29th October 2000
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Don't let a stammer get you down

Many children stammer when they start speaking. And the majority of their parents is alarmed by this and go in search of doctors for a remedy. 

Though there is no cause for panic, a doctor's opinion may be helpful at least for reassurance. 

Stammering is best thought of as a problem of communication rather than simply speech which is a part of it. Most stammerers can speak perfectly well and manage to do so most of the time. 

At for example, two years of age, most children try to get to grips with the incredibly complex and subtle ways in which we all communicate with each other. 

This will include learning a myriad words and also many other aspects of communication, such as how to use those words, when to use them and when to use non-verbal communication such as gestures. 

It's an astonishing process and a parent must remember that it's going on at a time when the child is also learning a million other things about the world around him and his relationship with it. It is amazing how tiny children pick up all of this and equally it's not surprising how many children have a few problems on the way. 

Research has shown that over half the children have signs of disfluency of speech at some time during the early years when they are learning to speak. Starting to stammer at two may be a perfectly normal part of development which he will pass through. Only a few children, about 1 in 100, develop a stammer which will persist and need help. The majority of these will be cured by therapy too. 

Having said that, you will want to know what you can do to help the child grow out of it or what you need to look out for if it continues. It's better that you get expert advice at this stage so talk to your doctor who should be able to refer you and your son to a local speech therapist, if the child continues to stammer after four or five years. 

A special clinic for such children is held at the Lady Ridgeway Children's Hospital in Colombo but you would need referral from a doctor to attend that clinic where speech therapy is given for children whose stammering persists. 

Remember that while stammering can be a huge disability, there are many people out there who lead very successful lives despite their stammer. 

Equally, while conventional therapy helps most, many individual stammerers have discovered their own ways to cope with the problem.

It's a headache

Migraine headaches can be one of the most isolating experiences, even though they are extremely common. Many people simply want to hide alone in the dark when they have an attack. 

One in ten of the population suffers from migraine, and it can cause havoc with work and family life. For an unlucky few it is an almost constant source of misery.

But the good news is that there are some very good treatments around for migraine now - which will, in many cases, cure or greatly improve an attack. But of course, even then migraine remains a serious problem because the average migraine attack can last approximately 4-72 hours. People with migraine have, on average, 13 attacks a year. Moreover, two out of three sufferers are female and only one in ten experiences the auras which people normally associate with migraine which predict the attack. 

Of course, if migraine is suspected, one should see a doctor. But it would be helpful if you could: 

-Make a note about the headaches. Write down carefully when attacks occur, what symptoms appeared first and how this changed, and what treatments were effective

-Think about triggers - make a note of anything unusual that you had to eat or drink, for example, that may have affected your migraine. This can be very helpful for your doctor. 

Most doctors use a step-by-step method for treating migraine, starting with simple treatments, including painkillers and complementary therapies. 

If these aren't working they may then move on to more powerful drug treatments such as migraine specific medicines called triptans or 5HT drugs. These act in a similar way to a natural substance in the brain called serotonin, which has been shown to be in short supply during a migraine attack. There are also drugs which can help prevent migraine in the first place.

Second opinion

Get facts right before acting as judge and jury

In recent times, several controversies involving the small world of Sri Lankan medicine have erupted in the print and electronic media. In all of these issues, medical practitioners have been portrayed as the villains of the piece.

The most glaring example was when a girl died almost immediately following an injection at a private nursing home in a Colombo suburb. The verdict of the media was guilty even before proper inquiries were made. If the print media cast aspersions on the incident, the electronic media went even further, being bold enough to pronounce that the wrong injection had been administered to the child!

The inquiry that ensued revealed that death was due to anaphylaxis- a very rare but significant reaction to the vaccine. Of course this verdict only got minute publicity in the media and the doctor concerned was not compensated in any way because the adverse publicity he received may have already done irreparable harm to his reputation, not to mention his practice.

A second case in point was a death, which allegedly followed a suicidal hanging. As there was some doubt about the incident a second post-mortem was ordered. But a particular television station took it upon itself to pronounce judgment. It interviewed relations of the victim voicing their suspicions and did its own 'investigative' work. And its deduction was that this was a sinister murder because the organs were missing from the body when the second post-mortem was done- not knowing that at any post-mortem, the organs are removed for further analysis. But, the unsuspecting viewer does not know this too and he is given the impression that the doctors who did the first post-mortem are also somehow involved in 'gruesome murder'.

A third transgression by the media recently was again by the same television station-the depiction of the state of affairs at a mental hospital where patients, and not doctors were the victims. Though a patient has a right to privacy and confidentiality- especially when the illness is a mental disorder- the programme blatantly focused on the patients, making them clearly identifiable, and therefore probably condemning them with the stigma of a mental illness in their hometowns, where they would have been recognized.

These are just a few of the more glaring examples of how the media violate the rights of both patients and doctors when they begin their crusade for better health care. This is not to say that the media has no role to play in ensuring that doctors give patients their due care- they do indeed and can be a powerful deterrent for errant doctors.

It is also readily accepted that all doctors are not angels and there are those- some with famous names and qualifications- who fleece the poor, unsuspecting patient. But that does not in any way give the media the arbitrary right to be judge and jury, especially when they are paying scant respect to facts.

The media must highlight the faults, if any, in the medical profession and in the manner in which medicine is practised in this country. But in so doing, they must be cautious and the least they could do is to get their facts and ethics correct.

If we are in an age where a television documentary says- to the accompaniment of sinister music in the background- that missing organs in a body where a post-mortem has been already done are an indication of foul play by doctors, then may God help the media and the unsuspecting public. A little learning, after all, is a dangerous thing!

No need to panic

A previously uncommon illness, characterized by fever and a rash in the mouth has created some panic as it spread recently, in Colombo and its suburbs. This is the "Hand, Foot and Mouth Disease" . The name sounds sinister and there is a similar sounding disease among cows- so, there is every reason to panic.

But, in reality, there is no need to be alarmed- no; it's not the same infection that affects cows. The animal infection is called Foot-and-Mouth disease. It's completely unrelated, and caused by a different virus altogether!

Hand, foot and mouth is a common childhood infection. It is very common in small children, but can occur at any age. It is caused by one of several viruses, most commonly the Coxsackie virus A16, which is one of a group of viruses called the enteroviruses. This virus is quite contagious, especially through the first week of illness, and spreads through direct contact. The name of the infection comes from the fact that a rash develops on the palms and soles of the feet, and sores appear in the mouth. The rash takes a couple of days to appear and consists of small, flat or raised red spots, some with blisters. Similar spots in the mouth, usually on the tongue, gums, and inside of the cheeks, may progress into mouth ulcers.

The child is also usually feverish, has a sore throat, and feels generally unwell. Nevertheless, Hand, Foot and Mouth disease is rarely a serious infection. Most children need no specific medical treatment, and are better within a week or so. Complications are rare, but occasionally, can lead to mild viral meningitis.

An ill child can be given simple remedies for unpleasant symptoms, such as pain relief for the ulcers and blisters, or to lower fever. 

The vast majority of children will recover within two weeks and will have no complications whatsoever. Therefore, specific preventive measures such as vaccines have not been used to contain the disease. And of course, it is a relatively benign condition, so there is no real reason to worry!

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