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By Marvin Cervantes

 As women approach midlife and menopause one of the things to be on the lookout for is depression. While menopause is not thought to be a cause of depression the two can occur at the same time. What is believed to be a cause of depression is changes in estrogen levels which occur during menopause. It is known that women are affected by depression over twice as much as men and that a family history of depression can factor into this as well.

The symptoms of depression and menopause are very similar and include sleep disorders, hot flashes,fatigue, anxiety, and irritability. Many women associate these symptoms with the changes that menopause bring, but they may be a sign of depression that needs to be understood and dealt with. There is no reason women need to suffer from depression duing menopause. It is important that they accept the physical changes happening to their bodies during this time and work with their doctor to mitigate the symptoms of menopause, but it is alaso important that they realize that depression and menopause can be mutually exclusive and both can be dealt with.

As women approach menopause their menstrual cycles begin to change and start to become unpredictable. This unpredictability of their monthly cycle is a sign of erratic ovulation. Erratic ovulation causes unpredictable releases of the hormones estrogen and progetserone leading to mood swings, forgetfulness, hot flashes and all the other symptoms associated with menopause.

Most women going through menopause feel that they are loosing control of their bodies when in fact it is just their natural reaction to the aging process. This feeling of loss of control can lead to symptoms of depression. As the symptoms of both menopause and depression worsen they start to feel that their is nothing they can do and a feeling of hoplessness falls over them. This feeling of hopelessness is a major part of depression and left untreated can lead to severe depression.

Untreated depression is a major health risk. Researchers have found that depression is linked to an increased risk of heart disease and in some cases it can lead to bone deterioration increasing the likely hood of osteoporosis and broken bones.

The treatment for dperession and menopause can follow a two pronged approach. It is important to treat not only the depression with antidepressant medications and counseling but also to treat the symptoms of menopause as well. Menopause can be treated with hormone replacement therapy where synthetic forms of estrogen and progesterone are used to even out the woman’s hormone levels.

If you are a woman approaching midlife and menopause be aware that depression can be a very real side affect of the changes that will happen to you. If start to see the symptoms of depression it is best to talk to your doctor about what treatment options may work best for you.

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Headache In Medical Diagnosis Today

By Marvin Cervantes

 Experienced clinicians begin the process of making a diagnosis upon first laying eyes on a patient, and probability is one of the main tools they use in this process. A glimpse “behind the scenes” from the point of view of a diagnosing physician might help to explain an otherwise mysterious process.

The diagnostic process can begin even before laying eyes on the patient. As an exercise (and to prove a point) I ask medical students who are with me in the office to diagnose the patient we haven’t seen yet who is still in the waiting room. Of course, they look at me like I’m crazy. But I tell them that we already know a lot about the patient and can make some educated guesses. For example, we might already know that the patient is a 34-year-old woman referred by a family doctor because of headaches.

So what have other women in their thirties referred to me for headaches ended up having as their diagnosis? In my neurology practice, as well as in those of most other headache specialists, about a third (33%) have migraine, another third have medication-overuse headaches (in which the treatment has become the problem instead of its solution), and the remaining third fall into an “everything else” category that includes tension-type headaches, arthritis of the neck or jaw-joints, sinus disease, tumors, etc. So before seeing the patient I’m already able to identify the two most likely diagnoses and assign an initial probability for each.

These starting-point likelihoods are called “anchor” probabilities. During the subsequent history, examination and supplemental testing (if necessary) the anchor probabilities will undergo a series of upward and downward adjustments according to what the patient has to say and what does or does not turn up on her physical examination and testing. The physician individualizes the questions asked and items examined so that the outcome of each query forces one diagnosis to be more likely and another to be less likely. Thus, diagnosis is a dynamic and sequential process.

We invite the woman into the examining room and listen to her story. In the headache example given, one key piece of data is how many days per month she takes an as-needed medication - for example, aspirin, acetaminophen or a prescription drug. If she takes as-needed medicine more days than not and has been doing so for a matter of months, then the initial 33% anchor probability of medication-overuse headaches gets adjusted upward and the initial anchor probability of uncomplicated migraine moves downward. This, of course, is just a single distinguishing feature, and cannot be relied upon to tell the whole story. The physician gathers many such data points to refine the diagnosis.

The physical examination provides another source of facts to distinguish among still-viable possibilities. If my patient has migraine or medication-overuse headaches, she might have tender muscles in her scalp and neck but should not have a blind spot in her visual fields, slurring of her speech or clumsiness on just one side of her body. These findings, if present, would cause the probabilities of migraine and medication overuse headaches to be revised downward. By contrast, the probability of a brain disease - like a tumor, for example - that started with a low anchor probability would get revised upwards.

