Traditional medicine

The concept of search activity and adaptation according to B.C. Rotenberg - V.V.

We feel bad when there is too little money, but do we feel good when there is enough? However, we are not talking about the amount of money here - anyone can experience “achievement depression”. If you have money but no joy, it’s not about the money. Nowadays, any child knows almost from infancy what money is, and is already thinking about how to earn it and what to spend it on. A few decades ago, kindergarten dreams came down to kilograms of candy or, in the sky-high version, a bicycle; now children’s dreams are more intense and their scale sometimes amazes even adults, pushing their limits of dreams. As it turned out, the ultimate dream greatly affects your health.

It is the limit, not the quality (of course, we are no longer talking about childhood, but about maturity). Physicians and psychologists have long noticed one psychophysiological phenomenon; it is sometimes called “disease of achievement”, and it also became known as Rotenberg-Altov syndrome (named after the scientists who discovered it). Its essence is that a person who has spent incredible efforts to achieve a goal, for example, a lot of money and other related attributes, does not experience satisfaction, but even the opposite. He experiences emptiness, loss of meaning in life. Opportunities that brought a lot of money are not realized, there is not enough dreams and imagination.

As it turns out, the period after achieving success is very dangerous for health. Psychological stability suffers, and the immune system cannot cope with purely physiological diseases.

Psychosomatics of depression

A striking example of the achievement syndrome was the figure of His Serene Highness Prince Potemkin-Tauride. Having unlimited power and a sea of money, he often shouted to his entire huge palace: “I’m bored!” Some historians believe that he was poisoned, but most likely, he was poisoned not by the poison given to him, but by a lack of imagination. He did not see his future, did not see a field of activity, new goals that were interesting to him, he no longer had a dream. This broke him, his body stopped resisting, he died on a road that no longer led him anywhere.

The same Vadim Rotenberg, this time with Doctor of Medical Sciences Viktor Arshavsky, put forward the “concept of search activity” more than three decades ago. It is highly correlated with “achievement depression.” Scientists argue that both a person’s psychological and physiological state directly depend on his desire to seek a goal and take action to achieve it. Moreover, it does not matter at all what emotions a person receives.
Even if you struggle with a problem to no avail, are tormented and angry, your body has a chance to be no less resistant to external influences than when you are successfully moving towards your goal. In any case, it will undoubtedly be more stable than if you wander from corner to corner and don’t know what else to do with yourself.
Of course, it's not about the money or even the amount of it. It's about our attitude to what we do. If business for us is just a means of making money, and not a business to which we devote our lives, then when we finally achieve success, considerable problems may arise. In life, a person should always have a goal, even on his deathbed.

Money as a goal can also have its place. Many billionaires lived to old age because their goal was not just to earn money, but to always earn it; in this case, there is simply no final goal. Finding new ways to make money kept them healthy and led to new commercial successes - it was their life's work.

For other people who view money not as a business, but as a symbol of success, as a means of satisfying their needs, a threshold arises that is sometimes difficult to cross. The fact is that human needs, in principle, are quite small, and even if they are hypertrophied to the point of impossibility, it will not be so difficult to achieve their exhaustion. There comes a moment when everything is there. Someone will say, “I would like their problems,” but there are such people in our world.

A person, regardless of his level of well-being, needs to convince himself that any success is only the achievement of an intermediate goal, and to know the path along which he will go further. Then he will be accompanied by both prosperity and the joy of life.
How we do this is everyone's subjective decision, but the choice is necessary if we care about our health and internal state.
Purpose provides us with constant activity. The pursuit of it preserves our health and prolongs our life. By the way, such a person is not subject to the “achievement syndrome”, because before him there is a path that has no end.

Wallenberg syndrome, orlateral medullary syndrome, is a disease that affects the central nervous system. The cause of this syndrome is an infarction of the brain stem, in particular, damage to the lateral medullary region and the lower parts of the cerebellum.

Photo: Wikipedia

Signs of Wallenberg syndrome

The brain stem is responsible for basic body functions such as swallowing, breathing, and heart rate. It also controls consciousness, wakefulness and sleep. Lack of blood flow and oxygen to the brain stem can cause serious problems throughout the body, including Wallenberg syndrome.

