Elena Scialtiel

May is mental health awareness and skin cancer awareness month, which are widely marked on the Rock, but there are other conditions whose prevention or treatment is given special coverage this month.

Here are discussed the most common ones, with different grades of rarity and severity.

Celiac disease is a long-term but usually not life-threatening condition affecting intestinal digestion. It is caused by allergy or intolerance to gluten, a protein found in cereals like wheat, barley and rye. In genetically predisposed individuals, exposure to gluten sparks anomalous autoimmune responses.

Diagnosis is not always straight-forward to achieve unequivocally, but early screening can help with mild symptoms easily mistaken with other digestive issues. Early symptoms in babies and children are steatorrhea and failure to grow.

Celiac disease must be told apart from wheat allergy, a rare but more serious condition which cannot be neutralised with gluten-free products consumption alone.

Treatment so far consists in a gluten-free diet, to avoid and prevent bloating, lethargy, anaemia, hyposplenism, vitamin and minerals deficiency, and complications like intestinal cancer or lymphoma, which are nevertheless rare.

In regions alien to traditional wheat farming, like south-eastern Asia where rice is the staple cereal, or Mesoamerica, where corn is, celiac disease still exists but it doesn’t manifest until the ingestion of wheat, barley and rye, European staples.

Celiacs can source their carbs from non-cereals like quinoa, amaranth and of course potatoes, pumpkins and bananas. Always seek medical advice before starting a carb-free diet.

Visit:
www.nationalceliac.org, www.celiac.org, www.coeliac.org.uk, www.beyondceliac.org.

Ehlers-Danlos syndromes are a group of separate but related connective-tissue disorders, occurring because of variation of a number of genes that affect the structure or production of collagen, and it can be potentially severe or life-threatening.

Early symptoms that may prompt you to seek medical attention for your baby or toddler are delayed walking beyond 18 months, and a preference for bottom-shuffling instead of crawling. Another alarm bell can be your toddlers’ habit to stick their tongue out and, so doing, reach comfortably their nose with its tip (Gorlin’s sign). 

Later, it can show through joint hyper-flexibility and skin hyper-extension, arthralgia, myalgia, scoliosis, kyphosis, translucent skin, heels’ piezogenic papules, hyper-mobile fingers and toes, bendable thumbs. 

There is no cure for this, but once a diagnosis is achieved through genetic testing, treatment is available for each of the symptoms and co-morbidities, like cardio-valvular disease, brittle cornea, keratoconus, macular degeneration, hiatus hernia, fragile skin, muscle hypotonia, periodontitis, and pregnancy complications.

There are different degrees of EDS and most patients can lead a normal life with it. Some have made of their skin hyper-elasticity a career in showbiz. Italian virtuoso Niccolò Paganini is believed to have suffered from a mild form of EDS making his fingers extra-long and agile on the strings.

Visit: www.ehlers-danlos.org

Cystic Fibrosis is a genetic disorder caused by gene mutation or deletion that affects mostly the lungs, but also pancreas, liver, kidneys and bowels, for which there is no cure, and which halves life expectancy in the developed world. 

It is mostly common in individuals of north European ancestry, where about a quarter of the population are estimated to be carriers. 

Africans and Asians seem to be almost immune to this mutation, and some studies suggest that it may be related to evolutionary exposure to dim lights and cold temperatures, although other populations from subarctic climates like Siberia, Alaska or Greenland, seem to be immune. Others suggested it may be linked to the mutations of eye colour, in other words if you have blue or green eyes you may have higher chances to be a carrier, but no theory has so far satisfactorily returned unequivocal proof.

Symptoms manifest in early childhood with poor growth and flimsy weight despite healthy appetites, frequent chest infections with sticky mucus and the characteristic salty-tasting and smelling skin.

Parents’ suspicions about salty skin may be confirmed by genetic testing. Preventive screening is available to warn prospective parents who are both carriers about the 1-in-4 possibility to produce an affected child, with a ratio akin to thalassaemia.

Most damage to the organs is caused by blockage from thickened secretions that can lead to lungs failure. Pulmonary physiotherapy is the key to support an improved quality of life. Lung transplant is an option for those worst affected with respiratory symptoms. 

