Sleep Apnea

Many of us are very fortunate to be able fall asleep with no interruptions but have you ever thought of what it would be like to fall asleep and suddenly waking up to a choking episode?  This is what is known as sleep apnea…….and what is sleep apnea…….what are the symptoms and treatments?

Sleep Apnea

A sleeping disorder that interrupts sleep due to shallow breathing or breathing suddenly stops lasting ten to twenty seconds constantly during sleep causing the person to wake up 20 to 30 times during an hour;  at this point the brain and the body may not be getting enough oxygen.  

2 Types of Sleep Apnea

• Obstructive Sleep Apnea

This is the most common of the two; it is estimated that over 12 million people suffer from obstructive sleep apnea, it is caused by blockage of the airway usually when the soft tissue in the back of the throat  collapse during sleep.  The majority of people who suffer this form of sleep apnea are overweight and snore. 

Sleep apnea is seen more in men; one out of 25 middle aged men and one out of fifty middle aged women.  Sleep apnea is commonly seen in African Americans, Hispanics, and may occur in children that snore.  

• Central Sleep Apnea

Unlike obstructive sleep apnea, there is no throat blockage the brain just fails to signal the muscles to breathe due to instability in the respiratory control  

Who is at risk?

Sleep apnea does not discriminate it can affect anyone and at any age.

• Males
• Overweight
• Over the age of forty
• Large neck size (Men 17in or more Women 16in or more)
•  Large tonsils, tongue, or a small jaw bone
• Family history of sleep apnea
• Gastroesophageal reflux
• Nasal obstruction due to deviated septum, allergies, or sinus problems

Signs & Symptoms

• Loud snoring
• Sudden choking or gasping for air
• Sleepiness during the day

Diagnosis

Your physician may order a sleep study to monitor your breathing and how often the interruptions are happing during sleep.

Treatment

Most common treatment for sleep apnea is Continuous positive airway pressure; it consist of the patient wearing a mask over the nose during sleep.  The mask provides air into the throat at a pressure level keeping the throat open while the patient sleeps.  The air pressure is adjusted enough to stop the airways from getting too small during sleep.  The patient must use the mask nightly and must use it correctly to get the maximum benefits.

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A child called IT……..

Intersex???? A condition in which a person is born with a reproductive or sexual anatomy that does not seem to fit the typical definition of female or male.  The person has the appearance a normal female but has male typical anatomy in the inside.  Or the person may be born with genitals that seem to be in between male and female.

The original term for this condition, hermaphroditism that came from joining the names of a Greek god and goddess, Hermes and Aphrodite.  As you may have already made the connection, Hermes was the god of male sexuality and Aphrodite the goddess of female sexuality, love, and beauty.

Causes

Intersex can be divided into 4 categories

• 46 - XX Intersex
• 46 - XY Intersex
• True Gonadal Intersex
• Complex or Undetermined Intersex

46 - XX intersex
The person has the chromosomes of a woman along with the ovaries, but external genital that appear male.  This the result of the fetus having been exposed to excess male hormones before birth.  These women have an enlarge clitoris that appears like a penis but usually they have normal uterus and fallopian tubes


46 - XY Intersex
This person has the chromosomes of a man but with external genitals are incompletely formed.  Internally testes may be normal, malformed or absent; this condition is also known as 46 - XY with undervirilization.  It was known as male pseudohermaphroditism; forming male external genitals depends on the right balance between male and female hormones.

True Gonadal Intersex
This person has both ovarian and testicular tissue, the person might have one ovary and one testis.  This person may have XX chromosomes, XY chromosomes, or both; but the external genitals may be unclear or may appear to female or male.  This condition was known as true hermaphroditism; in most people with true gonadal intersex the cause is unknown, yet in some animal studies it has been linked to exposure to common agricultural pesticides.

Symptoms 

• Unclear genitalia at birth
• Micropenis
• Clitoromegaly
• Partial labial fusion
• Undescended testes in boys (may be ovaries)
• Labial or inguinal masses (may be testes) in girls
• Hypospadias 
• Electrolyte abnormalities
• Delayed or absent puberty
• Unexpected changes at puberty

Exams

• Chromosome Analysis
• Hormone leves
• Hormone Stimulation tests
• Electrolyte test
• Specific Molecular testing
• Endoscopic examination - to verify the absence or presence of a vaginal or cervix
• Ultrasound or MRI to evaluate internal sex organs

Conclusion

It use to be that surgery was highly recommended because having to reconstruct the female genitalia was easier than male genitalia, yet surgery or no surgery the child was assigned to be a female.  

Now many experts disagree and encourage the delay of surgery for as long as possible without harming the child while involving the child in the gender decision.

Be aware that intersex is complex and its treatment has a short and long term consequences parents are encourage to have a good understanding of the condition before making  rushing into a decision. 

Smell……Men vs. Women

What is smell; is it that nasty smell coming from someone in the elevator or is that awesome smell you can not seem to get enough of.  

It is olfaction, a sense of smell, the ability of humans and other animals to perceive odors; odor the resultant from the sense of smell.  Smell is the response to chemicals that contact the membranes inside the nose.  Smell is usually our first response to stimuli, just like the smell of fire alerts us before the flames and the smell of rotten food before we even taste it.

Just like taste, smell is a chemical sense detected by sensory cells call chemoreceptors.  When smell stimulates the chemoreceptors in the nose that are alerted by smell, they pass on electrical impulses to the brain.  The brain then communicates these patterns in electrical activity as specific odors and olfactory sensation becomes perception; which we recognize as smell.  

