Prairie Doc Perspective Week of December 31st, 2023
"Seizures” By Andrew Ellsworth, MD A seizure can be one of the most frightening things for a family member, friend, or anyone to witness. However, for some people with epilepsy, seizures may be fairly common and not unexpected. Roughly 1 in 10 people may have a seizure at some point in their lifetime. A seizure occurs when there is a burst of uncontrolled electrical activity in the brain. This may cause a sudden change in awareness or full loss of consciousness, unusual sensations or thoughts, or temporary problems in muscle tone or movements, such as stiffness, twitching, or limpness. The two main types of seizures are focal and generalized. A focal onset seizure starts in one area of the brain and spreads, causing mild or severe symptoms. A generalized seizure occurs when both sides of the brain are affected. Generalized seizures may include: · Absence - which causes a staring spell, the “petit mal” seizure · Atonic - which causes someone to go limp suddenly · Myoclonic - which causes sudden body jolts or increased tone briefly · Tonic - which causes muscle stiffness · Clonic - which causes muscles to spasm and jerk · Tonic-clonic - a combination of jerking and muscle stiffness, the “grand mal” seizure If you witness someone having a seizure, stay with them until the seizure ends and they are fully awake. Stay calm, it should end in a few minutes. Ease them to the floor and turn the person gently to one side which can help them breathe. Clear the area of anything hard or sharp to help keep them safe. Consider putting something soft and flat like a folded jacket under their head. Consider removing their glasses or sunglasses. Loosen ties or anything around the neck. Not all people who have a seizure need to go to the hospital. Time the seizure and consider calling 911 if the seizure lasts longer than 5 minutes. Other reasons to call 911 include if they have never had a seizure before, if they have difficulty breathing or waking after the seizure, if they have another seizure soon after the first, if they get hurt from the seizure, if it happened in water, or if they have a known health condition like diabetes, heart disease, or are pregnant. Do not hold the person down or try to stop their movements. Never put anything in their mouth or forcefully open a tightly clenched jaw, since that could harm them. It is a myth that someone having a seizure is in danger of swallowing their tongue. After the seizure, the person is likely to be unconscious or sleepy for a few minutes more. This is the post-ictal phase, when the brain is still very active and trying to contain the electrical impulses. Once someone is alert, they are likely to be sore, confused, or frightened themselves. Tell them what happened in a calm and simple manner. Seizures can be quite frightening to witness, but with some knowledge, you may be better prepared to help. Prairie Doc Perspective Week of December 24th, 2023
Autoimmune Disorders: Self attack! By Jennifer May, MD Recently I met a new patient who had waited several months for her appointment. At this first meeting, I was quickly able to diagnose Rheumatoid arthritis. Like others with this disease, her joints were swollen, and she was stiff getting up and moving to the exam table. During our discussion I learned she had felt well until about six months before. There was no good explanation for the onset of her symptoms, so she asked the question, many ask…. Why did this happen? As a rheumatologist, I specialize in managing autoimmune diseases such as Rheumatoid arthritis, as well as several others. Autoimmune disorders are a group of diseases where the immune system mistakenly targets and attacks the body’s own tissues. The system of checks and balances that keeps our immune system running is broken, and the attack goes unaddressed by the body. Managing autoimmune diseases means turning down the volume on an overactive immune system to alleviate symptoms and prevent damage to one’s body. Like my patient, many ask, what makes our immune system make these mistakes? Well, we as we currently understand it, a combination of genetic predisposition and environmental triggers plays a role in the development of autoimmune disorders. Certain genes are associated with an increased risk. Environmental factors, such as infection, exposure to certain chemicals, or hormonal imbalances could trigger or exacerbate an immune response. All this to say, there are multiple reasons autoimmune disorders flare up, but it is difficult to determine the exact cause and likely there is more than one factor. Diagnosing autoimmune disorders can be challenging. The symptoms are wide ranging and overlap with other diseases. We have blood tests that identify specific markers of disease and inflammation. During the physical exam I look for rashes, joint swelling, circulation changes, hair loss, weight loss, and weakness, amongst other things. Interpreting the patient’s story, lab tests, and exam together helps paint a picture that leads to a specific diagnosis. However, the work isn’t done once there’s a diagnosis. Treatment for autoimmune disorders is unique to each person. Rheumatologists can prescribe medications that target specific immune cells that drive the process. Traditional treatments such as corticosteroids and immunosuppressants are used, but newer specific cell therapies, such as monoclonal antibodies, are also effective. We are also learning about ways to mobilize the immune system and restore its resilience. The future of medicine looks to tailor treatments based on individual genetic profiles and disease characteristics. Today, I can offer my new patient confidence that she will feel better with current treatments. However, she will have to continue taking medications to remain comfortable. Ideally, we will soon find treatments that allow patients to stop medication and be well. The future holds promise that we will improve diagnosis, targeted treatment, and quality of life for people living with autoimmune disorders. Jennifer May, M.D. is a contributing Prairie Doc® columnist. She practices rheumatology in Rapid City, South Dakota at Rapid City Medical Center and serves on the Healing Words Foundation Board of Directors, a 501c3 which provides funding for Prairie Doc® programs. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook and Instagram featuring On Call with the Prairie Doc®, a medical Q&A show providing health information based on science, built on trust, on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central. |
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