Visit: www.cff.org and www.lung.org.

Huntington’s disease is a degenerative inherited disorder resulting in the accelerated demise of brain cells, manifesting itself in the early stages with subtle motor skill problems, lack of hand-eye coordination, and mild loss of balance, not always paired with decline in cognitive abilities. 

Onset can be as early as in one’s twenties, and it can be difficult to diagnose it, if one is unaware that the genetic condition is running in the family. Jerky out-of-control movements are an early symptom to pay attention to, together with rigidity, poor posture or balance, reduced facial expression, seizures and sleeping disturbance.

There is no cure, but treatment is available to relieve symptoms and improve quality of life, but in later stages, patients inevitably become dependant on around-the-clock care.

Predictive genetic testing and prenatal testing are advised to carriers. Physical examinations like MRI and PET can map the areas of the brain affected, while psychological tests can gauge the extent – if any – of cognitive decline and devise brain retraining. Affected subjects are at risk of anxiety, depression, compulsive behaviour, addictions, hyper-sexuality, egocentrism and suicidal thoughts, as well as muscle atrophy,

cardiac failure, osteoporosis, and, when elderly, at higher risk of dying as consequence of a fall.

Visit: www.hda.org.uk.

This article aims at being informative only, with no medical or diagnostic pretenses. Consult your GP if you suspect you or a relative may be suffering from any of the conditions here described.

Some city breaks leave a mark on you, uplifting your spirit, enlightening you with their landmarks, culture and people; others will go beyond this and trigger a mystical experience – literally

Although it hasn’t been recognised and listed as a mental disorder, because of its usually fast remission and sporadic occurrence, the Jerusalem syndrome is a mental phenomenon affecting visitors, mostly first-timers, of the Holy City with religious-themed obsessions, delusions and even psychotic episodes, regardless of the absence of underlining or ongoing mental conditions, and no matter their religious background or devotional depths.

A similar behaviour, albeit less intense, may be observed in Rome, especially in Vatican City, while mental health issues manifested in Mecca are connected to the sheer volume of pilgrims, constricted space, and repetition of rituals, if not collective hysteria, according to some psychological studies.

Jerusalem syndrome arises in subjects who have no known psychiatric history, displaying a balanced lifestyle and clean bill of mental health, enjoying a rational relationship with their religion, or lack of thereof, and visiting Jerusalem for purposes that aren’t strictly of worshipping.

Usually the person experiences a sudden, sometimes unpleasant urge, rather than a mystical calling, to step up their devotion, extending their itinerary to all or most churches, donating to charities, fasting or performing genuflection and flagellation, overspending on souvenirs and attending confession and mass obsessive-compulsively, forsaking the secular aspects of their trip, like dinners, theatre, shopping or spending time with their families. 

Delusions are different from revelation of true vocation, and one must consider lucidly whether to pursue one’s newfound devotion, perhaps seeking expert advice once back home, before hastily signing up for the cloister. Jerusalem syndrome is a powerful suggestion that works on one’s mind only in the proximity of holy sites, so the persistence and consistence of beliefs weeks after the removal of the affected person should be an indicator of his or her true purposes.

In fact, acute symptoms drop once the visit to Jerusalem is over, with a very few cases persisting in their delusion beyond one week after their homecoming.

However, severe cases can produce psychosis and manifest in personality imbalances, schizophrenia or paranoia episodes, the impulse of joining a monastery, a yeshiva or a madrasa – not necessarily according to one’s familial background, though – or even go round preaching, convinced to be on a mission to pave the road for the second coming. 

Jerusalem syndrome has been described in medical and travel literature since the Middle Ages, but then it was kind of expected and welcomed, while in the late Nineteenth Century it was considered a form of hysteria, and collective hysteria.

Nowadays it is regarded with academic curiosity as well as concern, when its consequences may put someone’s life in danger with zealot-fuelled irresponsible conduct.

