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Doctor's Diary: If you don’t think it, you won’t diagnose it
Too often medical tests can be a substitute for critical thinking about the problem Tests can give a false impression that there is nothing seriously amiss Photo: ALAMY By Dr James LeFanu 7:30 AM BST 02 Jul 2012 There are so many tests nowadays – blood tests, X-rays, angiograms, scans of all sorts – that they can too readily be a substitute for critically reflecting on what is really going on or, if negative, give a false impression that there is nothing seriously amiss. The importance of the adage ''if you don’t think it, you won’t diagnose it’’, is illustrated by a woman whose complaint of dizziness on exertion warranted a referral to a cardiologist. First off she had an echocardiogram, which revealed some inflammation around the heart, known as pericarditis, which was felt to be ''non significant’’. Next up she had an angiogram of the arteries to the heart, which proved entirely normal. All this took around six months, after which the cardiologist discharged her, even though her symptoms were unchanged. Despairing, she sought a medical opinion abroad at her own expense – and within a couple of weeks she was informed she had a positive blood test for the tick-borne infection lyme borreliosis. Though not common, this type of infection is well recognised as the cause of persistent if poorly defined symptoms. It is thus always worth ''thinking’’ about. ----------------- For thousands of years, the transformation of the food and drink we consume into our flesh and blood ranked among the profoundest of all biological mysteries – until the elucidation over the past 50 years of the 3,000 or so biochemical reactions involved. It is possible to grasp the gist of how all this works courtesy of an astonishing ''map’’. In the Fifties, David Nicholson, of Leeds University, had the inspired idea of portraying the known (at the time) 20 pathways involved in the metabolism of fats, sugar and protein on to a single sheet of paper. Since then, with subsequent additions, it has become ever more detailed and reveals, like a musical score, the dazzling beauty of that symphony of biochemical interactions. It can be purchased for a modest sum by Googling IUBMB-Nicholson, and hung on the wall as a constant reminder of the miracle of life. ----------------- The possibility of a link between the spine and the workings of the gut – as with the lady who developed serious reflux following osteopathic manipulation for her back pain – has elicited a lot of interest. Some readers describe a similar experience. But for others, manipulation of the spine has markedly improved their heartburn or colicky abdominal pain. The suggestion here is that the manipulation influences (for better or worse) the autonomic nerves as they exit the spine to control such functions as the workings of the gut. ----------------- This week’s curiosity comes courtesy of Mr F T from Bath, who has noted that his TV and radio seem to be considerably louder in the morning than the evening. “When I wake and switch the radio on I find I invariably have to turn the volume down,” he writes – causing him to wonder whether his hearing might become sharper after a refreshing night’s sleep. ----------------- Finally, my thanks to Mr Ken Evans for passing on his fortuitously discovered cure for his seasonal eczema. This used to come on in August each year, starting with a few small bumps on his elbow before covering an area about 4in in diameter. At its worst it was impervious to all creams and unguents. Four years ago, while watching a Roman epic on television, he was struck by the comment of the wife of a centurion reminding him ''don’t forget your vinegar’’ before he marched off to battle. Mr Evans took this as a hint and applied vinegar three times daily to his itchy patch, which cleared within a week. He has continued to do so ever since, with similarly good results. “The only downside is that my arm smells like a chip shop,” he writes.
Staying up late cramming? Your grades might suffer for it By ALEXANDRA SIFFERLIN August 21, 2012 Teens who stay up late at night cramming are more likely to have academic problems the following day — doing poorly on the test they studied for — finds a new study by University of California, Los Angeles (UCLA), researchers. Since students increasingly give up sleep for studying as they get older, the researchers say the problem compounds over time. The study involved 535 students from Los Angeles high schools. For 14 days during each of three school years — 9th, 10th and 12th grades — the participants kept diaries tracking the amount of time they spent studying, how much they slept at night and whether or not they experienced academic problems the next day, such as not understanding something taught in class or doing poorly on a test, quiz or homework. The data showed that kids who didn’t get enough sleep were not only more likely to have problems understanding during class, a result the researchers had expected, but they were also more likely to do badly on tests, quizzes and homework — the very outcome the students were staying up late to avoid. ”If you’re really sacrificing your sleep for that cramming, it’s not going to be as effective as you think, and it may actually be counterproductive,” says study author Andrew J. Fuligni, professor of psychiatry and biobehavioral sciences at UCLA. Overall, students spent an average of just over an hour studying each school night throughout their high school years, but their average sleep time decreased by an average of 41.4 minutes from 9th to 12th grade. When they got enough sleep, 9th and 10th graders reported an average of one academic problem every three days; by 12th grade the rate of academic problems they experienced was reduced to one problem every five days. However, when teens spent more time studying and less time sleeping than usual, the following days were characterized by more academic problems than normal. “This wasn’t a whopping effect, it wasn’t a huge effect, but it was a consistent pattern that when kids crammed, they had problems the next day,” says Fuligni. ”That surprised us until we saw that when they crammed, they got significantly less sleep and when that happens, it’s more difficult to learn what you’re studying.” The National Sleep Foundation says that teens function best with 8.5 to 9.25 hours a sleep a night, but Fuligni says that in his research, teens are rarely getting that much.”This is fairly standard when people do teenage sleep surveys. [Teens] usually get less [sleep] than experts recommend and that’s not unique to this study. Sleep goes down during the high school years,” says Fuligni. The authors stress that they’re not encouraging teens to spend less time studying. As experience and research confirm, kids who study more tend to earn higher grades. Rather, the solution lies in better time management overall. “[Students] should balance their studying across the week and anticipate what is going on. Try to have a regular study schedule so that you’re not going to have those nights spent cramning,” says Fuligni.
Date: 2015-01-11; view: 1286
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Study or Sleep? For Better Grades, Teens Should Go to Bed Early