Men vs. Women

On average women detect odors more easily than men, brain responses to odors are stronger in women than men.  According to research the women's greater ability to detect odors and aromas may be linked to the estrogen hormone.  

Another study showed that females are far better at singling out odors than men after repeated exposure to the origin of the smell by one ten-thousand; whereas men never improve their ability to recognize odors with experience. 

It has been suggested by researchers that female sex hormones have a role in enabling exposure induce increases in odor sensitivity.

At the end of the day the structure of nose in women and men are the same; women do not have more receptors in the nose than men, only a better sense of smell.

Alzheimer's Disease

Alzheimer's Disease 

It is a developing brain disease that slowly does away with memory and thinking skills results in confusion, disorientation, reason, understanding, and eventually leading up to the inability to perform the most basic tasks of daily living.  Alzheimer's disease is the most common cause of dementia among older people.

The disease is named after Dr. Alois Alzheimer a german psychiatrist and neuropathologist who was the first to publish a case of  "presenile dementia" which would later be known as Alzheimer's Disease.

What is Dementia??

The loss of cognitive functioning; thinking, remembering, reasoning, and behavior abilities.  

Dementia is cause by many conditions and diseases but the two most common cause for dementia in older people are Alzheimer's disease and vascular dementia.

Continue

Memory loss or dementia may also be caused by:

• medication side effects
• chronic alcoholism 
• tumors or infections in the brain
• blood clots in the brain
• vitamin B12 deficiency
• thyroid, kidney, or liver disorders

Note that most of these conditions are temporary and reversible.

What happens to the Brain??

Alzheimer's disease comes into the brain like a thief, there is no specific knowledge of how the disease begins until there is  significant evidence that could have started a decade or more before.  Even though the person is asymptomatic at the early stage of Alzheimer's there is toxic changes taking place in the brain.  Alzheimer's disease causes abnormal deposits of proteins from amyloid plaques and tau tangles on both the inside and outside neurons while damage dendritic spines, decrease synaptic input, and decrease plasticity.  As the plaques accumulates the damages spreads to the cerebral cortex and  hippocampus, which is responsible for forming memories.  As the neurons die in large numbers the affected regions of the brain begin to shrink.

Early signs and symptoms

Memory problems, such as trouble finding the correct words or poor judgment.

Mild Alzheimer's disease 

Memory loss worsens and cognitive abilities are significant:

• getting lost
• trouble handling money and paying bills
• repeating questions
• taking longer to complete normal daily tasks
• poor judgement 
• losing things - misplacing things in odd places
• mood and personality changes

Moderate Alzheimer's disease

At this point the damage done to the brain affects language, reasoning, sensory processing, and conscious thoughts.

• increase memory loss and confusion
• problem recognizing familiar faces
• inability to learn new things
• unable to multitask 
• problems coping with new situations 
•  hallucinations, delusions, and paranoia 
• impulsive behavior

Severe Alzheimer's disease 

Once Alzheimer's is full blown the person is no longer able to communicate and is completely dependent on others and may be bedridden. 

• unable to communicate
• weight loss
• seizures
• skin infections
• difficulty 
• groaning, moaning, or grunting
•  sleeps most of the time
• uncontrolled bladder and bowel

Unfortunately there is no cure for Alzheimer's disease but there are medications that can help with the managing of symptoms allowing the patient to function at a higher level and for longer periods of time.

Split Brain

Split Brain…….What does this mean??

It is when the corpus callosum  that connects the two hemispheres of the brain is divided to some degree and interrupts the spread of the seizure from one hemisphere to the other.  Keep in mind that this procedure does not completely do away with the seizing, they will continue but only in the hemisphere it originated but will be less aggressive since they can no longer spread to the opposite side.
Roger Sperry and Ronald Meyers first discovered the split brain in the 1950s by experimenting with cats and then later in monkeys but it wasn't until 1961 that the first human underwent the the split brain surgery.

Who is a candidate??

Patients with severe and uncontrollable epileptic seizures or when the seizing is affecting both sides of the brain or especially the patients who because of the seizure suffer from sudden falls exposing them to serious injuries.  Another candidate who would highly benefit from split brain surgery is the patient who has had little to no improvement while on anti-seizure medications.


Post Split Brain Surgery Effects

The surgery itself was an instant cure for the epileptic seizures, but shortly after they noticed that the patients who had had the commissurotomy had some peculiar difficulties in their daily activities.  The patients were unable to process information from one hemisphere to the other,  as though each hemisphere started to acted independently.

• Difficulties speaking
• Remembering things
• Finding words
• Decrease in awareness of one side of the body
• Loss of coordination
• Speech impediment, such as stuttering

Conclusion 

What was concluded after much research by Roger Sperry was that the right and left hemispheres specialized in different duties.  The left side is responsible for the analytical, verbal duties, and has  better control of speech while the right side is responsible for the space perception.

Example: Right hemisphere contributes when making a map or giving directions on how to get from             point "A" to point "B".  The right hemisphere can only produce basic word and phrases, but is significant in the emotional context of language.  

What was amazingly noted was that each hemisphere is still able to learn after the split brain surgery because the brain learns to use the smaller connections between the left and right hemisphere but one hemisphere unfortunately has no idea what the other hemisphere has experienced or learned.