A common symptom of Wallenberg syndrome is difficulty swallowing. A person may have difficulty perceiving some senses, especially the sense of touch.

Other symptoms of Wallenberg syndrome:

difficulty breathing;
speech difficulties;
persistent hiccups;
nausea;
vomit;
headache;
hoarseness of voice;
rapid eye movements in different directions;
dizziness;
imbalance;
changes in body temperature such as fever or chills;
decreased sweating.

People with Wallenberg syndrome may also have other symptoms. Some people may experience neurological changes on one side of the body, so one side of the body may feel cold or there may be a tingling sensation or even complete numbness. This sensation can occur throughout the body, but is most common in areas such as the arms, legs, and face.

Some people report feeling like the world around them is out of balance or things are leaning to one side of the room. Many patients may experience sudden changes in heart rate and blood pressure.

People who experience any of these symptoms should discuss them with their doctor if the cause is unknown. This may be a sign of Wallenberg syndrome or another serious condition.

Causes and risk factors of Wallenberg syndrome

Wallenberg syndrome usually occurs as a result of a stroke when blood flow to the posterior region of the brain is stopped. In this case, the affected cells and nerves die due to lack of oxygen. These dying brain cells cause symptoms in the areas they control.

Differential diagnosis of Wallenberg syndrome

Symptoms may also be caused by other disorders, including:

Head or neck cancer;

Aneurysm;

Inflammation of the wall of the artery in the neck;

Abnormal thrombus formation;

Herpetic encephalitis;

Brainstem tuberculoma is a rare form of tuberculosis;

Some infections such as chickenpox.

People who have blood clots, heart disease, smokers, pregnant women, women who have recently given birth and people with circulatory problems may be more at risk.

Diagnosis of Wallenberg syndrome

Diagnosing Wallenberg syndrome is not difficult, but doctors must be sure they are not confusing symptoms with another disorder and should conduct a thorough neurological examination. A CT scan or MRI (magnetic resonance imaging) scan can help determine whether the lateral medullary region and lower cerebellum are affected.

Treatment

There is no simple treatment for Wallenberg syndrome. The goal of treatment is to minimize symptoms. Understanding the causes of symptoms is a necessary step in treatment.

Therapy and rehabilitation are important aspects of treating Wallenberg syndrome. Doctors may prescribe medications for specific symptoms. If a blood clot has formed, doctors may prescribe blood thinners. Doctors may recommend taking a low dose of medication, such as aspirin, for the rest of your life to reduce your risk of having another stroke.

One of the most challenging symptoms is persistent hiccups in people with Wallenberg syndrome. Hiccups can be painful and interfere with a person's ability to eat, talk, or even sleep. Hiccups can last for several days or weeks. A centrally acting muscle relaxant called baclofen may be a useful drug for patients with chronic hiccups, but treatment can be difficult.

Prognosis of Wallenberg syndrome

The prognosis for Wallenberg syndrome depends on the size and cause of the stroke. For some people, symptoms may improve within a few months of the stroke, while for others, symptoms may remain for several years after the initial stroke.

Literature

Lee J. H. et al. Treatment of intractable hiccups with an oral agent monotherapy of baclofen-a case report //The Korean journal of pain. – 2010. – T. 23. – No. 1. – pp. 42-45.

"Shadow, know your place." This quote from the famous play by Evgeny Schwartz can rightfully become an epigraph to this topic. Post-traumatic syndrome is a consequence of severe mental trauma that takes a person by surprise. A sudden break in family relationships, failure in some very important endeavors, an attack by bandits or terrorists, participation in a difficult battle, a fire, an earthquake, a car accident... It is impossible to list all the events that cause this emotional disorder.

But the traumatic event itself has long been in the past, the person survived and, it would seem, can return to his usual lifestyle, but he fails. From night to night he is haunted by frightening dreams in which vivid scenes arise that directly or metaphorically reproduce the trauma he experienced. In these dreams, as once during real events, a person unsuccessfully tries to escape, to overcome obstacles - and regularly fails and feels helpless. And while awake, if he accidentally becomes not even a participant, but simply a witness to some incident that is distantly and indirectly reminiscent of what he experienced, he suddenly experiences a severe vegetative crisis: an acute feeling of anxiety arises, the heart begins to pound, breathing becomes impaired, blood pressure rises, the muscles tense as if they need to immediately go into fight or flight. Sometimes, for the development of such an attack, it is enough to simply remember something or read about something that evokes associations with a long-experienced trauma. These attacks occur according to the law of “positive” feedback with negative consequences: each previous attack determines the development of the next one, preparing the ground for it.

