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May 30, 1997     Cape Gazette
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CAPE GAZE'PrE, Friday, May 30 - June 5, 1997 - 31 HEALTH & FITNESS Treatments available for those with narcolepsy By Kerry Kester "Mr. Sandman, bring me a dream..." but please not the fear I sometimes have seen... Narcolepsy, a sleep disorder, presents it- self in a variety of ways. Excessive sleepi- ness, a condition called cataplexy, sleep paralysis and sleep hallucinations are com- mon symptoms of the condition that al- though relatively uncommon, has been di- agnosed in several Cape Region patients during the last year. "This problem is out there and most peo- ple who have it don't know they have it," said Michael Salvatore, M.D., F.A.C.P., a pulmonologist in Lewes. "A lot of these people are labeled as lazy. They end up working jobs late at night, and some of the kids have problems at school. "These people aren't people who are tired all the time. These are people who are sleepy all the time. There's a difference." One way the condition manifests itself, said Salvatore, is a person may fall asleep during times when most people would stay awake. In severe cases, "they SALVATORE will have, basically, un- controlled sleep attacks." That, of course, poses a danger to many, he said, because they could be engaged in an activity where remaining alert is essential for personal safety. However, he said, many patients whose condition is not so severe will have little warning signals. How they cope with the problem, however, varies, said Salvatore. One patient, he said, worked close to home so was able to drive to and from the job without a problem. Later, when the pa- tient moved and faced a half hour to 40- minute drive, the patient would have to stop up to seven times to take naps. When the warning signal alerted the pa- tient, the patient pulled off to the side of the road and took a very short - only minutes long - nap. "Others people will have to lay down for an hour," said Salvatore. What are other symptoms? Cataplexy is another problem associated with narcolepsy. Cataplexy causes a pa- tient to suddenly lose muscle control. Most often, said Salvatore, the condition is prompted by an emotion such as laughter, anger, sadness or some other feeling. The condition may be subtle, such as a slight weakness in the arm or perhaps a fa- cial droop. "It usually just affects part of the body," said Salvatore. "Normally when you dream, your body is paralyzed," said Salvatore. Sleep paralysis, fundamentally a transient paralysis, he ex- plained, is another symptom of narcolepsy that appears generally just as someone falls asleep or is about to awaken. It can be frightening because although patients have a degree of cognizance of their surroundings, they are unable to speak or move. When they are touched, the paral- ysis usually stops, which differs from the paralysis of cataplexy, which must simply run its course and occurs when the patient is completely awake. Sleep hallucinations can be the most frightening symptom to some patients. Those who suffer from narcolepsy are like- ly to move from wakefulness to Rapid Eye Movement (REM), the dream sleep, in- stantly. "When you dream, your brain is very ac- tive," said Salvatore. Those with normal sleep patterns gradually move into REM sleep, he explained, so the body first rests then later allows the brain the lighter, dream sleep. When those with narcolepsy have the sleep hallucinations, they are in a state of drowsiness. The images may appear to be very real, and because those who experi- ence the problem are likely not to be aware they have a sleep disorder. "Some people who have sleep hallucinations - they think they're mentally ill," said Salvatore. In fact, said Salvatore, "Sleep behavior begins to intrude on awake behavior," cre- ating a boundary disorder. "Extra sleep doesn't relieve it because their brain doesn't separate awake sleep and dream sleep properly." Who gets narcolepsy? "It tends to cluster in families and tends to develop in late adolescence and into adulthood," said Salvatore. The disease is not progressive. "Once it's developed, it's usually pretty stable." What may vary somewhat, however, is the cataplectic symptom. People who live highly emotionally charged lives, or who have periods in their life that axe particular- ly emotionally charged, for example, will likely have more cataplectic incidents. Salvatore recommended that those who may have a sleep disorder tell their family doctors of their concerns. "A lot of people aren't programmed to go to their doctor with 'I'm sleepy all the time,'" he said. A sleep disorder may also lead to a de- gree of depression, and after conducting a physical examination and gathering the pa- tient history, family doctors will decide whether additional testing is an appropriate course of action for a patient. To identify those with narcolepsy, a physician skilled in diagnosis and treatment of sleep disorders will usually order an overnight sleep study. "That's