DOC I HAVE CHIKUNGUNYA FEVER
Chikungunya Fever is transmitted by the same carrier as dengue fever.
Unlike dengue fever which can cause bleeding in the brain the chikungunya fever predominantly gives rise to high fever and severe body aches.
The danger in chikungunya fever is low compared with dengue fever.
Prevention is again by getting rid of the carrier the Aedes mosquito which is the most difficult part of prevention.
Chikungunya fever is an acute viral disease caused by the chikungunya virus which is transmitted to humans by the bite of an infected mosquito (Aedes mosquito).
The incubation period in mosquito is 3-5 days and 1-12 days in humans.
Symptoms usually last 3-10 days.
Symptoms may be the same as denque fever:
fever
rash
severe and prolonged joint pains
muscle pain
chills
headache
fatigue
nausea
vomiting.
Unlike dengue, no cases of hemorrhagic (bleeding) shock syndrome have been reported in chikungunya infection.
There is currently no medication or vaccine for the treatment of chikungunya fever.
TREATMENT IS SYMPTOMATIC:
1.lots of rest,
2.a nutritious diet,
3.plenty of fluids and
4.pain medication may relieve symptoms of joint pain and body aches. Bodyaches is one of the major symptoms of chikungunya infection.
The best way to prevent chikungunya infection is to avoid mosquito bites.
Hence, getting rid of mosquito breeding sites is important. Preventive measures are similar to those for dengue such as:
1.Using insect repellent on exposed skin surfaces when outdoors, especially during the day.
2.Wearing long-sleeved shirt and long pants when outdoors.
3.Having well-screened rooms or air-conditioning to keep the mosquitoes out.
4.Emptying stagnant water from flower vases, flower pots, roof gutters and watering cans to eliminate breeding sites.
A person with chikungunya fever should stay indoors to prevent mosquito bites to avoid further spread of the infection.
Some useful tips when travelling to areas with chikungunya fever outbreaks:
1.Wear long-sleeved shirts and pants.
2.Apply mosquito repellents during the daytime
3.Use mosquito coils and bednet if you rest during the daytime or rest in air–conditioned or screened rooms.
4.Spray aerosol insecticide indoor.
If you experience any of the symptoms mentioned above, you are advised to see a doctor immediately.
The doctor may test your blood to detect the presence of the chikungunya virus.
If your blood test shows positive for the virus, stay at home to reduce risk of further transmission of the virus.
Friday, December 31, 2010
Thursday, December 30, 2010
A Family Doctor's Tale - DENGUE FEVER
DOC I HAVE DENGUE
Dengue is a dangerous virus which is still prevalent today especially in tropical countries like Singapore, Indonesia, Malaysia and India.
The important factor in the disease being prevalent is the presence of its carrier the Aedes mosquito.
Unfortunately getting rid of the mosquito is harder than expected.
The mosquito can unfortunately breed in a puddle of water about the size of a 20 cents count.
The water can even be found inside the cup-shape flowers. Inside these flowers were found the larva of the Aedes Mosquito.
Because the tropical countries has frequent rainfall, it is very difficult to get rid of the mosquito.
As long as there are carriers the dengue virus is always present.
Dengue fever is a acute viral infection caused by the dengue virus which is transmitted by the bite of an infected female Aedes mosquito.
The dengue virus has 4 strains called serotypes 1, 2, 3 and 4.
An infection with one serotype does not protect you from the other serotypes.
A second dengue infection, especially with serotype 2, can cause an even worse infection such as Dengue Hemorrhagic Fever and Dengue Shock Syndrome which can be fatal.
The incubation period in mosquito is 8-12 days and 3-14 days in humans.
Symptoms usually last 3-14 days.
1.High, acute, prolonged fever (usually lasts for 5 to 7 days)
2.Severe headache
3.Pain behind the eyes
4.Muscle and joint pains
5.Rashes
6.Nausea , vomiting
7.Abdominal discomfort
8.Loss of appetite
9.Fatigue
10.Diarrhoea
A rash usually appears 3-4 days after the fever.
There are 3 types of dengue rash.
1.Petechial Rash:
This is the most common with the petechial rash appearing as red dots under the skin.
The rashes are usually found on the limbs and lower abdomen and is due to the bleeding under the skin.
2.Diffuse erythematous rash with areas of normal skin:
The whole skin becomes reddish with scattered, small areas of normal skin .
3.Maculopapular rash:
The last type of rash appears as red flat or raised leisons(Maculopaular).
The rash can be itchy .
The Complications of Dengue Fever are:
1.Dengue Hemorrhagic Fever
a. Fever
b.bleeding likely to occur from the nose, mouth, and gums.
Bruises and ecchymosis may appear as a sign of bleeding under the skin.
There are small red spots on the skin.
c.the urine may contain blood.
d. vomiting of blood and malena(black stools) indicate bleeding in the stomach.
e.low platelet count of <100,000
f. Hypoalbuminaemia
g.pleural effusion
h.neurological disturbances(seizures,cranial nerve signs and coma) may indicate bleeding in the brain
2. Dengue Shock Syndrome
Without prompt treatment for the bleeding, the person can go into a.shock
b.hypotension
c.narrowed pulse pressure(< 2omm Hg)
d. impaired organ perfusion which result in organ failure and death.
Dengue Haemorrhagic Fever and Dengue Shock Syndrome is fatal in about 5 percent of the cases, mostly among children and young adults.
History of acute fever and bleeding signs
A low platelet count (<100,000)is suggestive of dengue fever.
Specific blood test(IgG and IgM antibody) for dengue virus can also be conducted. IgM antibodies occur on the 5th day of illness and last for 2 months.
There is no specific anti-viral drug to treat the disease or a vaccine to prevent a person from being infected with the dengue virus.
Treatment is mainly supportive.
1. Rest
2.drinking lots of water to prevent dehydration will help.
3. Paracetamol for fever, severe headaches and body aches( Avoid aspirin and NSAIDs due to the risk of bleeding) to reduce the discomfort.
4. Intravenous fluids for hypotension and dehydration.
5.Daily blood tests (platelets and hematocrit)may be necessary to monitor the risk of bleeding
6. Platelets transfusion when the the platelet count is less than 20,000.
The illness can last up to 10 days, but complete recovery can take as long as a month.
Dengue Fever is spread only through the bite of the infected Aedes mosquitoes.
The transmission cycle for dengue starts when:
1.Infected Aedes mosquito bites a healthy person.
2.4-7 days later,the infected person develops fever
3..When fever starts, the person is infectious for about 5 days.
4.If an Aedes mosquito bites the person during this time when he is infectious, it will be infected by the the dengue virus.
5.The virus will multiply in the second mosquito for 5-7 days.
6.The mosquito then becomes infective.
7.The cycle starts again when it bites another person.
To prevent dengue fever, you must prevent the breeding of its carrier, the Aedes mosquitoes, identified by their black and white stripes on the body .
A puddle of water about the size and depth of 20-cent coin is sufficient for an Aedes mosquito to breed in.
The Aedes mosquitoes are commonly found breeding in clear stagnant water in flower vases, flower pot plates, roof gutters, earthen jars for water storage or decorative purposes, watering cans, and bamboo pole holders.
The Aedes mosquito can also breed in unusual places such as water trapped in the hardened soil in potted plates, and the rim of unwanted pails
Every other day
1.Change water in flower vases.
2.Scrub the inside of vase to remove mosquito eggs filling in fresh water.
3.Remove water in plant pot plates.
4.Scrub the plate thoroughly to remove mosquito eggs.
5.Clear fallen leaves and stagnant water in drains and garden. Some leaves can collect water.
Once a month
1.Add prescribed amounts of sand granular insecticide into containers, vases, gully traps and roof gutters, even if they are dry.
2.Sand granular insecticide can be purchased from plant nurseries and DIY stores. (Caution: Do not add the chemical into drinking water. Keep out of reach of children.)
3.Clear away leaves in roof gutters and apron drains.
4.Remove roof gutters wherever feasible.
5.At all times Turn pails and watering cans over and store them under shelter.
6.Place all articles that can collect rain water under shelter at all times.
7.Cover bamboo pole holders when they are not in use.
8.Cover rarely used gully traps.
If possible, replace gully trap covers with non-perforated ones and install anti-mosquito valves.
9.Do not block the flow of water in scupper drains along common corridors in appartments.
10.Do not place potted plants and other paraphernalia over the drains.
11.Do not litter.
12.Paper cups and water bottles thrown indiscriminately into drains, grass verges, roadside, vacant lands and other public places can collect rainwater and breed mosquitoes.
If you are vacating your home or away on long holiday
1.Cover the toilet bowls.
2.Seal off the overflow pipe of the flushing cistern.
3.Cover all gully and floor traps.
Immunization
Vaccine development for dengue and DHF is difficult because any of four different viruses may cause disease, and because protection against only one or two dengue viruses could actually increase the risk of more serious disease.
Nonetheless, progress is being made in the development of vaccines that may protect against all four dengue viruses. Such products may become available for public health use within several years.
Dengue is a dangerous virus which is still prevalent today especially in tropical countries like Singapore, Indonesia, Malaysia and India.
The important factor in the disease being prevalent is the presence of its carrier the Aedes mosquito.
Unfortunately getting rid of the mosquito is harder than expected.
The mosquito can unfortunately breed in a puddle of water about the size of a 20 cents count.
The water can even be found inside the cup-shape flowers. Inside these flowers were found the larva of the Aedes Mosquito.
Because the tropical countries has frequent rainfall, it is very difficult to get rid of the mosquito.
As long as there are carriers the dengue virus is always present.
Dengue fever is a acute viral infection caused by the dengue virus which is transmitted by the bite of an infected female Aedes mosquito.
The dengue virus has 4 strains called serotypes 1, 2, 3 and 4.
An infection with one serotype does not protect you from the other serotypes.
A second dengue infection, especially with serotype 2, can cause an even worse infection such as Dengue Hemorrhagic Fever and Dengue Shock Syndrome which can be fatal.
The incubation period in mosquito is 8-12 days and 3-14 days in humans.
Symptoms usually last 3-14 days.
1.High, acute, prolonged fever (usually lasts for 5 to 7 days)
2.Severe headache
3.Pain behind the eyes
4.Muscle and joint pains
5.Rashes
6.Nausea , vomiting
7.Abdominal discomfort
8.Loss of appetite
9.Fatigue
10.Diarrhoea
A rash usually appears 3-4 days after the fever.
There are 3 types of dengue rash.
1.Petechial Rash:
This is the most common with the petechial rash appearing as red dots under the skin.
