The Ramsay Hunt Syndrome

 

The Ramsay Hunt Syndrome

  

What is Ramsay Hunt Syndrome?

It is a neurological disorder, a rare one that is characterized by the partial paralysis of the facial nerves (facial palsy). An erythematous vesicular rash of the skin affecting the ear or mouth may also be present.

Also accompanying the disorder could be ringing in the ears (tinnitus) and hearing loss. The disorder is also sometimes known as herpes Zoster oticus due to the rash around the ears that accompanies the disorder.

 

Discovery of Ramsay Hunt Syndrome

The disorder is named after James Ramsay Hunt, a physician, who first described it in 1907, through observations of a patient presenting mucosal and cutaneous rashes.

 

What causes Ramsey Hunt Syndrome?

Ramsay Hunt syndrome is caused by a virus, the same type that causes the chickenpox virus, known as the Varicella-Zoster Virus (VZV). After the chicken pox has cleared up, the virus are still present in the nerves in a dormant state. 

Years later, the virus may be reactivated causing shingles (herpes zoster) and infecting the facial nerves and leading to irritation, swelling, and partial paralysis.

 

Signs and Symptoms of Ramsay Hunt Syndrome

The symptoms can vary from individual to individual, but usually, only one side of the face is affected. The main symptoms of the disorder are -

·    Red painful blisters that may be fluid filled breaking out in and around either ear.

· Paralysis or facial weakness on the side of the face of the affected ear (unilateral paralysis).

·        Facial drooping

·        Sensorineural hearing loss (where sound is not properly transmitted to the brain) in the affected ear

·        Ringing in the ear (tinnitus)

·        Difficulty closing one eye (usually the eye on the affected face side

·        Develops a crooked smile

·        Dryness of the mouth and eyes

·        A sensation that you or your surrounding is in motion  or you are spinning (vertigo)

·        Painful reddish rash on affected side of face

·        Blisters on the tongue and ear canal

·        Dizziness

·        Ear ache

·        Change in taste or lose of

·        Nausea and vomiting

·        Hyperacusis - condition where sounds appear louder than they really are

·        Slurred speach

 

 

How to diagnose Ramsay Hunt Syndrome

There is a possibility of misdiagnoses of this disorder, more so as it not very common, like some ailments that Doctors are familiar with. In fact most doctors will never come across it in the course of their practice.

Ways in which Ramsay Hunt Syndrome can be diagnosed include

·  Taking a sample of the fluid in the blisters that usually forms around the ear on one side of the face

·   A sample of the patient’s  blood can also be taken and analyzed

· A magnetic resonance imaging scan is also used to detect inflammation in the facial nerves, indicative of the syndrome

·  Otoscope ear examination to check foe inflammation in the ear canal

·  All the above coupled with physical examination.

 

Risk factors for Ramsay Hunt Syndrome

· Anyone that had previously had chicken pox infection can become afflicted with the syndrome. Adults, usually above 50 years are at a higher risk that children.

·  Ramsay Hunt syndrome in not contagious, however anyone that has not been previously infected with the chicken pox virus or been vaccinated can contract it from someone with an active Ramsay Hunt Syndrome because the virus has become reactivated.

·   During the blister stage, babies, young children and pregnant women should avoid contact with an infected person. People with a weak or compromised immune system should also stay away.

 

Treatment for Ramsay Hunt Syndrome

Beginning treatment as soon as possible after the onset of the disorder is important, so as to minimize the risk of permanent nerve damage. Medications used include-

· Antiviral drugs – Famciclovir (famvir), Zovirax or Valacyclovir (Valtex), can be used to fight the disorder for between 7 to 10 days.

·  Corticosteroids – Like prednisone help increase the efficacy of the antiviral drugs used, for 3 to 5 days.

· Pain relievers- these are used to alleviate the pain, such as seizures associated with the syndrome. Medication for these include carbamazepine, an anti-seizure medicine.

· Anti-anxiety drugs – antihistamines and anticholinergics can help to suppress vertigo.

·   Because the patient may find it difficult to close their affected eye properly, dryness and irritation (from dust) can cause injury to the cornea. Artificial tears and eye ointment should be used to minimize this risk.

 

Prevention of Ramsey Hunt Syndrome

Since it is a reactivation the chickenpox virus that had remained dormant in the nervous system after the infection and treatment of the virus, probably due to a compromised immune system, vaccination against the chicken pox virus in the first place will help to prevent the Ramsay Hunt syndrome.

