Bipolar disorder or mood disorder is also known as manic depressive psychosis. It derives its name from the extreme mood swings (poles) that the patient goes through – from euphoria to depression. During the euphoric stage, the patient experiences heightened physical and mental activity and energy and expresses grandiose ideas coupled with increased talking. The patient may also experience total sleeplessness and fatigue. Ideally, an alert parent or spouse must consult a doctor at this stage. During the depressive phase, the patient becomes | melancholic, dull, withdrawn, restless and irritable.
There is a marked decrease in his concentration! And he experiences feelings of guilt and helplessness. He may even contemplate suicide and may actually attempt it. At times, the patient may experience a mixed state wherein the symptoms of mania and depression surface simultaneously. Although the exact cause is not known, it appears that multiple factors interact with each other to produce a chemical imbalance of neurotransmitters like serotonin and dopamine. Bipolar disorder often runs in families suggesting a genetic component. Above all, a stressful environment and negative life events like a broken engagement or relationship, a sudden bereavement, failure in exams or a sudden death of a loved one, can take a toll on the person’s system and eventually lead to such problems. Homoeopathy zeroes in on the genetic evolution of a disease and the trigger factors that are responsible for an acute flare-up. By studying the patient’s constitution and his predispositions minutely, a homeopath arrives at a specific remedy for the individual patient. Considering the nature of your husband’s illness and the medicines he is taking, you must consult an experienced homeopath at the earliest, which will carefully monitor your husband’s condition while initiating the treatment. This may be done in conjunction with his psychiatrist. Do not fear. Bipolar disorders can be very well treated and your husband can lead a normal and socially compatible life.

I was astonished to read in your column your advice that an orthopaedic surgeon would perform an operation to do a carpal tunnel repair. My operation was done by a neurosurgeon. You should know better?
Some of the less polite and wildly scrawled letters bring up some of the most interesting subjects.
I can assure readers that the column is written by a doctor, in fact by a general practitioner in private practice. There are no set rules about which doctors may perform which procedures, but by training, certain surgeons tend to perform operations on certain areas. Legally, there is no law restricting me as a GP from performing routine brain surgery, but it would be ethically wrong, and no reputable hospital would allow me to perform such surgery, as I have not been trained to perform this work.
Once a doctor has a surgical fellowship (and all surgeons have the same qualifications, but with emphasis in their training in a certain area), it is very difficult to delineate certain areas of the body to a particular type of surgeon. The simple operation on your wrist could have been equally well performed by an orthopaedic surgeon, neurosurgeon, general surgeon or a general practitioner with only moderate surgical skills (eg. in a rural area). Most are performed by orthopaedic surgeons.
Many other areas of overlap occur, particularly in the head and neck where otorhinolaryngologists (ear, nose and throat surgeons), plastic surgeons, general surgeons and even dental surgeons all may be involved.
Geographic location is another factor, and in major cities, more highly specialised surgeons are available. The emergency of a burst blood vessel in the brain would be dealt with by a neurosurgeon in the city, by a general surgeon in a major country town and by a general practitioner in a small country town.

I awoke last week with half my face paralysed. I am very scared, but my doctor says it will get better in a few weeks and she won’t give me any treatment. She says it is a Bell paralysis. What should I do?
You should not worry. Your GP is doing just the right thing—nothing!
The muscles of the face are controlled by the facial nerve, which comes out of a hole in the skull just below and in front of the ear. From there it spreads like a fan across the face, with branches going to each of the many tiny muscles that control our facial expressions. Damage to this nerve causes all these facial muscles to stop working, because the nerve tells the muscles when to contract and when to relax. The patient can no longer smile or close the eye properly.
By far the most common cause of this type of paralysis is Bell’s palsy. Bell’s palsy is caused by an inflammation of the facial nerve as it leaves the skull. The exact reason for this inflammation, and subsequent paralysis, is unknown. When the condition starts, the patient develops a sudden paralysis of the face muscles on one side only. There may be some mild to moderate pain at the point where the nerve leaves the skull beside the ear, but this settles after a few days. There may also be a disturbance to taste sensation.
Two-thirds of patients recover completely within a few weeks with no treatment. Most of the others obtain partial recovery, but 10% are significantly affected long term by facial paralysis. No treatment is necessary for most patients, but if the victim is elderly, the paralysis is total, or if there is severe pain, treatment may be tried. High doses of prednisone, a steroid, to reduce the inflammation in the facial nerve, is the usual medication. It is important that the treatment start within five days of the onset of the condition. Unfortunately, there is varying evidence about the value of any treatment, but at least it rarely causes any harm.