But the state of such anxious tension is not the only manifestation of post-traumatic syndrome. These panic attacks alternate with a state of depression, passivity and the same feeling of helplessness that was caused by the first stress suffered and which is so similar to the state of depression. What psychological mechanisms are behind these, at first glance, so different manifestations of post-traumatic syndrome? A careful analysis of the history of the formation of this syndrome shows that at the moment of the trauma that caused it, a person gives a reaction of surrender, manifested by a feeling of helplessness. This is a very difficult experience associated with a feeling of personal inferiority, and it is difficult to get rid of such a feeling, even if the incident itself is long in the past. It continues to live in the inner world of a person. Any random associations, what can be called the shadow of the past, again cause the same state of helplessness - as if the shadow came to life.

But what do the described attacks with which I began the story reflect in waking life and in dreams? They look like an active state of tension and mobilization. I assume that this mobilization is aimed at fighting the shadow. This is an attempt at a figurative level to “replay” the experienced defeat. But it is impossible to replay something that has already been completed once. You can't win a battle against a shadow. As soon as you come out of this strange symbolic game, whether it happens in the waking state or in the dream, you find that the past experience remains the same experience of defeat, the shadow of the past is invulnerable and again provokes in you a feeling of helplessness. These states replace each other regularly.

What can be done? You need to explain to yourself that this is only a shadow of what you have experienced. You can start new games in your life, not with the shadow of the past, but with real today’s difficulties, reminding yourself of the experience of overcoming that everyone has, which turned out to be obscured by the shadow of defeat. Psychotherapists should and can help with this. Every success in this direction, memories of past successes and orientation towards achieving current goals will also contribute to neutralizing the past experience of defeat. This is not an easy but promising path. The self-awareness of a fighter with real difficulties will return, and the shadow will also return - to its place in the past.

Gilbert's syndrome (Gilbert's disease) is a genetic pathology characterized by a disorder of bilirubin metabolism. The disease is considered quite rare among the total number of diseases, but among hereditary diseases it is the most common.

Clinicians have found that this disorder is more often diagnosed in men than in women. The peak of exacerbation occurs in the age category from two to thirteen years, but can occur at any age, since the disease is chronic.

A large number of predisposing factors can become a trigger for the development of characteristic symptoms, for example, leading an unhealthy lifestyle, excessive physical activity, indiscriminate use of medications and many others.

What is this in simple words?

In simple words, Gilbert's syndrome is a genetic disease that is characterized by impaired utilization of bilirubin. The liver of patients does not properly neutralize bilirubin, and it begins to accumulate in the body, causing various manifestations of the disease. It was first described by the French gastroenterologist Augustine Nicolas Gilbert (1958-1927) and his colleagues in 1901.

Because the syndrome has few symptoms and manifestations, it is not considered a disease, and most people do not know that they have this pathology until a blood test shows elevated bilirubin levels.

In the US, approximately 3% to 7% of the population has Gilbert's syndrome, according to the National Institutes of Health - some gastroenterologists believe the prevalence may be higher, as high as 10%. The syndrome occurs more often among men.

Reasons for development

The syndrome develops in people who inherited a defect of the second chromosome from both parents in the location responsible for the formation of one of the liver enzymes - uridine diphosphate glucuronyl transferase (or bilirubin-UGT1A1). This causes a decrease in the content of this enzyme by up to 80%, which is why its task - converting indirect bilirubin, which is more toxic to the brain, into the bound fraction - is performed much worse.

The genetic defect can be expressed in different ways: in the bilirubin-UGT1A1 location, an insertion of two extra nucleic acids is observed, but it can occur several times. The severity of the disease, the duration of its periods of exacerbation and well-being will depend on this. This chromosomal defect often makes itself felt only starting from adolescence, when the metabolism of bilirubin changes under the influence of sex hormones. Due to the active influence of androgens on this process, Gilbert's syndrome is recorded more often in the male population.