usually nor- mal," said Salvatore. However, the overnight study is neces- sary for the next step of the diagnostic course - the Multiple Sleep Latency Test (MSLT). For that, patients are kept in the lab for approximately 10 hours, where they are asked to take five 20-minute naps, two hours apart. "Most people won't fall asleep, or they will fall asleep after about 15 minutes," said Salvatore. "Normal sleepers will never dream during a nap, but narcoleptics fall asleep early and dream during their naps." Is narcolepsy treatable? According to Salvatore, there are basical- ly four treatment options for narcoleptics. Some narcoleptics may be treated simply by making a behavioral change. They may need to program into their daily schedule a certain time of day when they will take a nap. Others may benefit from medication, "which basically involves stimulant drugs." Medication is also sometimes useful for those with cataplexy. "Some people have to make lifestyle changes," said Salvatore. "Most of the time, narcoleptics sort themselves out." They understand something is different, so they avoid jobs that would have them oper- ating heavy machinery, for example. "They get sort of socially isolated jobs. "Success depends on how severe the dis- ease is," said Salvatore. Fortunately, he said, attitudes toward those who have sleep disorders are changing. As people learn that there are often medical reasons for those who appear sleepy or tired frequently, they become more tolerant and less likely to label people as "lazy." Those who suspect they may have a sleep disorder should contact their family doc- tors. By rendering herself a widow, ful in the diagnosis of a Brown tially harmless, especially if you Maryann Hofman, both RPh, CSPI There are more than 100,000 different kinds of spiders in the world and about 2.2 million spi- ders per acre of grassy field. Not a comforting thought if you suffer from arachnophobia, a fear of spi- ders. But you can relax - sort of - be- cause out of all the different types of spiders, only two in the U.S.A. are considered poisonous, and even those rarely bother humans unless they are provoJed. They muscle are the Black Widow and the in the Brown Recluse. sweatin Other spiders are not yen- cases omous, but they do bite. The Poi- son Control Center receives many calls about spider bites year but in round. Most victims usually ask, "How do I tell if the spider is poi- sonous?" and "What kinds of symptoms can I expect?" The female Black Widow spi- der can inflict a poisonous bite on humans. She is given her name because of her color and because she devours her male partners, This shiner black spider is eightao 10 millim',ters (o# inch) long and hi reddish hourglass mark on her domen. The bite feel., like a pin spots where Widow that S m effect after the bite, may per- extremely te. Most people cover .omple,, as long as thfly obtain adequ at eaql0r tive re. Treatme!t i-ncludes-lax- ers, admlstration oJ/fluids, tetanus shotsNuld o_thC'measures. Anti-venom .is av..,, hie .and high- ly effectivJ;mfit is used only for The Brown Reclus on than to cause likes to hide ider is [i tint and length, its back. chemi md Recluse is However, a few itching, ting redness occur and ale- takes on the appear- ance of several red rings encir- cling white areas, radiating from a white central blister; it is often re- ferred to as a 'bull's eye' or "tar- get" lesion. The "bull's eye" le- sion is usually fully evident within eight hours of the bite and is help- Recluse bite. If untreated, the lesion may blis- ter, ulcerate and eventually result tissue. Skin grafting pro- ay be required to repair e,In addition to exten- sive local tisff an un- bite may major organ sys- occurs, the symp- toms within 12-24 hours of and may include fever, headache and gas- bleeding disorders or kid- ney may result. Brown bites require prompt med- may m- elude wound care, antibiotics, oxygen and steroids. Healing le- sions can take weeks or months, depending on the severity of the wound. Currently, there is no available antidote; however, an experimental anti-venom is being studied. Although P lack Widow and Brown Recluse spiders may be threatening, most spiders that you are likely to en- leave them alone. They will bite if provoked; however, their bites are not con- sidered medically dangerous. You can expect to see a reaction similar to that of a bee sting, in- eluding redness, pain and swelling at the site. Sometimes other symptoms including headache, nausea and vomiting may occur. Good cleaning techniques and proper first-aid should be prac- ticed for all spider bites. The following are some initial steps to take if you are bitten by an unknown spider: Save the spider for identifica- tion purposes, even if the spider is dead. Clean the area thoroughly with soap and water. Check with your doctor about a tetanus booster. Apply topical antibiotic oint- ment to prevent infection. Hydrocortisone cream may be used to reduce inflammation. Consider using antihistamines for severe swelling. Continued on page 33