The rashes are usually found on the limbs and lower abdomen and is due to the bleeding under the skin.
2.Diffuse erythematous rash with areas of normal skin:
The whole skin becomes reddish with scattered, small areas of normal skin .
3.Maculopapular rash:
The last type of rash appears as red flat or raised leisons(Maculopaular).
The rash can be itchy .
The Complications of Dengue Fever are:
1.Dengue Hemorrhagic Fever
a. Fever
b.bleeding likely to occur from the nose, mouth, and gums.
Bruises and ecchymosis may appear as a sign of bleeding under the skin.
There are small red spots on the skin.
c.the urine may contain blood.
d. vomiting of blood and malena(black stools) indicate bleeding in the stomach.
e.low platelet count of <100,000
f. Hypoalbuminaemia
g.pleural effusion
h.neurological disturbances(seizures,cranial nerve signs and coma) may indicate bleeding in the brain
2. Dengue Shock Syndrome
Without prompt treatment for the bleeding, the person can go into a.shock
b.hypotension
c.narrowed pulse pressure(< 2omm Hg)
d. impaired organ perfusion which result in organ failure and death.
Dengue Haemorrhagic Fever and Dengue Shock Syndrome is fatal in about 5 percent of the cases, mostly among children and young adults.
History of acute fever and bleeding signs
A low platelet count (<100,000)is suggestive of dengue fever.
Specific blood test(IgG and IgM antibody) for dengue virus can also be conducted. IgM antibodies occur on the 5th day of illness and last for 2 months.
There is no specific anti-viral drug to treat the disease or a vaccine to prevent a person from being infected with the dengue virus.
Treatment is mainly supportive.
1. Rest
2.drinking lots of water to prevent dehydration will help.
3. Paracetamol for fever, severe headaches and body aches( Avoid aspirin and NSAIDs due to the risk of bleeding) to reduce the discomfort.
4. Intravenous fluids for hypotension and dehydration.
5.Daily blood tests (platelets and hematocrit)may be necessary to monitor the risk of bleeding
6. Platelets transfusion when the the platelet count is less than 20,000.
The illness can last up to 10 days, but complete recovery can take as long as a month.
Dengue Fever is spread only through the bite of the infected Aedes mosquitoes.
The transmission cycle for dengue starts when:
1.Infected Aedes mosquito bites a healthy person.
2.4-7 days later,the infected person develops fever
3..When fever starts, the person is infectious for about 5 days.
4.If an Aedes mosquito bites the person during this time when he is infectious, it will be infected by the the dengue virus.
5.The virus will multiply in the second mosquito for 5-7 days.
6.The mosquito then becomes infective.
7.The cycle starts again when it bites another person.
To prevent dengue fever, you must prevent the breeding of its carrier, the Aedes mosquitoes, identified by their black and white stripes on the body .
A puddle of water about the size and depth of 20-cent coin is sufficient for an Aedes mosquito to breed in.
The Aedes mosquitoes are commonly found breeding in clear stagnant water in flower vases, flower pot plates, roof gutters, earthen jars for water storage or decorative purposes, watering cans, and bamboo pole holders.
The Aedes mosquito can also breed in unusual places such as water trapped in the hardened soil in potted plates, and the rim of unwanted pails
Every other day
1.Change water in flower vases.
2.Scrub the inside of vase to remove mosquito eggs filling in fresh water.
3.Remove water in plant pot plates.
4.Scrub the plate thoroughly to remove mosquito eggs.
5.Clear fallen leaves and stagnant water in drains and garden. Some leaves can collect water.
Once a month
1.Add prescribed amounts of sand granular insecticide into containers, vases, gully traps and roof gutters, even if they are dry.
2.Sand granular insecticide can be purchased from plant nurseries and DIY stores. (Caution: Do not add the chemical into drinking water. Keep out of reach of children.)
3.Clear away leaves in roof gutters and apron drains.
4.Remove roof gutters wherever feasible.
5.At all times Turn pails and watering cans over and store them under shelter.
6.Place all articles that can collect rain water under shelter at all times.
7.Cover bamboo pole holders when they are not in use.
8.Cover rarely used gully traps.
If possible, replace gully trap covers with non-perforated ones and install anti-mosquito valves.
9.Do not block the flow of water in scupper drains along common corridors in appartments.
10.Do not place potted plants and other paraphernalia over the drains.
11.Do not litter.
12.Paper cups and water bottles thrown indiscriminately into drains, grass verges, roadside, vacant lands and other public places can collect rainwater and breed mosquitoes.
If you are vacating your home or away on long holiday
1.Cover the toilet bowls.
2.Seal off the overflow pipe of the flushing cistern.
3.Cover all gully and floor traps.
Immunization
Vaccine development for dengue and DHF is difficult because any of four different viruses may cause disease, and because protection against only one or two dengue viruses could actually increase the risk of more serious disease.
Nonetheless, progress is being made in the development of vaccines that may protect against all four dengue viruses. Such products may become available for public health use within several years.
Wednesday, December 29, 2010
A Family Doctor's Tale - POLIOMYELITIS
DOC I HAVE POLIOMYELITIS
Poliomyelitis is a very rare viral disease which is seldom seen in children unlike the 1950 or 60 where poliomyelitis is quite common resulting in deformities of the limbs.
The childhood vaccinations against poliomyelitis has resulted in significantly few cases of poliomyelitis mostly imported.
Poliomyelitis is an acute highly contagious viral illness with a wide range of severity caused by the polio virus.
It attacks the muscles and nerves throughout the body resulting in possible permanent paralysis or death.
The polio virus is an enteric virus classified into type 1, 2 and 3 according to tissue culture.
The disease is transmitted by human contact with discharges from the nose, mouth or faeces of an infected person.
From the nose and mouth, the virus proliferates in the nose and intestinal tract.
Once in the body it can spread through the blood and lymphatic system to attack the muscles and nerves.
The incubation period is 7 -14 days.
Symptoms of Poliomyelitis:
There are 3 patterns of polio infection;
1.subclinical -does not involve the central nervous system(CNS),
95% are subclinical infections which go unnoticed.
2.non-paralytic-involve the CNS but without paralysis
3.paralytic -involve the CNS with paralysis.
Bulbar Poliomyelitis affects the cranial nerves affecting paralysis of the facial movement,swallowing and larynx
Sufferers of polio have the following symptoms:
1.mild cases -
headache,
slight fever,
nausea and vomiting for up to 3 days.
2.slightly more severe cases -
moderate fever,
muscle pain,
stiff neck and back
fatigue.
3.severe cases -
high fever,
muscle pain or spasms,
muscle weakness,
stiffness of neck and body muscles,
constipation,
tremor
difficulty with swallowing.
difficulty in breathing
Symptoms post-polio( after the fever subsided):
1.progressive muscular weakness in muscles affected during the original infection.
Other muscles not to be affected during the original infection may also become weak.
2.Joint pain
3.extended periods of fatigue
4.Memory and concentration levels may be poorer.
5.Muscles may become smaller (atrophy) in some cases.
6.Difficulty with swallowing
7.Difficulty in breathing
8.Difficulty in walking
Investigations needed in Poliomyelitis:
1.CSF fluid-high leucocytes and protein
2.blood virological studies
Treatment for Poliomyelitis:
There is no cure for polio so treatment is symptomatic.
1.Bed rest
2.antibiotics are used to treat urinary tract infections.
3.Bethanechol can help reduce urine retention.
4.Analgesics are used to reduce headaches and muscle pain.
5.Assisted breathing with tracheostomy and respirator and intravenous fluids may be required in severe cases.
Poliomyelitis can be prevented by:
Vaccination against polio using oral doses or injection is recommended for all children from every month from 3rd to 5th month and a booster at 18 months of age.
Booster doses are also given at 6 years and 12 years of age.
Since immunization with polio vaccines started, the cases of poliomyelitis has declined worldwide.
Prognosis of Poliomyelitis:
Majority of patients has subclinical and non-paralytic Poliomyelitis and recovered completely.
The remainder has paralytic Poliomyelitis.
Half has complete recovery in 4-6 weeks.
25% has mild disability.
The last 25% suffer severe permanent damage of muscles and nerves.
These patients are usually crippled with difficulty in walking and may need special aids such as wheelchairs,walking sticks etc to help them in their everyday life.
Mortality is in children is 1-3%.
Bulbar Poliomyelitis and adult patients have higher mortality.
Poliomyelitis is a very rare viral disease which is seldom seen in children unlike the 1950 or 60 where poliomyelitis is quite common resulting in deformities of the limbs.
The childhood vaccinations against poliomyelitis has resulted in significantly few cases of poliomyelitis mostly imported.
Poliomyelitis is an acute highly contagious viral illness with a wide range of severity caused by the polio virus.
It attacks the muscles and nerves throughout the body resulting in possible permanent paralysis or death.
The polio virus is an enteric virus classified into type 1, 2 and 3 according to tissue culture.
The disease is transmitted by human contact with discharges from the nose, mouth or faeces of an infected person.
From the nose and mouth, the virus proliferates in the nose and intestinal tract.
Once in the body it can spread through the blood and lymphatic system to attack the muscles and nerves.
The incubation period is 7 -14 days.
Symptoms of Poliomyelitis:
There are 3 patterns of polio infection;
1.subclinical -does not involve the central nervous system(CNS),
95% are subclinical infections which go unnoticed.
2.non-paralytic-involve the CNS but without paralysis
3.paralytic -involve the CNS with paralysis.
Bulbar Poliomyelitis affects the cranial nerves affecting paralysis of the facial movement,swallowing and larynx
Sufferers of polio have the following symptoms:
1.mild cases -
headache,
slight fever,
nausea and vomiting for up to 3 days.
2.slightly more severe cases -
moderate fever,
muscle pain,
stiff neck and back
fatigue.
3.severe cases -
high fever,
muscle pain or spasms,
muscle weakness,
stiffness of neck and body muscles,
constipation,
tremor
difficulty with swallowing.
difficulty in breathing
Symptoms post-polio( after the fever subsided):
1.progressive muscular weakness in muscles affected during the original infection.
Other muscles not to be affected during the original infection may also become weak.
2.Joint pain
3.extended periods of fatigue
4.Memory and concentration levels may be poorer.
5.Muscles may become smaller (atrophy) in some cases.
6.Difficulty with swallowing
7.Difficulty in breathing
8.Difficulty in walking
Investigations needed in Poliomyelitis:
1.CSF fluid-high leucocytes and protein
2.blood virological studies
Treatment for Poliomyelitis:
There is no cure for polio so treatment is symptomatic.
