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Friday, December 16, 2016

The child with a learning disability

With more and more advances in the understanding of children with behavioural, mental and learning-related problems, it is becoming increasingly difficult to separate one disorder from the other. Thus, compartmentalising a child as one with, say, Attention Deficit, or, say, Dyslexia, is useful for classification, for stratifying data, and for planning individualised care, in reality, children often have a mixture of problems from more than one specific category of a disorder. 

This, on the one hand, complicates rendering simplified information to parents, and our ability to deliver specific modalities of therapy. On the other hand, it enables us to better deliver holistic care to the affected child, as many of the therapeutic modalities are dependent on simple but standardised principles. 

LD is the new compact form of addressing children with some or the other mental disability. This does not include the deficiencies resulting from acute illnesses that often causes complex mental problems and not just LD. However, it does include dyslexia, problems with maths, problems with praxis (the carrying out of tasks) - the latter being also called dyspraxia.

Often, children with minor epilepsies will seemingly not pay attention in class and we would mistakenly name them as dyslexics. In the same vein, dyslexics might get labelled as "retards"- a rather pejorative use of the expression. Thus, one can easily see why managing a child with a LD can be very challenging. 

Thursday, December 01, 2016

Invited post on Pericardial mesothelioma

Pericardial Mesothelioma 


Many doctors and researchers consider that asbestos fibres and dust are the major pericardial mesothelioma causes. Pericardial mesothelioma originates from the heart’s lining or the pericardium. Everyone out of 20 mesothelioma cases would turn out to be pericardial mesothelioma. A healthy pericardium provides protection and support to the heart. However, pericardial mesothelioma leads to the buildup of fluid around the heart and this exerts a great amount of pressure on the patient’s heart, which leads to pain and numerous symptomatic problems.

Asbestos Fibers and Pericardial Mesothelioma

Doctors and researchers are yet to establish or understand the causal relationship between pericardial mesothelioma and exposure to asbestos fibres or dust fully. Nevertheless, most patients that are diagnosed with pericardial mesothelioma have an asbestos exposure history. However, the rarity of pericardial mesothelioma hinders researchers from analysing this causal relationship comprehensively. Based on the reported cases, however, researchers have come up with an explanation for this relationship. 

How asbestos fibres and dust cause pericardial mesothelioma

Asbestos fibres are inhaled or ingested during asbestos exposure after which they travel through the bloodstream and become lodged in the pericardium or the membrane that surrounds the heart. Once lodged in this membrane, the body finds their elimination extremely difficult. Thus, the fibres remain stuck in this membrane for a long period. However, they cause the cells and tissues to undergo changes during this period and this causes cancer.

Ideally, the lodged asbestos fibres turn normal cells into cancerous cells. Cancerous cells divide abnormally or more rapidly without restraint or regulation as it is the case for the growth of normal or healthy cells. Continuous growth of mesothelioma cells lead to thickening of the heart’s lining and eventual development of tumours. Changes in the pericardium lead to fluid buildup between pericardial layers. When fluid buildups and thickening of the pericardium are combined, they exert more pressure on the heart. 


A patient may experience the following symptoms of mesothelioma once fluid builds up around the heart and starts exerting pressure on this vital organ:
ü  Heart palpitations
ü  Chest pain
ü  Persistent coughing
ü  Shortness of breath

These symptoms are similar to those of other ailments such as heart failure. As such, there are many cases of misdiagnoses which lead to the discovery of this disease at its advanced stages. Nevertheless, pericardial mesothelioma diagnosis can be done after a careful examination of the patient to determine whether additional testing is required. Generally, pericardial mesothelioma diagnosis is confirmed after tests like fluid and tissue biopsies which enhance the detection of mesothelioma cancer cells. After diagnosis, doctors determine the stage or progress of mesothelioma. This includes determining the extent to which the cancer has invaded tissues and organs that surround its point of origin. All tumours are located before appropriate treatment methods are determined.

Treatment Options

Since pericardium rests closely to the human heart which can easily be damaged by most therapies, pericardial mesothelioma has limited treatment options. Although surgery is mostly used to treat mesothelioma cancer, most pericardial mesothelioma patients cannot undergo surgery. Nevertheless, there are cases where this cancer is diagnosed in its early stages and surgery performed to remove the localised, small tumours. Other treatment options for pericardial mesothelioma include chemotherapy and palliative treatment.


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Dr. Fuhrman

Dr. Fuhrman