NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #17 Carol Rees Parrish, R.D., MS, Series Editor When Chyle Leaks: Nutrition Management Options Chylous leakage from the lymphatic system is a complex problem usually resulting from injury or abnormality of the thoracic duct. Although rare, when such leaks occur, they are often difficult to manage and correct. Nutrition therapy plays a major
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Trigeminal neuralgiaTrigeminal Neuralgia
Diagnosis & Treatment: Medical and Surgical Trigeminal neuralgia, also known as tic douloureux, is a common facial pain condition. It affects women more commonly than men. Generally symptoms began after 50 but can start at any time in adulthood. The pain is characterized by sudden stabbing waves of electrical shooting pain in the face. The pain varies in intensity from mild to excruciating. The pain generally lasts only seconds but can completely incapacitate an individual during that time. An affected individual may have many attacks during the day. This can lead to marked disability if the attacks occur through out the day. The pain can be trigger by touching the face on the affected side, chewing, talking, hot/cold beverages, brushing teeth, putting on make up or even laying on the affected side. Even cold air blowing across the face can trigger severe pain. Fortunately, good medical treatment is available to control the pain. In some instances, where medications are not effective, surgical intervention may be of benefit. Trigeminal neuralgia (TN) is not a fatal illness and is not associated with an increased incidence of suicide. The secondary incidence of depression is elevated due to the chronic severe nature of the pain. Diagnosis of this condition can be made on the basis of a detailed neurological history and examination. Brain imaging is not absolutely necessary but can be helpful in excluding other very rare causes of this condition such as multiple sclerosis and tumors. It is important to note that TN is not a dental disorder but rather an irritation of the trigeminal nerve. This is the major nerve involved in supplying sensory and pain information for the face, teeth and eyes. Some feel that it is a blood vessel pressing against the nerve but this has not been Fortunately there are many medications available to control this debilitating pain syndrome. One of the best medications over the past thirty years has been Tegretol (carbamazepine.) This drug was originally developed for seizure control but was found to be very effective in treating TN. A newer, chemically related drug Trileptal has been available over the past 8 years. This drug is also effective in treating TN pain. There are other medications that can be used alone or in combination with Tegretol or Trileptal. These include Topamax, Lamictal, Neurontin, Lyrica, amitriptyline, Baclofen and Dilantin. Narcotic medications are generally ineffective for TN and can be habit forming. Treatment by a physician specializing in head pain Surgical treatment may be appropriate for individuals who have classic TN that have not responded to a trial of the medications used to treat this condition. The surgery is usually performed on the trigeminal nerve ganglion. Anesthetic or alcohol blocks are commonly performed. Other treatments that are effective include gamma knife surgery (non-invasive) or decompression of the trigeminal nerve root (invasive.)
with analgesics until symptoms disappear. For the use only of a Registered Medical Practitioner or a Hospital or a LaboratoryMalaise and low-medium grade fever and/ or a flu like syndrome. These symptoms usually occur after 4 hours of instillation and disappear within 24-48 hours. RARE ADVERSE EFFECTS: Fever more than 39°C. The fever resolves within 24-48 hours with antipyretics and flui