1.Bed rest
2.antibiotics are used to treat urinary tract infections.
3.Bethanechol can help reduce urine retention.
4.Analgesics are used to reduce headaches and muscle pain.
5.Assisted breathing with tracheostomy and respirator and intravenous fluids may be required in severe cases.
Poliomyelitis can be prevented by:
Vaccination against polio using oral doses or injection is recommended for all children from every month from 3rd to 5th month and a booster at 18 months of age.
Booster doses are also given at 6 years and 12 years of age.
Since immunization with polio vaccines started, the cases of poliomyelitis has declined worldwide.
Prognosis of Poliomyelitis:
Majority of patients has subclinical and non-paralytic Poliomyelitis and recovered completely.
The remainder has paralytic Poliomyelitis.
Half has complete recovery in 4-6 weeks.
25% has mild disability.
The last 25% suffer severe permanent damage of muscles and nerves.
These patients are usually crippled with difficulty in walking and may need special aids such as wheelchairs,walking sticks etc to help them in their everyday life.
Mortality is in children is 1-3%.
Bulbar Poliomyelitis and adult patients have higher mortality.
Tuesday, December 28, 2010
A Family Doctor's Tale - TETANUS
DOC I HAVE TETANUS
Tetanus is a very potentially dangerous disease. I have one patient (my one and only ) who is alive today although she had a almost fatal episode of tetanus infection and was rescusitated after her heart and lung stopped muscle movement.
The danger of tetanus was that the muscles of the body go into spasm(locked) and the heart stopped and the breathing also stopped because the muscles goes into spasm.
After getting a history of being treated with with rusty dental instruments and the resulting stiffness of one side of her jaw, I sent her immediately to hospital where her heart stopped and was rescusitated back to life. She was very lucky to be alive. I was very angry at the unhygienic dentist.
Tetanus is an acute infectious disease caused by the bacteria Clostridium tetani which lives in the soil.
Tetanus is transmitted by bacterial spores of the tetanus bacteria entering a wound in the skin of a person such as wounds caused by rusty nails.
When the spore developed into the tetanus bacteria, it can produce a powerful toxin which can cause the muscles to go into spasm.
In the jaw the muscle may go into spasm causing a condition called lockjaw.
In more severe cases the respiratory muscles can go into spasm resulting in stoppage of breathing and therefore loss of oxygen to the brain and heart.
This usually results in death unless treated.
The infections occur in persons of all ages.
There is usually a history of a wound, laceration or operation with contamination of soil or rust in nails or surgical instruments.
Symptoms start off with:
1. irritability
2. fever
3. muscle cramps
4. lockjaw
5. difficulty in breathing or swallowing
Complications of tetanus occur when the muscle spasm affect the respiratory muscles resulting in inability to breathe.
The loss of oxygen to the heart can cause the heart to stop.
The loss of oxygen to the brain can cause the brain to stop functioning resulting in death.
Diagnosis of Tetanus :
The detection of tetanus bacterium in the wound can confirm tetanus infection.
Treatment of Tetanus is by:
Isolation in hospital is necessary.
1.Antibiotics (metronidazole) are used in the treatment of Tetanus.
2.Antitoxin can be given by intramuscular injection
3.Intravenous fluids given for dehydration
4.Respirator is used if breathing stops from spasm of respiratory muscles or vocal muscles
5.Proper wound cleansing is important to remove the infectious spores
6.Cardiac failure should be treated
Vaccination against Tetanus is the best prevention .
Since vaccination began, the worldwide incidence of Tetanus has declined.
Vaccination against Tetanus, pertussis (whooping cough), tetanus (DPT) is usually given to
1.a baby at 3 months of age and repeated at 4 and 5 months of age.
2.a booster vaccination at 18 months.
In adults tetanus vaccines are given in all cases of wounds:
first dose followed by a
second dose 6 weeks later and
third dose 6 months later and
fourth dose 18 months later
Besides the vaccinations there should be proper washing of wounds and avoidance of use of rusty instruments.
Prognosis in Tetanus is still not very good because by the time diagnosis is made complications may have set in.
Death occurs in 30% of cases.
Mortality is highest in very young children and adults over 50.
Death is usually due to respiratory failure or heart failure.
Tetanus is a very potentially dangerous disease. I have one patient (my one and only ) who is alive today although she had a almost fatal episode of tetanus infection and was rescusitated after her heart and lung stopped muscle movement.
The danger of tetanus was that the muscles of the body go into spasm(locked) and the heart stopped and the breathing also stopped because the muscles goes into spasm.
After getting a history of being treated with with rusty dental instruments and the resulting stiffness of one side of her jaw, I sent her immediately to hospital where her heart stopped and was rescusitated back to life. She was very lucky to be alive. I was very angry at the unhygienic dentist.
Tetanus is an acute infectious disease caused by the bacteria Clostridium tetani which lives in the soil.
Tetanus is transmitted by bacterial spores of the tetanus bacteria entering a wound in the skin of a person such as wounds caused by rusty nails.
When the spore developed into the tetanus bacteria, it can produce a powerful toxin which can cause the muscles to go into spasm.
In the jaw the muscle may go into spasm causing a condition called lockjaw.
In more severe cases the respiratory muscles can go into spasm resulting in stoppage of breathing and therefore loss of oxygen to the brain and heart.
This usually results in death unless treated.
The infections occur in persons of all ages.
There is usually a history of a wound, laceration or operation with contamination of soil or rust in nails or surgical instruments.
Symptoms start off with:
1. irritability
2. fever
3. muscle cramps
4. lockjaw
5. difficulty in breathing or swallowing
Complications of tetanus occur when the muscle spasm affect the respiratory muscles resulting in inability to breathe.
The loss of oxygen to the heart can cause the heart to stop.
The loss of oxygen to the brain can cause the brain to stop functioning resulting in death.
Diagnosis of Tetanus :
The detection of tetanus bacterium in the wound can confirm tetanus infection.
Treatment of Tetanus is by:
Isolation in hospital is necessary.
1.Antibiotics (metronidazole) are used in the treatment of Tetanus.
2.Antitoxin can be given by intramuscular injection
3.Intravenous fluids given for dehydration
4.Respirator is used if breathing stops from spasm of respiratory muscles or vocal muscles
5.Proper wound cleansing is important to remove the infectious spores
6.Cardiac failure should be treated
Vaccination against Tetanus is the best prevention .
Since vaccination began, the worldwide incidence of Tetanus has declined.
Vaccination against Tetanus, pertussis (whooping cough), tetanus (DPT) is usually given to
1.a baby at 3 months of age and repeated at 4 and 5 months of age.
2.a booster vaccination at 18 months.
In adults tetanus vaccines are given in all cases of wounds:
first dose followed by a
second dose 6 weeks later and
third dose 6 months later and
fourth dose 18 months later
Besides the vaccinations there should be proper washing of wounds and avoidance of use of rusty instruments.
Prognosis in Tetanus is still not very good because by the time diagnosis is made complications may have set in.
Death occurs in 30% of cases.
Mortality is highest in very young children and adults over 50.
Death is usually due to respiratory failure or heart failure.
Monday, December 27, 2010
A Family Doctor's Tale - DIPHTHERIA
DOC I HAVE DIPHTHERIA
Diphtheria is seldom seen because of the childhood vaccination regime which has been in place since the 1960.
It is a highly infectious disease which can cause a thick exudate in the throat and windpipe resulting in blockage of breathing.
Treatment is by antibiotics and isolation in hospital.
Diphtheria is an acute, infectious childhood disease of the respiratory tract caused by the bacillus Corynebacterium diphtheriae, a Gram positive, non-sporulating aerobic micro-organism.
Diphtheria is transmitted by droplets from the throat of infected patients or clothes soiled by discharges from the patients.
It is highly infectious.
Incubation period is 2-4 days.
The organism multiplies in the upper respiratory tract, secreting toxins which produce necrosis and fibrinous exudate.
This fibrinous exudate can form a leathery membrane which extends through the throat, tonsils, nasopharynx, larynx and trachea.
Through the blood, the toxin can spread to the heart, nervous system and kidneys. Infections may also be localized in wounds in the skin,conjunctiva and rarely the vagina.
The infections occur in persons of all ages.
The incubation period is usually 2-4 days after contact with an infected patient.
Symptoms start off with:
1. sudden onset of malaise
2. mild fever
3. sore throat
4. Thick white or grayish tonsillar exudate
5. Membrane may spread to nasopharynx
5. cervical lymphadenopathy(enlarged lymph nodes in the neck)
6. difficult breathing
7. respiratory stridor,
8. hoarseness of voice
9. brassy cough
10.dilirium and coma
Complications of Diphtheria are:
The worst affected are children below the 1 year old.
Some serious complications are:
1.myocarditis
2.cranial nerve paralysis, especially the soft palate and oculomotor nerves
3.peripheral neuritis
4.laryngeal obstruction
5.death can occur if there is obstruction to breathing.
Serious complications are less with older children or adults.
Adults rarely get Diphtheria because their immunity from vaccination usually last 10 years after the last dose.
When adults get Diphtheria, there is only slight inflammation with little or no exudates.
Diagnosis of Diphtheria is based on:
1.Pharyngeal and nasal swabs for culture in Loeffler medium
2.Methylene blue stain of membrane
Treatment of Diphtheria is by:
Isolation in hospital is necessary because of fear of infection.
1.Antibiotics (erythromycin or Penicillin) are used in the treatment of Diphtheria.
2.Antitoxin can be given by intramuscular or intravenous injection
3.Intravenous fluids given for dehydration
4.Tracheostomy if breathing obstruction is bad
5.Oxygen therapy in cases of breathing difficulty
6.Cardiac failure should be treated
Besides antibiotics, the following will help:
Steam inhalation
cough mixtures
avoid smokes, dust, dry air,sudden temperature change
Vaccination against Diphtheria is the best prevention .
Since vaccination began, the worldwide incidence of Diphtheria has declined.
Vaccination against diphtheria, pertussis (whooping cough), tetanus (DPT) is usually given to a baby at 3 months of age and repeated at 4 and 5 months of age.
There is also a booster vaccination at 18 months.
The prognosis in Diphtheria is generally good now as compared to 50 years ago.
Death occurs in 10% of cases.
Mortality is highest in children under 10 and adults over 50.
One attack usually confers immunity.
Diphtheria is seldom seen because of the childhood vaccination regime which has been in place since the 1960.
It is a highly infectious disease which can cause a thick exudate in the throat and windpipe resulting in blockage of breathing.