Cases have been recorded in which the affected person, usually a male subject, would claim to be Jesus and demand to carry the cross, or St. Peter going around preaching loudly and causing disturbance of the peace, and even an improvised St. John the Baptist with a bottle of soda. These acute psychoses went into immediate remission when the subject was removed from the streets, administered mild medication or sedated.

Muslims may be struck by the urge of impersonating the Prophet or more simply just attending daily prayers with clockwork precision and dedicating extra time to scriptures reading. As well, the Jewish response prompts adherence to alimentary prohibitions, prayer times and religious studies, and the impulse of manically stuffing handwritten prayers in the Western Wall’s cracks.

Non-monotheistic religions adepts may be affected too, curiously, and more curiously, there aren’t so far scientific recordings or studies of equivalent psychological phenomena developing at Hindu or Buddhist sanctuaries, where nevertheless a large volume of pilgrims is attested, daily or on high holidays.

There are indeed patients who land in Jerusalem already predisposed to the onset, temporary or long term, of this condition, because of deep rooted idiosyncratic ideas and a cultural obsession on the symbolism of the Holy City.

When Jerusalem syndrome is spontaneous and uncompounded with underlining mental health issues, the psychosis is acute and brief. It resolves in full recovery, and relapse is unlikely, even in the case of a future return to the Holy City.

Symptoms start with uneasiness, anxiety, agitation and absentmindedness and extend to the desire of declaiming psalms or verses louder than appropriate and singing hymns all the time. This is the best telltale sign to alert hotels and holy sites personnel, as well as tour guides, about the potential triggering of a psychotic episode, which may end in hospital admission in 40% of the cases.

Relatives and friends must be alerted by someone’s insistent demands of visiting Jerusalem alone, or unannounced splits from the group, as well as the sudden obsession with cleanliness and purity, especially with toenail clipping, or the odd request of taking on tour with them white bed linen borrowed from the hotel.

As harmless as it might appear, this psychosis, no matter how temporary, can escalate in reckless actions, and put the sufferer’s life in danger, or endanger life around him or her, with unpredictability and diminished responsibility. 

Men are more affected with the urge to deliver disjointed speeches in public places, while women tend to keep their worshipping private, and enjoy a serious church crawl and prayer marathon, from the crack of dawn to nightfall.

If the sub ject claims to be the Messiah, this shouldn’t be confused with the Messiah complex, which is a topographically unrelated, and often long-term, state of mind triggered by delusions of grandeur and the belief they’re destined to save the world in their lifetime, and perhaps act upon it by offering unsolicited and unqualified help, one ‘sinner’ at the time.

This article aims at being informative only, with no medical or diagnostic pretenses. Seek medical attention if you suspect you or a relative may be experiencing a psychotic episode while on holiday.

Anosmia: When your nose goes off-duty

Anosmia (inability to smell) and hyposmia (reduced ability to smell) are relatively rare conditions, especially when it is about a complete loss of sense of smell, while hyposmia can be a consequence of ageing, akin to hearing or sight loss. It can be genetic or acquired, and usually it isn’t serious, but it affects the sense of taste and it can, in extreme cases, fail to alert the sufferer of an immediate danger, like gas leaks, fires or poison.

It can be temporary, and in most cases it is. Surely you have experienced how all foods have little taste when you are nursing a bad cold, but just imagine dealing with this sensation for a long time, or all life long, if you are born with it and you can never know what spring in the air smells like, or you tell apart coffee from hot chocolate only by the size of the mug.

Anosmia sufferers usually show little interest in pleasure eating and cannot fully grasp the idea of gluttony, which can indeed be a plus when it comes to dieting, but often makes their mealtimes boring and may lead to malnutrition.

In fact, when we taste food, we actually smell it first, and in our lifetime we learn to recognise hundreds of flavours, while our tongue is designed to feel only a handful of different tastes.

Lack of smell is usually due to irritation of the nasal mucosa, because of viral infection or allergies, but it can also have neurological causes and alas be the symptom of undiagnosed illness, perhaps serious, such as head trauma, nasal polyps, nasal septum deformities, tumours, or stroke.

Anosmia happens when the airborne molecules of any aromatic substance fail to carry to the top of our nose and fire up the olfactory nerves, whether because of a nose blockage or because said nerves are malfunctioning.

