INTELLIGENCE QUOTIENT (IQ) TESTS LUMBAR PUNCTURE

IQ tests are usually performed by trained psychologists as part of a total assessment of a child’s development and achievement. An IQ test is often performed when a child is suspected of having developmental delay or learning difficulties. The test itself compares the child’s performance in a wide range of cognitive/thinking skills and tasks with the scores of a large sample of children of the same age. An average score falls between 85 and 115. IQ test results should not be looked at in isolation as being truly representative of overall intelligence. They can only be used as a guide, because many other factors come into play with respect to learning, such as motivation, health and social circumstances.

LUMBAR PUNCTURE

The fluid surrounding the spinal cord and brain is called cerebrospinal fluid and protects the delicate nervous system. If there is any suspicion that your child has developed an infection in this fluid (as in meningitis), then a lumbar puncture (or spinal tap) is performed under sterile conditions, usually at the hospital. A fine needle is passed into the spinal canal, and a small amount of fluid is removed and sent to the laboratory for testing. In older children, local anaesthetic may be used to make the area numb; this is not done in younger children, as it requires two needle pricks instead of the one.

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ECHOCARDIOGRAM

This test uses ultrasound techniques to produce an image of the heart on a television screen, and can be an invaluable aid in showing up abnormalities in both heart structure and function.

ELECTROCARDIOGRAM (ECG)

An electrocardiogram is produced by a machine which monitors the electrical activity of the heart. Leads are attached to your child’s chest with stickers, and rubber straps attached to leads are placed around the ankles and wrists. Electrical impulses are recorded on a moving graph. Abnormalities of the heart’s rhythm, size and structure can be detected. It is a harmless and painless procedure. Young children may be afraid because they have to lie as still as possible during the recording, so it helps if you are nearby to reassure your child.

ELECTROENCEPHALOGRAM (EEG)

This is a painless procedure performed when there is any suspicion that your child has epilepsy, or when he has had convulsions for any reason. Electrodes are attached to your child’s head with a gluey material, and the electrical activity of the brain IS recorded on graph paper by an electroencephalograph. The patterns are then interpreted by a specialist doctor. The procedure is harmless. Young children are often given sedation before the procedure, and sometimes the doctor may want an EEG performed while the child is asleep in order to diagnose certain conditions.

ENDOSCOPIES

Endoscopies are performed using a tiny fibre-optic camera attached to the end of a long, flexible tube. With the child under sedation, this is passed either through the mouth into the oesophagus (oesopbagoscopy), into the stomach and upper bowel (gastroscopy), or into the rectum and lower bowel (colonoscopy). Younger children may require a light general anaesthetic. Gastroscopy is performed if there is any suspicion that the child has a problem such as a peptic ulcer. Colonoscopy may be performed if a diagnosis such as inflammatory bowel disease has been suggested.

EYE SWAB

If your child has a sore or itchy eye in which a discharge is present, your doctor will usually take an eye swab. This involves gently removing some of the material with a sterile cotton bud, and sending it to the laboratory for identification of the germ causing the infection. The appropriate antibiotic to fight the germ can also be determined.

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Question

A friend of mine has told me alternative therapies such as massage or acupuncture will help me. I’m not sure if I should try them.

Answer

Massage and acupuncture can help to release and balance bodily tensions. As with all other therapies, we need to learn to control and^fnanage the anxiety and attacks ourselves. While we are learning the management skills, massage and acupuncture can be useful in reducing anxiety and tension. In the long term they can help keep our bodies relaxed.

Question

lam not happy about taking prescribed medications and I am wondering if herbal medications and vitamin therapy would help me instead.

Answer

Herbal and vitamin preparations are used regularly by many people. They can be bought over the counter or prescribed by a herbalist or naturopath. They can be helpful in easing the condition, but again they do not teach us the necessary skills for the long-term management of the disorder.

There is, however, one note of caution regarding these and other medications. Some people have reactions to them which are put down to anxiety; yet when the medication is discontinued the reactions disappear. If we are using these preparations, we must be aware of how we feel after taking them. We should not assume any new sensation or symptom is part of the disorder. It may be a reaction to the medication.

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It was one of those beautiful autumn evenings. The light from the setting sun filtered through the trees and their leaves blazed with colour. Jane wondered how many other people were looking at this natural masterpiece as they hurried home after the day’s work. Jane knew that she had never taken much notice before. Now was different. Once or twice a day she would be struck by the beauty of her surroundings. A moment here, a moment there. But those moments were precious in their spontaneity. They added to the peace she felt within herself. She was amazed at the last few years of her life. It had not always been like this. The years of panic disorder/agoraphobia had appeared to take everything from her. They were desolate years. The fight back was long and hard but she knew now it had been worth it. Everything that had been taken away from her had been given back a thousand-fold. She was at peace with herself and she was free.