Treatment is by antibiotics and isolation in hospital.
Diphtheria is an acute, infectious childhood disease of the respiratory tract caused by the bacillus Corynebacterium diphtheriae, a Gram positive, non-sporulating aerobic micro-organism.
Diphtheria is transmitted by droplets from the throat of infected patients or clothes soiled by discharges from the patients.
It is highly infectious.
Incubation period is 2-4 days.
The organism multiplies in the upper respiratory tract, secreting toxins which produce necrosis and fibrinous exudate.
This fibrinous exudate can form a leathery membrane which extends through the throat, tonsils, nasopharynx, larynx and trachea.
Through the blood, the toxin can spread to the heart, nervous system and kidneys. Infections may also be localized in wounds in the skin,conjunctiva and rarely the vagina.
The infections occur in persons of all ages.
The incubation period is usually 2-4 days after contact with an infected patient.
Symptoms start off with:
1. sudden onset of malaise
2. mild fever
3. sore throat
4. Thick white or grayish tonsillar exudate
5. Membrane may spread to nasopharynx
5. cervical lymphadenopathy(enlarged lymph nodes in the neck)
6. difficult breathing
7. respiratory stridor,
8. hoarseness of voice
9. brassy cough
10.dilirium and coma
Complications of Diphtheria are:
The worst affected are children below the 1 year old.
Some serious complications are:
1.myocarditis
2.cranial nerve paralysis, especially the soft palate and oculomotor nerves
3.peripheral neuritis
4.laryngeal obstruction
5.death can occur if there is obstruction to breathing.
Serious complications are less with older children or adults.
Adults rarely get Diphtheria because their immunity from vaccination usually last 10 years after the last dose.
When adults get Diphtheria, there is only slight inflammation with little or no exudates.
Diagnosis of Diphtheria is based on:
1.Pharyngeal and nasal swabs for culture in Loeffler medium
2.Methylene blue stain of membrane
Treatment of Diphtheria is by:
Isolation in hospital is necessary because of fear of infection.
1.Antibiotics (erythromycin or Penicillin) are used in the treatment of Diphtheria.
2.Antitoxin can be given by intramuscular or intravenous injection
3.Intravenous fluids given for dehydration
4.Tracheostomy if breathing obstruction is bad
5.Oxygen therapy in cases of breathing difficulty
6.Cardiac failure should be treated
Besides antibiotics, the following will help:
Steam inhalation
cough mixtures
avoid smokes, dust, dry air,sudden temperature change
Vaccination against Diphtheria is the best prevention .
Since vaccination began, the worldwide incidence of Diphtheria has declined.
Vaccination against diphtheria, pertussis (whooping cough), tetanus (DPT) is usually given to a baby at 3 months of age and repeated at 4 and 5 months of age.
There is also a booster vaccination at 18 months.
The prognosis in Diphtheria is generally good now as compared to 50 years ago.
Death occurs in 10% of cases.
Mortality is highest in children under 10 and adults over 50.
One attack usually confers immunity.
Sunday, December 26, 2010
A Family Doctor's Tale - CROUP
DOC I HAVE CROUP
Croup is a childhood viral disease which is seldom seen in the modern age.
The typical symptoms is the triad of inspiratory stridor( a whistling sound when the child breathes), fever and barking cough.
Treatment is usually symptomatic as it is a viral disease.
Prognosis is generally good in the absence of breathing complications.
Croup is an acute viral disease of the upper and lower respiratory tract associated with inspiratory stridor ( whistling obstructive sound during inhalation) and respiratory distress in severe cases.
It typically affects infants and children below 6 years old.
It causes a typically barking type of cough and hoarseness of the voice due to obstruction at the vocal box.
Croup is caused by:
Viral infections:
1.parainfluenza virus, primarily types 1 and 2
2.Other viral infections such as adenorhinovirnese, enterovirus and mycoplasma pneumoniae
Genetic predisposition:
Some families are more prone than others to get the disease.
It is also more common in males than females.
Symptoms:
1.harsh barking cough
2.sneeze
3.inspiratory stridor (a high-pitched whistling sound during inspiration),
4.nausea and vomiting
5.fever.
6.Hoarseness -usually present
7.respiratory distress due to airway obstruction
8.lethargy
Signs:
1.Reduced breath sounds - air movement is reduced in the lungs
2.Prolonged inspiration on auscultation with laryngeal stridor
3.Chest retraction
4.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.
This will considered as a medical emergency.
Diagnosis of Croup is made based on:
1.Symptoms and signs of fever, laryngeal stridor and barking cough
2.blood tests (complete blood count, ESR and blood culture)
5.frontal X-ray of the Cervical spine
the presence of the the steeple sign confirms the diagnosis of croup.
Complications of Croup are:
1.Respiratory distress
2.Bacterial tracheitis
Treatment of Croup is by:
1.Rest, fluids and oxygen
2.Humidifiers and steam inhalations
3.Corticosteroids especially dexamethasone are the most commonly used agent as it reduces inflammation
4.Antibiotics are not useful because the cause is viral. If there is bacterial tracheitis, antibiotics may be needed
5.Bronchodilators such as theophylline, epinephrine, ventolin, bricanyl are all helpful to open the airways
6.Intubation and tracheostomy may be needed in severe cases.
Prognosis of croup depends on the severity and type of infection.
Most cases, if treated early and correctly, recovered completely with return of normal lung function within 7 days.
Preventive measures taken for Croup are:
1.Vaccination against the influenza virus yearly may help.
Croup is a childhood viral disease which is seldom seen in the modern age.
The typical symptoms is the triad of inspiratory stridor( a whistling sound when the child breathes), fever and barking cough.
Treatment is usually symptomatic as it is a viral disease.
Prognosis is generally good in the absence of breathing complications.
Croup is an acute viral disease of the upper and lower respiratory tract associated with inspiratory stridor ( whistling obstructive sound during inhalation) and respiratory distress in severe cases.
It typically affects infants and children below 6 years old.
It causes a typically barking type of cough and hoarseness of the voice due to obstruction at the vocal box.
Croup is caused by:
Viral infections:
1.parainfluenza virus, primarily types 1 and 2
2.Other viral infections such as adenorhinovirnese, enterovirus and mycoplasma pneumoniae
Genetic predisposition:
Some families are more prone than others to get the disease.
It is also more common in males than females.
Symptoms:
1.harsh barking cough
2.sneeze
3.inspiratory stridor (a high-pitched whistling sound during inspiration),
4.nausea and vomiting
5.fever.
6.Hoarseness -usually present
7.respiratory distress due to airway obstruction
8.lethargy
Signs:
1.Reduced breath sounds - air movement is reduced in the lungs
2.Prolonged inspiration on auscultation with laryngeal stridor
3.Chest retraction
4.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.
This will considered as a medical emergency.
Diagnosis of Croup is made based on:
1.Symptoms and signs of fever, laryngeal stridor and barking cough
2.blood tests (complete blood count, ESR and blood culture)
5.frontal X-ray of the Cervical spine
the presence of the the steeple sign confirms the diagnosis of croup.
Complications of Croup are:
1.Respiratory distress
2.Bacterial tracheitis
Treatment of Croup is by:
1.Rest, fluids and oxygen
2.Humidifiers and steam inhalations
3.Corticosteroids especially dexamethasone are the most commonly used agent as it reduces inflammation
4.Antibiotics are not useful because the cause is viral. If there is bacterial tracheitis, antibiotics may be needed
5.Bronchodilators such as theophylline, epinephrine, ventolin, bricanyl are all helpful to open the airways
6.Intubation and tracheostomy may be needed in severe cases.
Prognosis of croup depends on the severity and type of infection.
Most cases, if treated early and correctly, recovered completely with return of normal lung function within 7 days.
Preventive measures taken for Croup are:
1.Vaccination against the influenza virus yearly may help.
Saturday, December 25, 2010
A Family Doctor's Tale - INFECTIOUS MONONUCLEOSIS
DOC I HAVE INFECTIOUS MONONUCLEOSIS
Infectious mononucleosis is a rare disease which affects the lymph nodes of the neck and jaws.
It is also called glandular fever in the past.
The Epsein Barr virus is the main culprit of this disease.
There may be complications such as breathing problems or heart disease.
In rare cases there may be association with nasopharyngeal cancer.
Treatment is usually symptomatic unless there are heart or lung complications .
Infectious Mononucleosis is an infectious disease which typically cause swelling of the lymph nodes of neck, sore throat and fever.
The cause of Infectious Mononucleosis is the Epstein Barr virus which can be spread by droplets and kissing.
It is more common in young adults.
The incubation period (from contact to illness) is 10-15 days.
It is usually sporadic but may be epidemic.
The triad of symptoms which are common to Infectious Mononucleosis are:
1.Neck and axillary lymph nodes are enlarged
2.Fever with headache
3.sore throat with sometimes extensive tonsillar exudates and swelling
Other symptoms are:
4.fatigue
5.bodyaches
6.jaundice(rare)
Signs:
1.Throat is red and inflamed with enlarged tonsils
2.Pinpoint petechiae at junction of hard and soft palate
3.Enlarged lymph nodes are felt below the jaw and neck region; sometimes in the axillary region
4.Swelling of lacrimal glands and eyelids
5.Spleen is enlarged in 50% of cases
6.Generalised maculopapular rash may occur
Onset is usually insidious with mild fever which may becomes worse and lasts for 2 to 21 days.
Disease usually lasts for 2-3 weeks.
Diagnosis
1.Classical symptoms and signs as above especially lymph nodes enlargement.
2.blood tests (complete blood count, ESR, liver function tests and blood culture).
Blood count usually shows more than 10% atypical mononuclear cells.
3.Blood for Epstein Barr antibody
4.X-rays of chest and abdomen
5.CT Scan or ultrasound of the abdomen to detect presence of other lymph nodes and enlarged spleen.
Complications of Infectious Mononucleosis are:
1.Obstruction to airway from enlarged lymph nodes
2.thrombopenic purpura
3.myocarditis
4.pericarditis
5.lymphocytic meningitis
6.encephalitis
7.polyneuritis
8.hepatitis
Treatment routine of Infectious Mononucleosis is:
1.Bed rest in isolation ward
2.Adequate fluids
3.Antipyretic medicines such as paracetamol for fever
3.corticosteroids is useful to reduce complications such as upper airway obstruction and severe hepatitis
4.High-flow oxygen and tracheostomy in airway obstruction
5.Isolation of cases at home or in hospital. Avoid contacts.
Prognosis of Infectious Mononucleosis is generally good.