If a blood test or a scan is ordered, it is again with the idea that the test has been individualized to discriminate between competing diagnoses and re-adjust their relative probabilities.

There is an important principal in medical diagnosis called Bayes’ theorem. In a nutshell, Bayes’ theorem states that the probability of a diagnosis after a new fact is added depends on what its probability was before the new fact was added. Another way of saying this is that the same “yes” answer on history-gathering, reflex result on physical exam or dark spot on an MRI scan has different implications in different people. The meaning of each depends on its context. Yet another implication of Bayes’ theorem is that one can’t skip past the history and examination by ordering a test in isolation and expect it to make an accurate diagnosis. A test is an answer to a question. If there was no question, how could the test be an answer?

Let’s say that at a particular point in time we have completed the diagnostic process for a patient. Then what? By the end of the diagnostic process the doctor might have a diagnosis that is nearly 100% likely, but in other cases, the working diagnosis (number one choice) might still be just 70% or 80% probable, with a number two choice less likely, but still on the radar screen. It might make some patients uncomfortable to realize that the diagnostic process does not lead to 100% certainty in every case, but a doctor wouldn’t be doing a patient any favors by pushing the analysis past the outcome that the available information leads to.

When a diagnosis is not 100% likely at the time of initial evaluation, the patient’s course of symptoms over time provides yet another form of data that can lead to revision of diagnostic probabilities. Fortunately, in cases involving uncertainty, even just narrowing down the list of diagnoses to a small number of concrete alternatives allows the doctor and patient to discuss reasonable options and make sensible choices.

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The Effective Development of Leadership

By Clyde Howell

 Leadership, what is it and what is the difference between being a manager and being a leader?. Definitions of leadership, there is not a single definition that everyone agrees on. Manfred Kets de Vries, a professor at INSEAD, says that leadership is a set of characteristics, behaviour patterns, personality attributes that makes certain individuals more effective in achieving a set goal or objective.

Another way of describing leadership is to say that, to get the best out of people, individuals, teams, organisations, they need to be led, guided, persuaded, motivated, inspired, to be committed, to do their best, to work together to achieve a common objective. This, rather than the pure management approach of being told, directed, ordered, and treated as subordinates.

True leaders are recognised as being the leader, and their followers accept that they need to be guided by that leader, but they do not feel that they are mere subordinates. A good example is the captain of a sports team - hockey, baseball, netball, cricket, soccer, football, athletics - these are individuals who have an individual role to play, yet find time and ways to motivate and encourage others to do their best, to use their own individual skills, knowledge and experience (scoring goals, defending, winning races, hitting home runs) whilst at the same time working together as a member of the team to achieve team objectives.

There are other ways of defining leadership, managers perform transactions, and leaders bring about transformations.

The transactional manager influences others by appealing to self-interest, primarily through the exchange of rewards and services. The relationship between this type of manager and the follower is seen as a series of rational exchanges that enable each to reach their own goals. Transactional managers supply all the ideas and use rewards as their primary source of power. Followers comply with the leader when it’s in their own interest - the relationship continues as long as the reward is desirable to the follower, and both the manager and the follower see the exchange as a way of achieving their own ends.

The transformational leader inspires followers to not only perform as expected, but to exceed expectations - transformational leaders motivate followers to work for goals that go beyond immediate self-interest, where what is right and good becomes important - these leaders transform the needs, values, preferences and aspirations of followers. They do this so that the interests of the wider group replaces the self-interest of individuals within that group.

It’s interesting that research has shown that the way women leaders describe how they behave, lead, is in line with the transformational style, whereas most male leaders when describing themselves use words and phrases that describe the transactional style. There are exceptions of course, and in some situations the leader can by viewed differently by different groups. Many people in the UK would not describe Margaret Thatcher as transformational in style, but more likely they would use words such as dictatorial, domineering, riding roughshod over opponents, yet others, in her close team for example, describe her as charismatic, motivational, inspirational, kind, supportive.

We can see from this look at Leadership that there are different ways of describing what a leader does, and how, at least in some ways, this is different to how a manager behaves. Individuals recognised as leaders makes it obvious that there are great differences in the way in which certain leaders behave. On the surface there are great differences between the leadership style of Prime Minister Thatcher, and that of the Indian industrialist Rajiv Bajaj. Yet both are widely acknowledged as highly successful leaders. The common factor, it seems, is that all are able to persuade others to follow them, in order to achieve success in their particular field. They all have something that brings diverse people together, to work as a team, to aim for and work hard to achieve a common objective. It is, perhaps, a special talent, or characteristic, or personality trait, or set of circumstances that they find themselves in, or perhaps a combination of all of these. Perhaps leaders are born with this ability, perhaps it is something that can be, or has to be, learned.

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