 

Prognosis

Treatment just after the onset of symptoms gives a good chance of recovery. If the damage to the nerves is minimal, then a high degree of recovery is expected. More serious damage to the nerves reduces the chance of full recovery even months after treatment.

The younger the patient, the better the chances of making a full recovery with little or no complications. Complications include synkinesis, a situation where the damaged nerves grow and connect back to the wrong areas. This can lead to inappropriate responses to certain actions.

 

Related disorders

Bell’s palsy is a neurological disorder that presents symptoms similar with Ramsay Hunt syndrome. It start with a fever, stiffness on the affected face side, and a stiff neck.

 

Additional information

·   How long does Ramsay Hunt syndrome last – with proper treatment, the disorder lasts between 6 weeks and 3months before recovery.

·  Can Ramsay Hunt syndrome relapse or re-occur? – No, it does not usually re-occur.  

 

Take Away

The Ramsay Hunt Syndrome can cause pain, discomfort and anxiety in affected persons. To greatly reduce the chance of developing the disorder, vaccination against the chickenpox Virus is key. This is so because the chickenpox virus that goes dormant after the treatment of and recovery from the virus getting reactivated is the precursor to the development of the Ramsay Hunt Syndrome.

 

What is gut health, and why is it important?

 Gut health and you           

                     Content

·       What the gut is

·       What is the use of the gut

·       How the process begins

·       What lives in the gut

·       So why maintain a healthy Gut? And how it affects the body

·       Signs of a healthy gut

·       Signs of an unhealthy gut

·       Causes of poor gut health

·       How to improve gut health

  

What the Gut is 

 

The long tube, sometimes referred to as the gastro-intestinal tract. It starts at the mouth (buccal cavity) and ends at the anus. It comprises of the mouth, esophagus, stomach, duodenum, small intestine, the large intestine, the rectum and the anus, effectively covering the entire digestive system

 

What is the use of the Gut?

The movement of food from the mouth to the stomach and unto other areas of the gastro-intestinal tract for break down into nutrients, to be absorbed into the body and energy released for bodily processes.

 

How the process begins

The breakdown of food begins in the mouth by a process called mastication. This is when food is broken down into smaller pieces by the help of the teeth and mixed with saliva to form a paste known as bolus that is easier to swallow.

Once swallowed, it begins its journey along the gut where the different parts help to break down the food into vital nutrients required to power our body processes. Saliva itself contain enzymes (amylase, lysozyme and lingual lipase), which begin the breakdown of the food by acting on the carbohydrates and sugars.

What lives in the Gut?

The gut is home to millions if not billions of micro- organisms, referred to by the term microbiomes, particularly bacteria that thrive in the different parts of the gut. Different kinds of bacteria inhabit different sections specialized in the effective breakdown of different types of foods into readily absorbable nutrients for the overall health of the human body.

Almost 500 types of bacteria live in the human gut. Most of them are beneficial to the body, while a small part are harmful. The kinds of food we eat has a direct impact on the types of bacteria present in our gut.

 

So why maintain a healthy Gut? And how it affects the body 

Maintaining a healthy gut is important for several reasons and we shall be looking at some of them -

· Body immunity – The gut plays a vital role in the immunity of the human body. This is so because the walls of the gut provide an impermeable barrier to undesirable microbiomes from passing into the blood stream and making us ill. The only way the gut can effectively do this is if it is healthy.

Conditions such as Inflammatory bowel disease (IBD), Irritable bowel syndrome (IBS), Crohn’s disease and Ulcerative Colitis brought about by bad bacteria can leave the gut walls vulnerable to the passage of undesirable microbes into body system and manifesting as a host of other diseases.

·   Human Mental Health - Medical research has shown that there is a connection between our gut and our brain. This is referred to as the gut–brain axis. It is believed that the gut bacteria are able to stimulate the nervous system to send information through the vagus nerve to the brain.  

 

This can affect things like our mood, emotions and appetite. The bacteria in our gut are also able synthesize homes which regulates our body processes.  

·   Obesity – A healthy gut has the right balance of microbiomes helping to keep our food intake optimal. An unhealthy balance however, can lead to conflicting signals sent to the brain, resulting in an over indulgence in food consumption and unnecessary cravings, leading to an unhealthy waist line.

· Heart Disease – A healthy gut contains bad bacteria that can act on certain kinds of food. Red meat for example, when eaten, these bacteria produce a chemical that the liver converts into TMAO (trimethylamine N-oxide) – a molecule produced from betaine, choline and carnitine through the process of microbial metabolism.