Epstein Barr infections has been associated with nasopharyngeal cancer.
Infectious mononucleosis is a rare disease which affects the lymph nodes of the neck and jaws.
It is also called glandular fever in the past.
The Epsein Barr virus is the main culprit of this disease.
There may be complications such as breathing problems or heart disease.
In rare cases there may be association with nasopharyngeal cancer.
Treatment is usually symptomatic unless there are heart or lung complications .
Infectious Mononucleosis is an infectious disease which typically cause swelling of the lymph nodes of neck, sore throat and fever.
The cause of Infectious Mononucleosis is the Epstein Barr virus which can be spread by droplets and kissing.
It is more common in young adults.
The incubation period (from contact to illness) is 10-15 days.
It is usually sporadic but may be epidemic.
The triad of symptoms which are common to Infectious Mononucleosis are:
1.Neck and axillary lymph nodes are enlarged
2.Fever with headache
3.sore throat with sometimes extensive tonsillar exudates and swelling
Other symptoms are:
4.fatigue
5.bodyaches
6.jaundice(rare)
Signs:
1.Throat is red and inflamed with enlarged tonsils
2.Pinpoint petechiae at junction of hard and soft palate
3.Enlarged lymph nodes are felt below the jaw and neck region; sometimes in the axillary region
4.Swelling of lacrimal glands and eyelids
5.Spleen is enlarged in 50% of cases
6.Generalised maculopapular rash may occur
Onset is usually insidious with mild fever which may becomes worse and lasts for 2 to 21 days.
Disease usually lasts for 2-3 weeks.
Diagnosis
1.Classical symptoms and signs as above especially lymph nodes enlargement.
2.blood tests (complete blood count, ESR, liver function tests and blood culture).
Blood count usually shows more than 10% atypical mononuclear cells.
3.Blood for Epstein Barr antibody
4.X-rays of chest and abdomen
5.CT Scan or ultrasound of the abdomen to detect presence of other lymph nodes and enlarged spleen.
Complications of Infectious Mononucleosis are:
1.Obstruction to airway from enlarged lymph nodes
2.thrombopenic purpura
3.myocarditis
4.pericarditis
5.lymphocytic meningitis
6.encephalitis
7.polyneuritis
8.hepatitis
Treatment routine of Infectious Mononucleosis is:
1.Bed rest in isolation ward
2.Adequate fluids
3.Antipyretic medicines such as paracetamol for fever
3.corticosteroids is useful to reduce complications such as upper airway obstruction and severe hepatitis
4.High-flow oxygen and tracheostomy in airway obstruction
5.Isolation of cases at home or in hospital. Avoid contacts.
Prognosis of Infectious Mononucleosis is generally good.
Epstein Barr infections has been associated with nasopharyngeal cancer.
Friday, December 24, 2010
A Family Doctor's Tale - LEPROSY
DOC I HAVE LEPROSY
Leprosy is no longer the feared disease as seen in the stories from the bible.
Because of modern antibiotics leprosy is usually treated easily.
There is seldom the deformities and nodular skin disease seen in the past.
In fact most leprosy patients can be cured 100 per cent if detected early.
Leprosy or Hansen's disease is a chronic granulomatous disease caused by the bacteria mycobacterium leprae.
At present 10 countries:
Brazil, Democratic Republic of the Congo, Guinea, India, Indonesia, Madagascar, Mozambique, Myanmar, Nepal and Tanzania account for 90 per cent of the disease in the world.
The disease affects mainly young people between 10-20 years of age, males more than females.
The exact mode of spread is unclear.
It is believed to be from person to person via nasal discharge, respiratory droplets and skin contact.
People prone to contacting the disease have:
1.weak immune system -these people develop multibacillary leprosy which is infectious,
Those with a stronger immune system develop paucibacillary leprosy which is non-infectious.
2.malnutrition and
3.unhygienic and crowded living conditions
Signs and Symptoms of Leprosy are:
The incubation period can vary from 1 year - 40 years.
Paucibacillary leprosy:
1.milder and non-infectious
2.one or more hypopigmented skin macules with loss of sensation.
3.Peripheral nerves may be damaged and enlarged.
Multibacillary leprosy :
1.numerous shiny, reddish nodules, thickened skin,
2.nasal discharge, nasal congestion and bleeding from the nose.
3.Distal peripheral nerves are thickened, enlarged and painful.
4.loss of eyelashes and eyebrows.
5.Skin smears are always positive for bacilli.
Diagnosis of leprosy is based on the following signs:
1.chronic skin lesions,
2.peripheral neuropathy,
3.thickened nerves,
4.muscle weakness
Confirmation of diagnosis is by
1.biopsy of skin lesions and thickened nerve.
2.Nasal and skin smears may show presence of leprosy bacteria.
Complications of Leprosy include
1.damage to the peripheral nerves
2.numbness,
3.muscle weakness
4.paralysis with consequent claw hand or foot drop
5.skin rashes
6. painful skin nodules.
7.loss of sensation, with resultant injuries
8.infections from injuries which can cause ulcers that damage the dermal tissues,
9.joints and bones infections resulting in the loss of extremities (toes and fingers)
10.secondary crippling deformities can occur in 25 per cent of cases not treated at an early stage.
Treatment of Leprosy is medically possible with modern treatment:
Leprosy can be cured.
Early Treatment averts disability.
Multidrug therapy (MDT) consists of three drugs:
dapsone,
rifampicin and
clofazimine.
This drug combination effectively kills leprosy bacteria.
It prevents mutilations and deformities.
The 80 per cent with paucibacillary leprosy (PB) are non-infectious and cured within six months.
The remaining 20 to 30 per cent with the multibacillary form (MB) are cured within one year.
The drugs are safe with little side effects.
After the first dose of MDT, the patients are no longer infectious .
There is virtually no recurrence of the disease with treatment.
No resistance of the bacillus to MDT has been detected.
The chain of transmission of the leprosy is stopped.
Prevention measures are:
1. early detection and treatment with MDT has prevented about 3 to 4 million people from being disabled.
2.Better hygiene and nutrition
3.Better living conditions
Leprosy is no longer the feared disease as seen in the stories from the bible.
Because of modern antibiotics leprosy is usually treated easily.
There is seldom the deformities and nodular skin disease seen in the past.
In fact most leprosy patients can be cured 100 per cent if detected early.
Leprosy or Hansen's disease is a chronic granulomatous disease caused by the bacteria mycobacterium leprae.
At present 10 countries:
Brazil, Democratic Republic of the Congo, Guinea, India, Indonesia, Madagascar, Mozambique, Myanmar, Nepal and Tanzania account for 90 per cent of the disease in the world.
The disease affects mainly young people between 10-20 years of age, males more than females.
The exact mode of spread is unclear.
It is believed to be from person to person via nasal discharge, respiratory droplets and skin contact.
People prone to contacting the disease have:
1.weak immune system -these people develop multibacillary leprosy which is infectious,
Those with a stronger immune system develop paucibacillary leprosy which is non-infectious.
2.malnutrition and
3.unhygienic and crowded living conditions
Signs and Symptoms of Leprosy are:
The incubation period can vary from 1 year - 40 years.
Paucibacillary leprosy:
1.milder and non-infectious
2.one or more hypopigmented skin macules with loss of sensation.
3.Peripheral nerves may be damaged and enlarged.
Multibacillary leprosy :
1.numerous shiny, reddish nodules, thickened skin,
2.nasal discharge, nasal congestion and bleeding from the nose.
3.Distal peripheral nerves are thickened, enlarged and painful.
4.loss of eyelashes and eyebrows.
5.Skin smears are always positive for bacilli.
Diagnosis of leprosy is based on the following signs:
1.chronic skin lesions,
2.peripheral neuropathy,
3.thickened nerves,
4.muscle weakness
Confirmation of diagnosis is by
1.biopsy of skin lesions and thickened nerve.
2.Nasal and skin smears may show presence of leprosy bacteria.
Complications of Leprosy include
1.damage to the peripheral nerves
2.numbness,
3.muscle weakness
4.paralysis with consequent claw hand or foot drop
5.skin rashes
6. painful skin nodules.
7.loss of sensation, with resultant injuries
8.infections from injuries which can cause ulcers that damage the dermal tissues,
9.joints and bones infections resulting in the loss of extremities (toes and fingers)
10.secondary crippling deformities can occur in 25 per cent of cases not treated at an early stage.
Treatment of Leprosy is medically possible with modern treatment:
Leprosy can be cured.
Early Treatment averts disability.
Multidrug therapy (MDT) consists of three drugs:
dapsone,
rifampicin and
clofazimine.
This drug combination effectively kills leprosy bacteria.
It prevents mutilations and deformities.
The 80 per cent with paucibacillary leprosy (PB) are non-infectious and cured within six months.
The remaining 20 to 30 per cent with the multibacillary form (MB) are cured within one year.
The drugs are safe with little side effects.
After the first dose of MDT, the patients are no longer infectious .
There is virtually no recurrence of the disease with treatment.
No resistance of the bacillus to MDT has been detected.
The chain of transmission of the leprosy is stopped.
Prevention measures are:
1. early detection and treatment with MDT has prevented about 3 to 4 million people from being disabled.
2.Better hygiene and nutrition
3.Better living conditions
Thursday, December 23, 2010
A Family Doctor's Tale - LIPOMA
DOC I HAVE LIPOMA
Lipoma is usually a benign tumor of fat tissue. Many patients have these swellings and are usually worried because the swelling becomes bigger with time.
Most wants the swellings to be removed while others are fearful of operations .
I have a taxi driver who has a lump of the size of a small water melon on one side of his neck .
In spite of my reassurances he refused to go for surgery.
Eventually I recommended him to a very well known surgeon and he finally had his operation done.
Lipoma is a benign tumor which consists of well circumscribed fatty tissue.
Lipoma is more common in women than in men.
A possible reason is that women has more fatty tissue than men.
Lipomas can also be found all over the body:
1.subcutaneous
2.subfascial
3.subsynovial
4.intrarticular
5.intramuscular
6.perosteal
7.subserous
8.submucous
9.extradural
Lipoma is a well encapsulated round swelling consisting fats cell which are not distinguishable from normal fat cells.
Possible causes are:
1.hereditary - more common in some families than others
2.injury to fatty tissue - stimulation for the fat cells to grow and accumulate at one site.
Symptoms :
1.slow growing round soft tissue swelling on the skin
2.multiple swellings may also be present.
3.painless
Signs:
1.swelling are well demarcated and rounded
2.Soft tissue felt on palpation.
3.May grow to considerable size.