The transmission mechanism is called autosomal recessive. This means the following:

There is no connection with chromosomes X and Y, that is, the abnormal gene can appear in a person of any gender;
Every person has a pair of each chromosome. If he has 2 defective second chromosomes, then Gilbert's syndrome will manifest itself. When a healthy gene is located on a paired chromosome at the same locus, pathology has no chance, but a person with such a gene anomaly becomes a carrier and can pass it on to their children.

The probability of manifestation of most diseases associated with a recessive genome is not very significant, because if there is a dominant allele on the second similar chromosome, a person will only become a carrier of the defect. This does not apply to Gilbert's syndrome: up to 45% of the population have a gene with a defect, so the chance of passing it on from both parents is quite high.

Symptoms of Gilbert's syndrome

The symptoms of the disease in question are divided into two groups – obligatory and conditional.

Mandatory manifestations of Gilbert's syndrome include:

general weakness and fatigue for no apparent reason;
yellow plaques form in the eyelid area;
sleep is disturbed - it becomes shallow, intermittent;
appetite decreases;
patches of yellow skin that appear from time to time; if bilirubin decreases after an exacerbation, the sclera of the eyes begin to turn yellow.

Conditional symptoms that may not be present:

pain in muscle tissue;
severe itching of the skin;
periodically occurring trembling of the upper limbs;
regardless of food intake;
headache and dizziness;
apathy, irritability – disturbances of the psycho-emotional background;
bloating, nausea;
stool disorders - patients are bothered by diarrhea.

During periods of remission of Gilbert's syndrome, some of the conditional symptoms may be completely absent, and in a third of patients with the disease in question they are absent even during periods of exacerbation.

Diagnostics

Various laboratory tests help confirm or refute Gilbert's syndrome:

bilirubin in the blood - the normal content of total bilirubin is 8.5-20.5 mmol/l. With Gilbert's syndrome, there is an increase in total bilirubin due to indirect bilirubin.
general blood test - reticulocytosis (increased content of immature red blood cells) and mild anemia - 100-110 g/l are noted in the blood.
biochemical blood test - blood sugar is normal or slightly reduced, blood proteins are within normal limits, alkaline phosphatase, AST, ALT are normal, thymol test is negative.
General urine test - no deviations from the norm. The presence of urobilinogen and bilirubin in the urine indicates liver pathology.
blood clotting - prothrombin index and prothrombin time - within normal limits.
Markers of viral hepatitis are absent.
Ultrasound of the liver.

Differential diagnosis of Gilbert's syndrome with Dabin-Johnson and Rotor syndromes:

Liver enlargement is typical, usually insignificant;
Bilirubinuria - absent;
Increased coproporphyrins in urine - no;
Glucuronyltransferase activity decreased;
Enlarged spleen - no;
Pain in the right hypochondrium is rare, if present it is aching;
Skin itching - absent;
Cholecystography - normal;
Liver biopsy - normal or lipofuscin deposition, fatty degeneration;
Bromsulfalein test is often normal, sometimes there is a slight decrease in clearance;
An increase in bilirubin in the blood serum is predominantly indirect (unbound).

In addition, special tests are performed to confirm the diagnosis:

Fasting test.
Fasting for 48 hours or restricting food calories (up to 400 kcal per day) leads to a sharp increase (2-3 times) in free bilirubin. Unbound bilirubin is determined on an empty stomach on the first day of the test and two days later. An increase in indirect bilirubin by 50-100% indicates a positive test.
Test with phenobarbital.
Taking phenobarbital at a dose of 3 mg/kg/day for 5 days helps reduce the level of unconjugated bilirubin.
Test with nicotinic acid.
Intravenous injection of nicotinic acid at a dose of 50 mg leads to an increase in the amount of unconjugated bilirubin in the blood by 2-3 times over three hours.
Test with rifampicin.
Administration of 900 mg rifampicin causes an increase in indirect bilirubin.

Percutaneous liver puncture can also confirm the diagnosis. Histological examination of the punctate shows no signs of chronic hepatitis and cirrhosis of the liver.