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Remember, any person, including one facing emergency surgery, still has a right to know beforehand what is likely to be found and how the surgeon will probably want to deal with it. Any person also has a right to set limits on what he or she will permit. We discussed this earlier in this chapter. For example, the emergency patient described above may not wish to have a colostomy (bowel emptying through an opening on the abdominal wall). He or she has the right to refuse a colostomy and also the right to know what could happen because of such a refusal. Refusal may not create a problem if the surgeon can relieve the obstruction by some other means, such as removing or bypassing the blocked section of bowel. However, if this is not possible, the person’s refusal to have a colostomy could mean his or her death within a few days of the operation. Knowing this, he or she is still entitled to refuse a colostomy. No surgeon has the right to override an adult patient’s refusal to agree to any procedure, even though that procedure could be temporarily life saving. You know what’s best for you. You know what you can and can’t handle. You may know that you would rather die than have some drastic temporarily life saving treatment. Hold on to what is right for you.

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There are some cases when all efforts to make a pre-operative diagnosis are either unsuccessful or prevented by the urgency of the situation. Here is an example of the first type of situation. A person has had persistent abdominal pain and weight loss, for which no cause can be found on clinical examination and extensive tests. Cancer is suspected but cannot be proved. An exploratory operation may be recommended. In this case the person must either be prepared to have two major abdominal operations within a few days of each other, or agree to the surgeon immediately performing whatever operation seems best once the diagnosis is made. Fortunately, it is rarely so difficult to make a diagnosis. If such an exploratory operation is recommended to you I suggest that you ask for a second opinion before agreeing to it. Another doctor may be able to think of a way of making the diagnosis without operating.

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Hepatitis is inflammation of the liver, usually an infection caused by one of three viruses.

Type A hepatitis is what we previously called infectious hepatitis. This virus is shed in the faeces and spreads from person to person by contamination from faecal matter. It has an incubation period of about 30 days.

The virus has recently been identified and can now be grown in culture and a vaccine to protect against this form of hepatitis may be available soon.

To protect immediate contacts of those with this type of hepatitis, an injection of gamma globulin may be given. This is prepared from human serum collected by the Blood Bank and, in Australia, extracted at the Commonwealth Serum Laboratories. It contains antibodies to the virus and can give short-term protection over two to three months.

Type  hepatitis, formerly called serum hepatitis, is due to a different virus and has a much longer incubation period, around 90 days. It is usually spread by contact with the blood.

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Persistent indigestion may be due to an ulcer, to irritation of the stomach or to the presence of what is called an hiatus hernia.

We now realise that it is not the presence of the hernia itself, but of the associated reflux of acid into the gullet which causes the trouble.

The gullet or oesophagus runs through the chest, then passes through a gap or hiatus in the diaphragm, the sheet of muscle which separates the chest from the abdominal cavity. Once through this hiatus, it widens out to become the stomach.

In hiatus hernia, this gap is widened and allows a portion of the stomach to push up or herniate through the diaphragm into the chest.

Hiatus hernia becomes increasingly common as we age. Symptoms do not seem to correlate with the size of the hernia.

Associated with the hernia is gastro-oesophageal reflux. The distortion in the anatomy allows the acid contents of the stomach to regurgitate into the lower part of the gullet and this irritates the lining and is responsible for the symptoms.

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The Rh antibodies should also be checked at 28 and 34 weeks of the pregnancy. Following delivery, the antibodies are again checked and so is the blood group of the child.

Should Rhesus antibodies be found in the mother’s blood, the doctor will consider inducing labor earlier than the due date. This is because the risk of the baby being affected increases as the birth date is approached.

However, if the child is delivered too soon, it has to face the risks of prematurity.

Amniocentesis is a procedure where a needle is inserted through the womb into the amniotic sac that surrounds the baby, and fluid is removed for examination to determine if the child is affected and how severely.

Those women who are already sensitised have to rely on the skill of their obstetrician and the paediatrician to save their babies.

Those other women who are Rhesus negative and conceive an Rh positive child should have anti-D globulin after each pregnancy and particularly after spontaneous or induced abortion. In this way, the frequency if not the severity of this disorder can be greatly reduced.

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Once the mother has formed these antibodies, they readily cross the placenta to enter the baby’s circulation and can destroy the baby’s red cells.

If the baby is severely affected, this can lead to death in the womb or soon after birth. Destruction of the red cells can also cause anaemia and jaundice due to an excess of bile pigment from the broken-down cells.

Destruction of the baby’s red cells, with a rapid onset of severe jaundice, is more likely in the first few hours after birth. If the jaundice is severe, it can lead to brain damage.

If Rhesus iso-immunisation occurs and the baby is severely affected, it is possible to treat by the technique of exchange transfusion.

In this, most of the baby’s blood is withdrawn and replaced by Rh negative blood. In this way, the Rh antibodies from the mother which are circulating in the child’s blood are washed out and those which remain are destroyed by the baby’s own immune system. While this is happening, the transfused Rh negative cells do the work of transporting oxygen and are not affected by the antibodies.

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