Diagnosis of Lipoma is made based on:
1.round well encapsulated swelling
2.soft on palpation
3.Unlike sebaceous cyst doe not have an central blocked opening
4.Ultrasound may used to confirm the presence of fatty tissue and not a cyst or malignant tumor
5.Biopsy of the swelling will confirm presence of fat cells
Complications of Lipoma are:
The lipoma may grow to considerable size over time and can cause blockage to neighbouring organs:
1.intestinal obstruction at the abdominal area
2.difficulty in breathing especially near the trachea
3.In rare cases lipoma may become malignant liposarcoma
The only treatment is surgical excision of the lipoma.
Small lipomas may left alone if they are slow growing and does not impinge on the nearby organs.
The prognosis is usually excellent.
Recurrence at the same spot is rare but do occur due to regrowth of the blood vessel supplying the lipoma.
Rarely a lipoma may undergo malignant degeneration and become liposarcoma.
Lipoma is usually a benign tumor of fat tissue. Many patients have these swellings and are usually worried because the swelling becomes bigger with time.
Most wants the swellings to be removed while others are fearful of operations .
I have a taxi driver who has a lump of the size of a small water melon on one side of his neck .
In spite of my reassurances he refused to go for surgery.
Eventually I recommended him to a very well known surgeon and he finally had his operation done.
Lipoma is a benign tumor which consists of well circumscribed fatty tissue.
Lipoma is more common in women than in men.
A possible reason is that women has more fatty tissue than men.
Lipomas can also be found all over the body:
1.subcutaneous
2.subfascial
3.subsynovial
4.intrarticular
5.intramuscular
6.perosteal
7.subserous
8.submucous
9.extradural
Lipoma is a well encapsulated round swelling consisting fats cell which are not distinguishable from normal fat cells.
Possible causes are:
1.hereditary - more common in some families than others
2.injury to fatty tissue - stimulation for the fat cells to grow and accumulate at one site.
Symptoms :
1.slow growing round soft tissue swelling on the skin
2.multiple swellings may also be present.
3.painless
Signs:
1.swelling are well demarcated and rounded
2.Soft tissue felt on palpation.
3.May grow to considerable size.
Diagnosis of Lipoma is made based on:
1.round well encapsulated swelling
2.soft on palpation
3.Unlike sebaceous cyst doe not have an central blocked opening
4.Ultrasound may used to confirm the presence of fatty tissue and not a cyst or malignant tumor
5.Biopsy of the swelling will confirm presence of fat cells
Complications of Lipoma are:
The lipoma may grow to considerable size over time and can cause blockage to neighbouring organs:
1.intestinal obstruction at the abdominal area
2.difficulty in breathing especially near the trachea
3.In rare cases lipoma may become malignant liposarcoma
The only treatment is surgical excision of the lipoma.
Small lipomas may left alone if they are slow growing and does not impinge on the nearby organs.
The prognosis is usually excellent.
Recurrence at the same spot is rare but do occur due to regrowth of the blood vessel supplying the lipoma.
Rarely a lipoma may undergo malignant degeneration and become liposarcoma.
Wednesday, December 22, 2010
A Family Doctor's Tale - CELLULITIS
DOC I HAVE CELLULITIS
Cellulitis can be a serious condition because the bacteria in the infected tissues can spread quickly through the skin especially in patients with diabetes and varicose veins.
The skin is red and warm and the bacteria can spread through the subcutaneous tissues very rapidly.
One of my diabetic patient had to have his leg amputed because the bacteria spread from his foot to the upper legs within 24 hours.
That is how fast cellulitis can spread.
Cellulitis is a condition where bacterial infection and inflammation spread through the skin and subcutaneous tissues.
The causes of Cellulitis are usually:
1.The bacteria that attack the skin and subcutaneous tissues are usually streptococci and staphylococci.
2.Rarely the bacteria can be clostridia.
Spread occurs as a result of
1.tissue damage
2.lower body immunity (eg, diabetes,AIDS)
3.virulence of the bacteria
Symptoms and signs of Cellulitis are:
1.Red painful hot and swollen skin with ill defined borders
2.Pain and tenderness on palpation
3.In anaerobic infections, crepitation may be present.
4.Pussy discharge may be foul smelling
5.Lymphangitis and lymphadenitis ma be present
Investigations in Cellulitis are:
1.Wound swabs may be necessary to determine the bacteria and their resistance to antibiotics
2.Deep cellulitis may required Xrays and ultrasound scans to see the spread.
Treatment of Cellulitis is:
1.The underlying disease such as diabetes must be treated.
2.Cool compress may relieve local discomfort.
3.Analgesics and painkillers may help to relieve pain
4.Appropriate antibiotics may be taken orally or by skin applications.
5.Anaerobic infections require systemic antibiotics.
If fascilitis (infection of the fascia of muscles) is present, surgical debridement(removal of damaged tissues and pus) is necessary.
The prognosis of Cellulitis is good with early detection and treatment.
Cellulitis can be a serious condition because the bacteria in the infected tissues can spread quickly through the skin especially in patients with diabetes and varicose veins.
The skin is red and warm and the bacteria can spread through the subcutaneous tissues very rapidly.
One of my diabetic patient had to have his leg amputed because the bacteria spread from his foot to the upper legs within 24 hours.
That is how fast cellulitis can spread.
Cellulitis is a condition where bacterial infection and inflammation spread through the skin and subcutaneous tissues.
The causes of Cellulitis are usually:
1.The bacteria that attack the skin and subcutaneous tissues are usually streptococci and staphylococci.
2.Rarely the bacteria can be clostridia.
Spread occurs as a result of
1.tissue damage
2.lower body immunity (eg, diabetes,AIDS)
3.virulence of the bacteria
Symptoms and signs of Cellulitis are:
1.Red painful hot and swollen skin with ill defined borders
2.Pain and tenderness on palpation
3.In anaerobic infections, crepitation may be present.
4.Pussy discharge may be foul smelling
5.Lymphangitis and lymphadenitis ma be present
Investigations in Cellulitis are:
1.Wound swabs may be necessary to determine the bacteria and their resistance to antibiotics
2.Deep cellulitis may required Xrays and ultrasound scans to see the spread.
Treatment of Cellulitis is:
1.The underlying disease such as diabetes must be treated.
2.Cool compress may relieve local discomfort.
3.Analgesics and painkillers may help to relieve pain
4.Appropriate antibiotics may be taken orally or by skin applications.
5.Anaerobic infections require systemic antibiotics.
If fascilitis (infection of the fascia of muscles) is present, surgical debridement(removal of damaged tissues and pus) is necessary.
The prognosis of Cellulitis is good with early detection and treatment.
Tuesday, December 21, 2010
A Family Doctor's Tale - ATOPIC DERMATITIS
DOC I HAVE ATOPIC DERMATITIS
This is a very common disease occurring especially in childhood and may be inherited.
My own granddaughter has very bad eczema during her first year .
It was made worse when she caught the chicken pox from her older sister.
Happily after the first year the skin recovered by itself.
Mild steroids like hydrocortisone may be applied in severe cases.
Atopic Dermatitis is a common skin condition which presents as a chronic, relapsing, and very itchy rash at some point during childhood.
Atopic Dermatitis clears and often disappears with age.
The causes of Atopic Dermatitis is unknown.
However some possible causes are:
1.Genetic
Genes play a part in Atopic Dermatitis as the condition runs in families
2.External causes
a.abnormal response of the body’s immune system play a part in the development of Atopic Dermatitis.
b.damage to the skin barrier may lead to dryness and inflammation of the skin
c.irritating substances overacts, causing itching and scratching.
Atopic Dermatitis is not contagious .
Atopic Dermatitis occurs in both children and adults, but usually appears during infancy.
1.Those who are genetically predisposed
2.Those exposed to environmental triggers
a.rough or coarse materials coming into contact with the skin causes itchiness.
b.feeling too hot and/or sweating will cause an outbreak.
c.certain soaps, detergents, disinfectants,
d.contact with juices from fresh fruits and meats,
e.food allergens in childhood such as cow's milk, hen's egg,peanuts, nuts, shellfish
f.dust mites,
g.animal saliva and faeces may trigger itching.
h.Upper respiratory infections (caused by viruses) may also be triggers.
i.Stress can also sometimes aggravate an existing flare-up.
Many people who have Atopic Dermatitis also suffer from Atopic rhinitis and asthma, or have family members who do.
Atopic Dermatitis affects both sexes equally.
Atopic Dermatitis can occur on just about any part of the body
In infants, Atopic Dermatitis typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck.
In children and adults, Atopic Dermatitis typically occurs on the face, neck, and the insides of the elbows, knees, and ankles.
In some people, Atopic Dermatitis may "bubble up" and ooze.
In others, the condition may appear more scaly, dry, and red.
Chronic scratching usually make the skin worse taking on a leathery texture because the skin thickens (lichenification).
Symptoms and signs of Atopic Dermatitis are:
Typical features of Atopic Dermatitis are:
1.dry,
2.red,
3.extremely itchy patches on the skin.
4.Oozing of the rash
5.Thickening of the skin
Atopic Dermatitis is diagnosed based on :
1.History and appearance of the rash
2.Screening test for food allergy
3.Blood test for specific antibodies to food substances
Treatment of an Atopic Dermatitis is:
1. prevent scratching.
2. application of lotions or creams to keep the skin as moist as possible after bathing (within three minutes is a common recommendation) so that the moisture from the bath is "locked in."
3.Cold compresses applied directly to itchy skin can also help relieve itching.
4.application of nonprescription corticosteroid creams and ointments to reduce inflammation
if the condition persists, worsens, or does not improve satisfactorily.
Hydrocortisone cream and ointment are preferred to prevent side effects such as skin thinning.
5.For severe flare-ups, your doctor may prescribe oral corticosteroids (this treatment is not recommended for long-term use).
6.topical or oral antibiotics may be needed for the skin infection which may affect the dry inflamed skin.
7.sedative antihistamines are sometimes used to reduce the itch
8.Tar treatments can have positive effects; however, tar can be messy.
9.Phototherapy requires special equipment (lights).
10.cyclosporine A, which modifies immune response; however, this is used only in extreme cases because of its association with serious side effects.
Atopic Dermatitis outbreaks can usually be avoided with some simple precautions.
The following suggestions may help to reduce the severity and frequency of flare-ups:
Moisturize frequently
Avoid sudden changes in temperature or humidity
Avoid sweating or overheating
Dress the child in breathable cotton clothes
Reduce stress
Avoid scratchy materials (e.g., wool or other irritants)
Avoid harsh soaps, detergents, and solvents
Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites, and animal dander)
Be aware of any foods that may cause an outbreak and avoid those foods
This is a very common disease occurring especially in childhood and may be inherited.