Complications

The syndrome itself does not cause any complications and does not damage the liver, but it is important to differentiate one type of jaundice from another in time.

In this group of patients, increased sensitivity of liver cells to hepatotoxic factors, such as alcohol, drugs, and some groups of antibiotics, was noted. Therefore, in the presence of the above factors, it is necessary to monitor the level of liver enzymes.

Treatment of Gilbert's syndrome

During the period of remission, which can last many months, years and even a lifetime, no special treatment is required. The main task here is to prevent aggravation. It is important to follow a diet, a regime of work and rest, not to overcool and avoid overheating of the body, to avoid high stress and uncontrolled use of medications.

Drug treatment

Treatment of Gilbert's disease when jaundice develops includes the use of medications and diet. Medicines used:

albumin - to reduce bilirubin;
antiemetics - according to indications, in the presence of nausea and vomiting.
barbiturates - to reduce the level of bilirubin in the blood (Surital, Fiorinal);
hepatoprotectors – to protect liver cells (“Heptral”, “Essentiale Forte”);
choleretic agents - to reduce the yellowness of the skin (“Karsil”, “Cholenzim”);
diuretics – to remove bilirubin in the urine (“Furosemide”, “Veroshpiron”);
enterosorbents - to reduce the amount of bilirubin by removing it from the intestines (activated carbon, Polyphepan, Enterosgel);

It is important to note that the patient will need to undergo diagnostic procedures regularly to monitor the course of the disease and study the body’s response to drug treatment. Timely testing and regular visits to the doctor will not only reduce the severity of symptoms, but also prevent possible complications, which include such serious somatic pathologies as hepatitis and cholelithiasis.

Remission

Even if remission has occurred, patients should under no circumstances “relax” - care must be taken to ensure that another exacerbation of Gilbert’s syndrome does not occur.

Firstly, you need to protect the bile ducts - this will prevent stagnation of bile and the formation of stones in the gall bladder. A good choice for such a procedure would be choleretic herbs, the drugs Urocholum, Gepabene or Ursofalk. Once a week, the patient should do “blind probing” - on an empty stomach you need to drink xylitol or sorbitol, then you need to lie on your right side and warm the area of the anatomical location of the gallbladder with a heating pad for half an hour.

Secondly, you need to choose a competent diet. For example, it is imperative to exclude from the menu foods that act as a provoking factor in the event of an exacerbation of Gilbert's syndrome. Each patient has a different set of products.

Nutrition

The diet should be followed not only during periods of exacerbation of the disease, but also during periods of remission.

Prohibited for use:

fatty meats, poultry and fish;
eggs;
hot sauces and spices;
chocolate, pastry;
coffee, cocoa, strong tea;
alcohol, carbonated drinks, juices in tetra packs;
spicy, salted, fried, smoked, canned foods;
whole milk and high-fat dairy products (cream, sour cream).

Permitted for use:

all types of cereals;
vegetables and fruits in any form;
low-fat fermented milk products;
bread, biscuits;
meat, poultry, fish of non-fatty varieties;
freshly squeezed juices, fruit drinks, tea.

Forecast

The prognosis is favorable, depending on how the disease progresses. Hyperbilirubinemia persists for life, but is not accompanied by an increase in mortality. Progressive changes in the liver usually do not develop. When insuring the lives of such people, they are classified as a normal risk group. When treated with phenobarbital or cordiamine, the bilirubin level decreases to normal. It is necessary to warn patients that jaundice may appear after intercurrent infections, repeated vomiting and missed meals.

High sensitivity of patients to various hepatotoxic effects (alcohol, many drugs, etc.) was noted. It is possible to develop inflammation in the biliary tract, cholelithiasis, and psychosomatic disorders. Parents of children suffering from this syndrome should consult a geneticist before planning another pregnancy. The same should be done if relatives of a married couple planning to have children are diagnosed with the syndrome.

Prevention

Gilbert's disease occurs as a result of an inherited gene defect. It is impossible to prevent the development of the syndrome, since parents can only be carriers and do not show signs of abnormalities. For this reason, the main preventive measures are aimed at preventing exacerbations and prolonging the period of remission. This can be achieved by eliminating factors that provoke pathological processes in the liver.