home is the air conditioner. The air-conditioning unit not only emits a “normal” amount of oil as it runs but generally has an oil-impregnated glass-wool or fiber filter. Some patients who were affected by air conditioners have been able to use the appliance with impunity when unoiled filters were substituted.

Kitchen devices with motors may be another source of indoor air pollution. These time-saving appliances are proliferating, often without a thought being given to their possible drawbacks. If a refrigerator, food processor, electric hand beater, can opener, and air conditioner are all operating in a kitchen, this can represent a considerable source of oil fumes. In addition, it should be noted that such electric motors emit minute amounts of ozone, a rare form of oxygen, which is highly toxic. American and Soviet scientists have found that humans may be endangered by exposure to fifty parts per billion of ozone in the atmosphere. Susceptible persons may be even more likely to incur damage from ozone in a closed environment.

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Encephalitis is an inflammation of the brain. The causes are many, including poisons, bacteria, vaccines, and parasites. Most cases are caused by viruses, many of which cause familiar diseases such as mumps, measles, rubella, chicken pox, herpes, mononucleosis, hepatitis, and influenza. The whooping cough bacterium can cause encephalitis, as can the vaccines used to prevent whooping cough, measles, influenza, yellow fever, and typhoid. The vaccines are far less likely to cause encephalitis, however, than are the illnesses they prevent. Lead, mercury, and other poisons also may cause encephalitis.

Signs and symptoms

Encephalitis may start with the symptoms of a common cold. The child may have no fever or a high fever (40.6°C). The child usually has a headache, vomits, and is disoriented (confused) and sleepy. Occasionally, convulsions and unconsciousness may occur.

A child with encephalitis will usually be unable to flex his or her neck forward to touch the chin to the chest while the mouth is closed. Sometimes the child cannot sit up without supporting the trunk with both hands braced behind (in a tripod fashion). This is a life-threatening situation.

Home care

None. See your doctor immediately if your child shows any symptoms of encephalitis.

Precaution

• If your child has had a severe reaction to any of the vaccines listed, be sure to tell your doctor before a booster of the vaccine is given.

Medical treatment

Since encephalitis may be a complication of another disease (such as measles, mumps, whooping cough), a child with such a disease and encephalitis symptoms will probably be examined for encephalitis. Knowing that the child has been exposed to poisons may also lead the doctor to suspect encephalitis.

A definite diagnosis is based on the child’s medical history; a blood count; a spinal tap; identification of the infecting organism in the spinal fluid, nose, throat, or stools; and the presence of antibodies (protective substances made by the body to fight the infecting organism) in the patient’s blood.

If encephalitis is diagnosed, hospitalization may be required. There is specific treatment for only a few types of encephalitis, since most viral infections are hard to treat. There is no medication that can kill the invading virus after it has caused the infection. Usually, however, treatment to ease the symptoms and to help the patient withstand the disease until it runs its course leads to recovery.

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