My own granddaughter has very bad eczema during her first year .
It was made worse when she caught the chicken pox from her older sister.
Happily after the first year the skin recovered by itself.
Mild steroids like hydrocortisone may be applied in severe cases.
Atopic Dermatitis is a common skin condition which presents as a chronic, relapsing, and very itchy rash at some point during childhood.
Atopic Dermatitis clears and often disappears with age.
The causes of Atopic Dermatitis is unknown.
However some possible causes are:
1.Genetic
Genes play a part in Atopic Dermatitis as the condition runs in families
2.External causes
a.abnormal response of the body’s immune system play a part in the development of Atopic Dermatitis.
b.damage to the skin barrier may lead to dryness and inflammation of the skin
c.irritating substances overacts, causing itching and scratching.
Atopic Dermatitis is not contagious .
Atopic Dermatitis occurs in both children and adults, but usually appears during infancy.
1.Those who are genetically predisposed
2.Those exposed to environmental triggers
a.rough or coarse materials coming into contact with the skin causes itchiness.
b.feeling too hot and/or sweating will cause an outbreak.
c.certain soaps, detergents, disinfectants,
d.contact with juices from fresh fruits and meats,
e.food allergens in childhood such as cow's milk, hen's egg,peanuts, nuts, shellfish
f.dust mites,
g.animal saliva and faeces may trigger itching.
h.Upper respiratory infections (caused by viruses) may also be triggers.
i.Stress can also sometimes aggravate an existing flare-up.
Many people who have Atopic Dermatitis also suffer from Atopic rhinitis and asthma, or have family members who do.
Atopic Dermatitis affects both sexes equally.
Atopic Dermatitis can occur on just about any part of the body
In infants, Atopic Dermatitis typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck.
In children and adults, Atopic Dermatitis typically occurs on the face, neck, and the insides of the elbows, knees, and ankles.
In some people, Atopic Dermatitis may "bubble up" and ooze.
In others, the condition may appear more scaly, dry, and red.
Chronic scratching usually make the skin worse taking on a leathery texture because the skin thickens (lichenification).
Symptoms and signs of Atopic Dermatitis are:
Typical features of Atopic Dermatitis are:
1.dry,
2.red,
3.extremely itchy patches on the skin.
4.Oozing of the rash
5.Thickening of the skin
Atopic Dermatitis is diagnosed based on :
1.History and appearance of the rash
2.Screening test for food allergy
3.Blood test for specific antibodies to food substances
Treatment of an Atopic Dermatitis is:
1. prevent scratching.
2. application of lotions or creams to keep the skin as moist as possible after bathing (within three minutes is a common recommendation) so that the moisture from the bath is "locked in."
3.Cold compresses applied directly to itchy skin can also help relieve itching.
4.application of nonprescription corticosteroid creams and ointments to reduce inflammation
if the condition persists, worsens, or does not improve satisfactorily.
Hydrocortisone cream and ointment are preferred to prevent side effects such as skin thinning.
5.For severe flare-ups, your doctor may prescribe oral corticosteroids (this treatment is not recommended for long-term use).
6.topical or oral antibiotics may be needed for the skin infection which may affect the dry inflamed skin.
7.sedative antihistamines are sometimes used to reduce the itch
8.Tar treatments can have positive effects; however, tar can be messy.
9.Phototherapy requires special equipment (lights).
10.cyclosporine A, which modifies immune response; however, this is used only in extreme cases because of its association with serious side effects.
Atopic Dermatitis outbreaks can usually be avoided with some simple precautions.
The following suggestions may help to reduce the severity and frequency of flare-ups:
Moisturize frequently
Avoid sudden changes in temperature or humidity
Avoid sweating or overheating
Dress the child in breathable cotton clothes
Reduce stress
Avoid scratchy materials (e.g., wool or other irritants)
Avoid harsh soaps, detergents, and solvents
Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites, and animal dander)
Be aware of any foods that may cause an outbreak and avoid those foods
Monday, December 20, 2010
A Family Doctor's Tale - ICHTHYOSIS
DOC I HAVE ICHTHYOSIS
Ichthyosis presents with a scale like appearance of the skin like the scales of a fish.
Because of the scales there is reduction of sweat and oil secretion resulting in dry skin and dehydration.
Treatment is with petroleum jelly or oils which will help to hydrate the skin and eases the discomfort and itch of the patients.
Ichthyosis is a rare non contagious disease of the keratin of the skin where there is reduction of sweat and sebaceous secretions.
The word Ichthus means fish.
So Ichthyosis means fish like appearance of the skin.
People who are at risk of Ichthyosis have a family history of ichthyosis.
Most forms of ichthyosis are due to:
A.genetic conditions:
1.Ichthyosis vulgaris 95% -autosomal dominant
2.X-linked ichthyosis -sex linked recessive
3.Ichthyosis lamellaris - autosomal recessive usually in newborns
4.Harlequins Ichthyosis -autosomal recessive
5.Bullous Ichthyosis - autosomal dominant
B.Acquired Ichthyosis
6.Ichthyosis acquisita occur in :
leprosy,
hypothyroidism,
lymphoma,
sarcoidosis,
Hodgkin disease
7.Xeroderma - is a mild form of ichthyosis, occurs in middle aged and older patients.
Symptoms:
1.extensor surface of limbs covered with dry scales(rarely the whole body is covered).
2.axilla and antecubal fossa (elbows,armpits,groins,back of knee)not affected
3.Usually symptoms present in childhood but improve during puberty to becoming worst again in later life.
4.Rashes can be extremely itchy in xeroderma
5.The condition is worse in colder weather.
6.Hair may be thin and dry.
7.Nails are brittle and dry.
The diagnosis of Ichthyosis is made based on:
1.Appearance of the skin
2.Family history of Ichthyosis
3.Skin biopsy for microscopic examination.
The complications of Ichthyosis are:
1.keratisis with corneal and ocular surface disease
2.Ectropion of eyelids due to dehydration
3.Deafness in a Keratitis-Ichthyosis-Deafness (KID)Disease
There is no cure for Ichthyosis.
1.Symptomatic treatment with emolient creams such as petroleum jelly may help to hydrate the skin.
2.Itch may be controlled with antihistamines
3.Hydration with propylene glycol solution will help
4.Urea in emulsion creams has also help the dry skin
5.Topical or oral retinoic acid has brought some improvement to the skin.
6.Exposure to the sun may improve or worsen the condition.
It is a lifelong condition and need continuous treatment.
There is no known preventive measure for ichthyosis
Ichthyosis presents with a scale like appearance of the skin like the scales of a fish.
Because of the scales there is reduction of sweat and oil secretion resulting in dry skin and dehydration.
Treatment is with petroleum jelly or oils which will help to hydrate the skin and eases the discomfort and itch of the patients.
Ichthyosis is a rare non contagious disease of the keratin of the skin where there is reduction of sweat and sebaceous secretions.
The word Ichthus means fish.
So Ichthyosis means fish like appearance of the skin.
People who are at risk of Ichthyosis have a family history of ichthyosis.
Most forms of ichthyosis are due to:
A.genetic conditions:
1.Ichthyosis vulgaris 95% -autosomal dominant
2.X-linked ichthyosis -sex linked recessive
3.Ichthyosis lamellaris - autosomal recessive usually in newborns
4.Harlequins Ichthyosis -autosomal recessive
5.Bullous Ichthyosis - autosomal dominant
B.Acquired Ichthyosis
6.Ichthyosis acquisita occur in :
leprosy,
hypothyroidism,
lymphoma,
sarcoidosis,
Hodgkin disease
7.Xeroderma - is a mild form of ichthyosis, occurs in middle aged and older patients.
Symptoms:
1.extensor surface of limbs covered with dry scales(rarely the whole body is covered).
2.axilla and antecubal fossa (elbows,armpits,groins,back of knee)not affected
3.Usually symptoms present in childhood but improve during puberty to becoming worst again in later life.
4.Rashes can be extremely itchy in xeroderma
5.The condition is worse in colder weather.
6.Hair may be thin and dry.
7.Nails are brittle and dry.
The diagnosis of Ichthyosis is made based on:
1.Appearance of the skin
2.Family history of Ichthyosis
3.Skin biopsy for microscopic examination.
The complications of Ichthyosis are:
1.keratisis with corneal and ocular surface disease
2.Ectropion of eyelids due to dehydration
3.Deafness in a Keratitis-Ichthyosis-Deafness (KID)Disease
There is no cure for Ichthyosis.
1.Symptomatic treatment with emolient creams such as petroleum jelly may help to hydrate the skin.
2.Itch may be controlled with antihistamines
3.Hydration with propylene glycol solution will help
4.Urea in emulsion creams has also help the dry skin
5.Topical or oral retinoic acid has brought some improvement to the skin.
6.Exposure to the sun may improve or worsen the condition.
It is a lifelong condition and need continuous treatment.
There is no known preventive measure for ichthyosis
Sunday, December 19, 2010
A Family Doctor's Tale - VITILIGO
DOC I HAVE VITILIGO
Many patients with vitiligo are fearful that they have a serious condition because of the change of the color of their skin.
It is actually a auto-immune disorder which causes the loss of pigmentation in the cells of the skin.
A simple treatment is by camouflage with cosmetics.
Vitiligo is a skin disorder which presents as white spots or patches on the skin.
It is not contagious.
The cause of Vitiligo is not known.
However many people with Vitiligo may have associated auto immune disease including thyroid disease and pernicous anemia.
Autoimmune conditions are conditions where the body's own cells attack its cells (in this case the skin cells)
There is a progressive loss of the pigment melanin which gives us our skin color.
The loss of pigment occurs when the pigment cells (melanocytes) are destroyed and melanin cannot be produced.
Signs and symptoms of Vitiligo are:
1.white spots or patches on the skin
Common sites affected by Vitilgo are:
1.Bony surfaces - back of hands and fingers,elbows and knees
2.Body orifices - around the eyes, mouth and nose
3.Body folds - armpits and groins
Vitiligo may also occurs over an area of injury such as a cut or burn.
The hair in the vitilgo patch may be white in color.
Diagnosis of Vitiligo is made by:
1.typical white patches or spots
2.skin biopsy for microscopic examination.
There are different treatments for Vitiligo:
1.Corticosteroid creams
Corticosteroid creams are effective against small patches or spot of vitilgo but there may be side effects such as skin thinning.