 

Signs of a healthy gut

·  How often you use the loo, yes, how often you poop- There is no standard chart for how often one poops. What we have instead is a rage within which it is considered normal.

Different people also have different patterns. Generally however, going to the loo between one and three times per day, and up to three times per week, is considered normal.

The time of day you poop is also indicative of a healthy gut system. Pooping should usually be done during the day. Pooping at night, especially when you have to wake from sleep is indicative of a problem 

·  Gut transit time – This refers to how long it takes food to travel through the gut during the digestive process. This bowel transit time varies from one person to another, however the average transit time through the colon is between 28- 40 hours.

·  Nature of the poop – The nature refers to the shape, the colour and consistency of the poop and can tell a lot about the health of your gut.

The colour of poop from a healthy gut is usually brown, ranging from medium to light brown. A different colour such as black, green or red, if not as a direct result of food factor, might be indicative of an issue that requires medical attention.

The shape of the poop should be sausage like, in a single lump or come in smaller pieces. It should also be smooth in texture and firm, being neither too hard nor too soft.

· Easy pooping- without pain – Pooping with ease, comfortably without much strain is a sign of a healthy gut. You should not have to force yourself to get it out.

·  No excessive bloating and gas – The breakdown of food in the gut asides the release of valuable nutrients for the body also produces gases as a byproduct. This gas is released by farting. An average  person farts between 10 to 20 times per day.  

Gas that is trapped in the gut can lead to bloating and can cause abdominal pain. While a bit of bloating is normal, a healthy gut is free from bloating persistently.

 

Signs of an unhealthy gut

Sometimes the processes in the gut do not go the way they are supposed to go. Digestive problems stemming from an unhealthy gut afflict quite a number of people every year for which they need to seek medical help.

The more common signs that point towards this are

·   Stomach discomfort – This can result from conditions such as constipation, heartburn, diarrhea, nausea, bloating and gas. Food is not being properly processed and eliminated.

·  Skin irritation – Our gut health affects the overall health of our body. One way in which we can tell from the appearance of an individual is through the skin. A smooth glowing skin indicates good health.

Skin conditions such as eczema, rosacea and inflammation, are tied to imbalance in gut microbiome.

·  Food intolerance – Develops from the inability or difficulty of the body to digest some types of food. This can be caused by an unhealthy balance of good bacteria necessary to act on the different types of food we consume. Symptoms of food intolerance include diarrhea, bloating, abdominal pain and bloating. 

·   Sleep disorders – Because bacteria in our gut can stimulate our nervous system, and also produce serotonin, a hormone affecting sleep and mood, an unhealthy gut will produce a reduced amount. This can lead to insomnia, irregular sleep patterns and mood swings.

·   Weight fluctuations – An unhealthy and imbalanced gut will have a diminished ability to absorb nutrients, store fat and regulate blood sugar.

Decreased absorption of nutrients may lead to weight gain due overeating, while the body may gain weight due to bacteria overgrowing in the small intestine.

·    Autoimmunity – Some school of thought believe that an unhealthy gut disrupts the proper functioning of the body’s immune system. This can trigger an autoimmune response, leading to autoimmune diseases, which causes the body to attack its own cells instead of harmful pathogens.

·  Bad breath (halitosis) – An overabundance of bad bacteria living in the gut, especially in the throat can result in the production of foul smelling breath.

Causes of poor gut health

Poor gut health basically indicates a lack of balance between the microbiome in the gut. An overwhelming presence of bad or harmful bacteria over beneficial bacteria is a condition known as dysbiosis.

Causes of poor gut health include-

·  Restricted diet – The variety of foods that we consume helps to develop a healthy gut microbiome. A wide variety ensures a good balance of grains, vegetables and fruits, providing a diverse range of nutrients, thereby encouraging a more diverse and healthier gut flora. A restricted diet does not allow this.

·  The use and abuse of antibiotics – Antibiotics are drugs used to treat bacterial infections, by killing harmful and stopping them from multiplying. The down side however is, the antibiotics also kill good bacteria. This causes a change in the types of bacteria present and upsetting the ideal balance of good and bad bacteria.

·   Smoking – The harmful chemicals found in cigarettes and tobacco can inflammation in the digestive tract, leading to the development of certain diseases, such as, inflammatory bowel disease. Smoking also increases the risk of heart disease and lung cancer.

·   Excessive intake of alcohol – Large quantities of alcohol taken consistently over time can be toxic to the body, leading to an imbalance in the gut microbiome.