Certain medications can list partial anosmia in their side effects, particularly antibiotics – which are taken for a short period after which your sense of smell should be restored – and hypertension medication. In the latter case, treatment is prescribed for longer periods or permanently, so patients have to seek alternative ways around their secondary anosmia, unless their doctor can explore alternative medication that keeps blood pressure controlled without affecting the olfactory receptors.

Smoking, alcoholism, lengthy exposure to chemicals also damage the receptors, so anosmia can be an occupational hazard for cleaners, lab technicians, factory workers, and even police officers who spend long time in the midst of traffic jams.

It is important to investigate the causes of anosmia, especially when it manifests relatively suddenly and is not connected to rhinitis. 

In fact, it can be an early symptom for vitamin deficiency, hypothyroidism, diabetes, epilepsy, schizophrenia, multiple sclerosis, Parkinson’s, Alzheimer’s and Huntington’s diseases, and one of the subtle red flags for transient ischemic accidents.

Conversely, anosmia is difficult to diagnose and measure, since different people are naturally born with different receptivity and different ability to notice and tell odours apart, when they are dim or similar. For example, have you ever noticed how frying onions smell like stale sweat? Well, you aren’t completely wrong there, since they contain the same sulfur-based molecules!

Anosmia is diagnosed with CT and MRI scans or nasal endoscopy and currently there is no treatment for it. It is particularly difficult to recognise when congenital, but alarm bells do ring when babies and toddlers don’t fuss over vegetables like broccoli or peppers, and when they don’t show any emotional reaction to being introduced to strong pleasant smells, like roses, or are invited to follow the scent towards the oven where a cake is baking.

Usually, there are no life-threatening complications for this condition, but it is recommended that sufferers install smoke alarms and are cautious with food storage, since they cannot detect any pong from deteriorated produce, or when opening jars and tins, as well as when using insecticide, bleach or ammonia.

The opposite to anosmia is called hyperosmia, described as a heightened sense of smell. This has no cure either, and it triggers recurrent headache and nausea. 

Commonly, hyperosmia affects pregnant women, but it isn’t the direct cause for morning sickness. The condition may continue during breastfeeding.

Congenital hyperosmia does significantly affect the sufferers’ lives, limiting their comfort in crowded areas, whether indoors like public transport, elevators, restaurants, cinemas or nightclubs, or outdoors, like carnivals or busy thoroughfares. There, they will suffer from sensorial overload from other people’s perfumes and bodily odours, mixed with cooking food and spilt alcohol. Sadly, they’ll shun rose and lilies in their wedding bouquets…

But there is a silver lining: hyperosmia can even land you a prestigious job as essence mixer at a perfume factory, or sommelier in fancy wineries – it is known in the business as ‘nez absolu’, French for absolute nose.

Full-time job, housework, grocery shopping, young family, elderly care, entertaining, arts and culture, charity drives, sports, weekend escapades… are you juggling all this in an 18-hour-plus day, followed by
a few hours of fitful sleep before it starts all over again tomorrow at the crack of dawn? 

Can’t remember last time you had some ‘me-time’? 

Actually, can’t even remember what ‘me-time’ means?

You may be suffering from Superwoman Syndrome, a behavioural condition that mostly affects western countries’ women, but it is spreading to the developing world too.

It is the compulsion and the pressure for women, usually aged 30 to 50, despite more and more adolescents already feeling they’re running a rat-race in high school, to having and being it all – career, family, health & fitness, social life – without wanting – or affording – to delegate to family members or to paid help. 

A superwoman is different from, and perhaps busier than, a career woman: the latter, in fact, is a woman who pursues any profession until not long ago regarded as the boys’ exclusive playground, a woman who commits to working long hours, perhaps travelling and commuting, but she either relinquishes family life for it, or hires a small army of professionals to run her household while she focuses on work.

Conversely, a superwoman is, or feels she is, a one-man, ehm, one-woman, band who reckons she can, and will, control it all, juggle it all. Her mantra “If others can, I can too. And better.” She might have been raised by empowering feminist role models or on the contrary escaped an abusive, dysfunctional or simply over-traditional family background, or she may want to emulate somewhat unrealistic images portrayed in the media.

