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22 Cheshvan 5766 - November 23, 2005 | Mordecai Plaut, director Published Weekly
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Home and Family

Your Medical Questions Answered!
by Joseph B. Leibman, MD

Director, Emergency Services, Bikur Cholim Hospital

Yes, finally someone did a good look into the literature and confirmed what we felt all along: stress can cause heart attacks. So it was no surprise when I was sent an article from a reader about stress being "crippling." Controlling stress is imperative as not only does it cause heart disease, but it can lead to impaired immunity and all that goes with that.

Controlling stress in our lives is extremely difficult. Life in Israel is stressful enough, and dealing with large families and money problems can make life even more anxiety producing.

This column's purpose is not to give strategies in organizing your life, and reducing stress, but only to warn you about its effects and to also warn about some outlets that are used. Smoking, drinking coffee, and drinking are poor ways of dealing with stress, as well as eating your way out of anxiety.

We all have stressful times, and an occasional tranquilizer may be necessary. One should be careful about taking one too often, but once a week or less often is OK if you live a particularly stressful life and are not successful in controlling it.

I was sent a letter about headaches: oh, are these trouble for the emergency physician. While the public mostly fears a brain tumor, these are rare in emergency practice because they are usually a slow boring headache that persists. Most headaches are nothing serious: tension headaches or migraines. But the fearsome ones must be ruled out. One is meningitis — the viral type doesn't have to have fever, but if the person looks well it is usually benign.

The bacterial one is treacherous. It usually has a high fever or a low one. In kids it can be a tough call especially if they are infants or newborns. The diagnosis is made by a spinal tap and it is treated with immediate antibiotics. While the test looks fearful and does indeed hurt, it is absolutely necessary and rarely has any complications. Because every minute in this disease counts, if the diagnosis is being entertained, then this is not the time to call your husband or neighbor for advice.

There is another feared disease, and that is a bleed in the brain. These are catastrophic events that are usually clear clinically. Sometimes there is a little leak before the vessel blows. That presents with a sudden "thunderclap" headache. If you catch it at this point, a life can be saved. A CT scan will make the diagnosis 75 percent of the time but it can miss, so if the diagnosis is being entertained and the CT is negative, you must proceed with a spinal tap again.

Other causes of headaches that come to the emergency department include carbon monoxide poisoning, post spinal tap headache, and electrolyte abnormalities, especially dehydration. Sinusitis is a common cause and can be dangerous if it is in the sinus located in the forehead accompanied by fever. The article sent to me was about a headache in a person who had a leak of spinal fluid. This is a rare cause of headaches that is also not going to be recognized in the emergency department. Write me in care of the Yated.

A message from GlaxoSmithKline, sponsor of this column. If we are talking about headaches we must speak about Imitrex, the first and still the standard for headache treatment. It is available in nasal spray for quick relief, injection for those who are vomiting, and pills for longer relief. Consider it for your headache. It works.

 

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