·   Stress – Excessive stress from the daily activities of life impacts the whole body, the gut inclusive. It can reduce blood flow and heighten sensitivity in the gastro intestinal tract.

How to improve gut health

·   Adjust your diet – What you eat has an impact on your gut health. Lean protein, plant based foods that are rich in fiber helps maintain a healthy gut. Prebiotic foods such as oats, bananas, legumes and asparagus should also be included in the diet.

Probiotic foods which help to increase the number of good bacteria by encouraging their growth are also important. Examples include yogurt and kimchi.

·   Staying hydrated – Water helps to keep the mucus lining of the intestines in shape ensuring easy bowel movement. It also aids in providing a healthy balance of good bacteria in the gut.

·    Get enough sleep – Sufficient sleep is beneficial to the overall health of the body, the gut inclusive. Between 7 to 8 hours of sleep is recommended.

·    Reduce stress level – Raised levels of stress impacts gut health negatively. Find ways to lower the level by perhaps engaging in some form of relaxing activity, for instance, massage, meditation or yoga.

·    Eat healthy – Avoid unhealthy foods such as fried foods, artificial sugars and too spicy foods. 

Take away

Over the years, studies have shown that the human gut plays a more important role in the overall wellbeing of an individual than was previously thought. Many of the illnesses that afflict us are now thought to be a direct or indirect result of the conditions that exist within the gut.

What we eat, what we don’t eat, how we eat it and when we eat it, all have a factor to play in the health of our gut, and ultimately our body.

The key word here is BALANCE. The microbiomes that exist in the gut need to be in optimal proportions for good health.

Lastly our lifestyles and habits should not be such that are harmful and detrimental to our health. There should be moderation in all we do.      

 

Monkeypox- Things you need to know

 

Monkeypox

Table of contents

1.    Introduction

2.    Discovery

3.    Host

4.    Transmission

5.    Path taken

6.    Incubation Period

7.    Symptoms

8.    Progression

9.    Duration

10. Fatality Rate

11. Prevention

12. Treatment

 

 

 

 

Introduction

Monkeypox is a rare, self-limiting disease caused by an infection with the orthopox virus of the family, poxviridae. Also included in this family is the smallpox and cowpox viruses. The monkeypox virus has attracted attention and awareness of late due to its outbreak in areas in which it normally was not seen. It's incursion into Europe, The United States and other countries outside of Africa have put health bodies on high alert.

 

Discovery

 

-First discovered in 1958 in monkeys

-First detected in humans in 1970 in the democratic republic of Congo, and   since then has been reported in countries across Central and west Africa, and now spreading across other Continents, aided by international travel.

 

Host

The natural host of the monkeypox virus is unknown,but rodents like squirrels, rats and non- human primates like monkeys are known to transmit the virus to people.

Transmission

Types -

·         Animal to human - through bites and scratches

·         Human to human - through respiratory droplets

 

Path Taken

·         Through the respiratory tract

·         Through the mucus membrane of the eye, nose and mouth.

·         Through broken skin like, scratches

·         Through body fluids

 

Incubation Period

 

This is the period between infection and appearance of symptoms. It

can stretch from 5 – 21 days, but usually, is between 7 – 14 days.

 

Symptoms

These include

·         Fever

·         Muscle ache

·         Back ache

·         Chills

·         Headache

·         Tiredness

·         Swollen lymph nodes

 

Progression

After the fever, a rash develops about three (3) days later, starting

from the head and spreading to other parts of the body. The rash

progresses to-

·         Macules – flat lesions that are generally less than 1 cm in size

·         Papules – elevated areas of skin and can be in various shapes

·         Vesicles or Blister- small thin walled sac of skin, filled with clear fluid

·         Pustule- areas of skin containing a yellowish fluid, known as pus

·         Scab – a hard skin tissue that protects the skin when damaged, and allows new skin to grow underneath.

 

Duration

The disease usually lasts between 2 and 4 weeks

 

Fatality Rate

The fatality rate is usually low when adequate health care is provided,

Usually 1 in 10.

 

Prevention

·         Avoid travelling to endemic areas or areas of outbreak

·         Avoid contact with unquarantined animals, especially rodents from endemic areas.

·         Vaccination – The smallpox vaccine (JYNNEOS- Imvamune or Imvanex).

 

Treatment

There is no specific treatment for now. However, many antiviral drugs

might be effective, such as, Brincidofovir, Cidofovir and others.