The unhealthy strife to be perfect in every situation may build up to unsustainable levels when the superwoman fails to meet her own expectations. Beware I said ‘her own expectations’, because most superwomen are responsible for setting their bar too high, while their loved ones can see they’re overdoing it and warn them to slow down, and yet superwomen might interpret this as condescendence, criticism or veiled attempts to suggest they are failing at this modern ‘glass-ceiling-crashing nonsense’ and that a woman’s real place remains in the kitchen!

So ask yourself: do you constantly give without anything in return? 

• Do you attend to needs of others before your own?
• Are you a people pleaser even if it makes you unhappy?
• Do you throw or attend parties you feel alone at?
• Do you feel exhausted and anxious?
• Do you find yourself to mentally dismiss, disparage or belittle stay-at-home mums and homemakers in general, even if they are family?
• Do you often compare yourself to other working mothers or colleagues?
• Do you critically compare your kids’ milestones to those of other children their age?
• Do you help your kids in educational tasks like dressing up or homework, just to speed up their getting ready in the morning or for bed?
• Are you driven by a competitive edge even in casual situations like holidays, sports’ days, family picnics, or corporate team-building events?
• Are your meal plans bordering eating disorders, including orthorexia?
• When was the last time you were satisfied with your accomplishments at work or at home?
• Do you tend to sceptically shun compliments on a job well done but you are overly sensitive and receptive to those about your physical appearance?
• Do you pay too much attention to gossip and judgement?
• Are you judgemental?
• Do you make a big fuss of a bad hair day?

Furthermore, if you are irritable, incensed, indecisive, unable to concentrate, subject to mood swings and negative thoughts, and if you lack sense of humour, it may be time to slow down and admit that Rome wasn’t built in a single day – or by a single individual.

When your body cannot keep up with your schedule demands, it might ring alarm bells through cephalea, elevated blood pressure, shortness of breath, palpitations, insomnia, restless sleep, loss of appetite, sudden weight gain or loss, hair loss, brittle fingernails, dry and itchy skin, rashes, hyperhidrosis, blackheads, dull complexion, yellowing sclera, bloodshot eyes, dark circles, bleeding gums.

Sometimes it is difficult for clinicians to make the connection to stress, if patients are in denial about being under excess stress, and truly believe they’re breezing through life ‘just peachy’.

Many superwomen find their quick-fix in caffeine brewing or pill popping. Prescription drugs misuse is harmful when it neutralises the symptoms but not the causes of chronic fatigue or mental health acute disorders, and it leads to blurred circadian rhythms, irregular heartbeat and ultimately to self-bestowed cardiac disease.

Rather than indulging in overloading your bloodstream with chemicals, you must take stock of your life priorities and exercise an energetic spring cleaning, perhaps with the support of your family, friends and therapist.

When FOMO (fear of missing out) and perfectionism turn into addiction, you are the sole, or almost the sole, healer of your soul, through acceptance that you are only human, so you cannot do everything perfectly, but you must focus on what is really making you tick and life worth living in a serene, personalised-paced way.

Your decalogue to a balanced lifestyle:

• Let go of perfectionism: you are not auditioning for Mary Poppins’ role in a panto.
• Make your goals realistic. Tell the difference between wants and needs.
• De-clutter, materially and emotionally.
• Learn to say no: nobody is expendable, but nobody is indispensable either.
• Learn to delegate: it is ok, indeed brave, to ask for help.
• Train yourself to assert your own priorities, to express your thoughts and feelings, instead of complying or abiding to others’.
• Build a support network with your relatives or other working mothers. Sisters do it for themselves. And for each other.
• Take time off to do what you really want with whom you really want.
• Make regular time to enjoy the company of a ‘slow-living’ friend.
• Embrace JOMO, the joy of missing out. And toasting to me-time!

This article aims at being informative only, with no medical or diagnostic pretenses. Consult your GP if you suspect you or a relative may be suffering from the condition here described.

Percutaneous coronary interventions are minimally invasive surgical procedures aimed at treating coronary artery disease, either after a heart attack or to potentially prevent one, when the narrowing of a coronary artery is diagnosed, due to a number of factors, including genetic and behavioral, that medication and lifestyle changes alone cannot successfully reverse.

Angioplasty can be delivered with or without stents, although a stent is usually inserted in order to give the blood vessel or the aortic valve an extra boost to stay clear for longer and avoid narrowing again under the constriction of cholesterol or calcification (aortic valve stenosis).

The procedure is carried out under sedation, to help the patient relax, but seldom under general anesthetic because the patient’s alertness and cooperation are required involuntarily muscle contraction.

A catheter is inserted in a large artery, usually at the groin, wrist and arm, and then guided upwards to the heart, following its progress on the X-Ray video screen, thanks to the contrasting agent. 

Once it reaches the treatable area, there are different options:

Rotational atherectomy: this procedure is less common nowadays, since angioplasty tends to be more precise and less invasive, but it may prove necessary in some cases. Cardiologists insert a special mini-drill in the artery, and this blasts off hardened calcium deposits in the blood vessel.

Balloon angioplasty: the catheter contains a minute folded balloon, which the doctor inflates when it reaches the blocked artery, to expand it. Once it is stabilised, the balloon is deflated and removed. Since this is a temporary solution that may not succeed in keeping the passage clear for a long time, when possible it is preferable to proceed with

Stent angioplasty: a mesh tube wrapped around the folded balloon expands when the balloon is inflated, and it is left in place when the balloon is removed, so that it can prop the artery open for longer. Stents may be coated with slow-releasing drugs to decrease scar tissue texture and to act as blood thinners, and are often dissolvable so that metal isn’t lodged in the heart permanently. The downside is that, if the pathology recurs, the insertion of a new stent may be required later in life.

Laser angioplasty: if the catheter is equipped with a laser, the cardiologist can guide it to shoot and vaporise arterial blockages. This technique is indicated for extreme cases only, as absolute precision is required and it may cause cauterisation damage to surrounding tissue.

Recovery

Being minimally invasive, angioplasty carries minor risks and enjoys speedy recovery, and complications only depend on the patient’s general health.

The procedure takes no longer than two hours and if there are no complications or previous co-morbidities, the patient can be discharged on the same day or overnight. 

The intervention can be either planned or emergency, for angina the first, and following a heart attack the latter. Longer hospitalisation may be advisable if the patient was admitted and treated for heart attack.

Of course emergency treatment is riskier because there is little time to prepare the patient for the procedure, evaluate co-morbidities and modify medication, especially if the patient was already on anticoagulants.

Routine angioplasty patients are usually able to return to work after one or two weeks, while emergency ones may require longer convalescence.

Strenuous physical activity must be avoided until the wound heals, and driving after angioplasty is discouraged.

If the patient suffers from kidney disease, the contrast chemicals used during the procedure to highlight the catheter progress on screen can put further strain on the renal system.

Chest tenderness is a common post-op effect and can be relieved with pain killers. Medical attention should be sought immediately if you experience severe chest pain, lumps, discolouration or numbness in the area where the incision was made, or insistent bleeding which doesn’t stop when applying pressure. In these instances, dial for an ambulance, never drive yourself to hospital.

It is important to dress the bruise under the skin where the catheter was inserted to make sure it doesn’t get infected.

The patient is offered cardiac rehabilitation which includes diet, physiotherapy and gentle exercise, tailored to the patient’s general state of health and fitness.

Angioplasty patients are advised to avoid climbing stairs and put their sex lives on hold. However, after the procedure, their sex lives will improve in the long run. The vox populi rule tends to be that, if you can negotiate a couple of flights of stairs without being short of breath, then you can also have great sex.

This article aims at being informative only, with no medical or diagnostic pretenses. Consult your GP if you suspect you or a relative may be suffering from angina or atherosclerosis.

February is Cardiac Awareness Month. 

The Gibraltar Cardiac Association is organising a public talk by consultant cardiologist Dr Roger Moore on Thursday 6th February at 6pm at the Charles Hunt room.