2.Topical Immunodulators
Tacrolimus or pimecrolimus are topical immunodulators which work by:
1.modulating the immune attack against the melanocytes on the skin and
2.stimulating the functions of the melanocytes
3. UltraViolet Light Treatments
a.Psoralen photochemotherapy(PUVA)
PUVA is a combination treatment involving
1.the use of the drug Psoralen(P)
2.and then exposing the skin to UltraViolet A light(UVA)
hence the term PUVA.
Psoralen makes the skin temporarily sensitive to UVA which is part of natural sunlight.
Psoralen can be applied to the skin as a solution or ingested orally with subsequent exposure to ultraviolet light A.
Patient treated with PUVA may need to undergo treatment for 1 year for satisfactory results.
Use of PUVA may result in sunburn and blister fromation.
b.Narrowband UVB
Narrowband UltraViolet light B treatment does not require Psoralen tablets before treatment.
In fact this treatment is safer and as effective if not better than PUVA. Again treatment may require 1 year before satisfactory results.
c.Focused Multiple Wavelength UltraViolet Therapy(Multiclear)
This is a form of targeted light therapy as only the vitiligo areas are treated.
It is useful for small localised lesions.
d.Excimer Laser
This laser emits a certain UVB wavelength but is more costly than Multiclear Light therapy.
4.Surgery
Surgical transplants are meant for patients with stable vitligo that fail to respond to topical or phototherapy.
Stable vitiligo means no new lesions or progressive lesions for 12 to 24 months.
Surgery involve tissue and cellular grafting.
5.Camuoflage Cosmetics.
Cover up camouflage provides good color and camouflage of vitiligo lesions.
They are particularly useful for white patches on the face ansd back of the hands.
6.Sunscreens
Areas of vitiligo exposed to the sun are very prone to sunburn as they lack protective pigments.
Patients should always use broad spectrum sunsceens to protected the affected vitiligo areas.
Prognosis of Vitiligo is generally fair.
Treatment takes time and patience.
Preventive measures can be taken for Vitiligo:
1.Sunscreens
2.Proper skin care
Many patients with vitiligo are fearful that they have a serious condition because of the change of the color of their skin.
It is actually a auto-immune disorder which causes the loss of pigmentation in the cells of the skin.
A simple treatment is by camouflage with cosmetics.
Vitiligo is a skin disorder which presents as white spots or patches on the skin.
It is not contagious.
The cause of Vitiligo is not known.
However many people with Vitiligo may have associated auto immune disease including thyroid disease and pernicous anemia.
Autoimmune conditions are conditions where the body's own cells attack its cells (in this case the skin cells)
There is a progressive loss of the pigment melanin which gives us our skin color.
The loss of pigment occurs when the pigment cells (melanocytes) are destroyed and melanin cannot be produced.
Signs and symptoms of Vitiligo are:
1.white spots or patches on the skin
Common sites affected by Vitilgo are:
1.Bony surfaces - back of hands and fingers,elbows and knees
2.Body orifices - around the eyes, mouth and nose
3.Body folds - armpits and groins
Vitiligo may also occurs over an area of injury such as a cut or burn.
The hair in the vitilgo patch may be white in color.
Diagnosis of Vitiligo is made by:
1.typical white patches or spots
2.skin biopsy for microscopic examination.
There are different treatments for Vitiligo:
1.Corticosteroid creams
Corticosteroid creams are effective against small patches or spot of vitilgo but there may be side effects such as skin thinning.
2.Topical Immunodulators
Tacrolimus or pimecrolimus are topical immunodulators which work by:
1.modulating the immune attack against the melanocytes on the skin and
2.stimulating the functions of the melanocytes
3. UltraViolet Light Treatments
a.Psoralen photochemotherapy(PUVA)
PUVA is a combination treatment involving
1.the use of the drug Psoralen(P)
2.and then exposing the skin to UltraViolet A light(UVA)
hence the term PUVA.
Psoralen makes the skin temporarily sensitive to UVA which is part of natural sunlight.
Psoralen can be applied to the skin as a solution or ingested orally with subsequent exposure to ultraviolet light A.
Patient treated with PUVA may need to undergo treatment for 1 year for satisfactory results.
Use of PUVA may result in sunburn and blister fromation.
b.Narrowband UVB
Narrowband UltraViolet light B treatment does not require Psoralen tablets before treatment.
In fact this treatment is safer and as effective if not better than PUVA. Again treatment may require 1 year before satisfactory results.
c.Focused Multiple Wavelength UltraViolet Therapy(Multiclear)
This is a form of targeted light therapy as only the vitiligo areas are treated.
It is useful for small localised lesions.
d.Excimer Laser
This laser emits a certain UVB wavelength but is more costly than Multiclear Light therapy.
4.Surgery
Surgical transplants are meant for patients with stable vitligo that fail to respond to topical or phototherapy.
Stable vitiligo means no new lesions or progressive lesions for 12 to 24 months.
Surgery involve tissue and cellular grafting.
5.Camuoflage Cosmetics.
Cover up camouflage provides good color and camouflage of vitiligo lesions.
They are particularly useful for white patches on the face ansd back of the hands.
6.Sunscreens
Areas of vitiligo exposed to the sun are very prone to sunburn as they lack protective pigments.
Patients should always use broad spectrum sunsceens to protected the affected vitiligo areas.
Prognosis of Vitiligo is generally fair.
Treatment takes time and patience.
Preventive measures can be taken for Vitiligo:
1.Sunscreens
2.Proper skin care
Saturday, December 18, 2010
A family Doctor's Tale - RETINA PIGMENTOSA
DOC I HAVE RETINITIS PIGMENTOSA
Retinitis pigmentosa is a rare condition in which the retinal pigmentation cause progressive loss of vision.It is a inherited condition .Unfortunately there is usually no cure.
Retinitis pigmentosa is a slow degenerative disease of the retina.
Retinitis pigmentosa is a genetically determined disease in which
abnormal photoreceptors (rods and cones) or the Retinitis
pigment epithelium of the retina cause progressive loss of vision.
Initially there is night blindness due to the abnormal photoreceptors.
This is followed by the loss of peripheral visual field known as tunnel vision which may persist for some years.
Finally the macular region is affected with loss of central vision in the later stages.
In rare cases blindness may occur in childhood.
The cause is usually in the genes and of the recessive trait.
There is a mild form of dominant trait.
Rarely it is sex linked and can be severe.
Symptoms:
1.loss of night vision even in childhood
2.tunnel vision occurs at age of 40-50 for several years or decades
3.loss of central vision usually at 50-60 years of age
Signs:
1. In early stage, direct opthalmoscopy show small spidery black spots
2. vessels are sheathed with pigments in some areas
3. Retinal vessels become attenuated (thinned)
4. Optic atrophy(cellophane maculopathy) sets in
5. posterior subcapsular cataracts form at late stage.
Retinitis pigmentosa is diagnosed by:
1. electroretinography (ERG) show progressive loss of photoreceptor function
2.Visual field testing show loss of peripheral vision
3.Flourescin angiography may show dark pigments to establish the presence of Retinitis pigmentosa.
The complications of Retinitis pigmentosa are:
Partial to complete loss of vision.
There is no cure for Retinitis pigmentosa.
Several methods of treatment aimed at slowing down the progression of
loss of vision have been tried:
1.daily intake of 15000 IU of vitamin A palmitate.
2.Retinitis transplants,
3 artificial Retinitis implants,
4.gene therapy,
5.stem cells,
Retinitis pigmentosa must be monitored regularly:
1.regular follow up with the eye doctor.
2.examining the retina for further damage
3.analyzing the visual fields.
The prognosis is very poor as progression to blindness is the rule.
There is no prevention for Retinitis pigmentosa.
The following may help:
1.Genetic counselling
2.Examination of family members for signs of loss of vision
Retinitis pigmentosa is a rare condition in which the retinal pigmentation cause progressive loss of vision.It is a inherited condition .Unfortunately there is usually no cure.
Retinitis pigmentosa is a slow degenerative disease of the retina.
Retinitis pigmentosa is a genetically determined disease in which
abnormal photoreceptors (rods and cones) or the Retinitis
pigment epithelium of the retina cause progressive loss of vision.
Initially there is night blindness due to the abnormal photoreceptors.
This is followed by the loss of peripheral visual field known as tunnel vision which may persist for some years.
Finally the macular region is affected with loss of central vision in the later stages.
In rare cases blindness may occur in childhood.
The cause is usually in the genes and of the recessive trait.
There is a mild form of dominant trait.
Rarely it is sex linked and can be severe.
Symptoms:
1.loss of night vision even in childhood
2.tunnel vision occurs at age of 40-50 for several years or decades
3.loss of central vision usually at 50-60 years of age
Signs:
1. In early stage, direct opthalmoscopy show small spidery black spots
2. vessels are sheathed with pigments in some areas
3. Retinal vessels become attenuated (thinned)
4. Optic atrophy(cellophane maculopathy) sets in
5. posterior subcapsular cataracts form at late stage.
Retinitis pigmentosa is diagnosed by:
1. electroretinography (ERG) show progressive loss of photoreceptor function
2.Visual field testing show loss of peripheral vision
3.Flourescin angiography may show dark pigments to establish the presence of Retinitis pigmentosa.
The complications of Retinitis pigmentosa are:
Partial to complete loss of vision.
There is no cure for Retinitis pigmentosa.
Several methods of treatment aimed at slowing down the progression of
loss of vision have been tried:
1.daily intake of 15000 IU of vitamin A palmitate.
2.Retinitis transplants,
3 artificial Retinitis implants,
4.gene therapy,
5.stem cells,
Retinitis pigmentosa must be monitored regularly:
1.regular follow up with the eye doctor.
2.examining the retina for further damage
3.analyzing the visual fields.
The prognosis is very poor as progression to blindness is the rule.
There is no prevention for Retinitis pigmentosa.
The following may help:
1.Genetic counselling
2.Examination of family members for signs of loss of vision
Friday, December 17, 2010
A Family Doctor's Tale - RETINAL DETACHMENT
DOC I HAVE RETINAL DETACHMENT
Retinal detachment can be a very difficult condition to diagnose and treat.
In severe cases the risk of blindness is very high.
Treatment with Vitrectomy which involves the removal of the vitreous gel followed by filling the eye with a gas bubble is painful and need a long period to recover.
Retinal detachment is a condition in which there is a separation of the neurosensory retina from the underlying retinal pigment epithelium.
Retinal detachment is a medical emergency.
The following are at risk from Retinal detachment:
1. age above 55 yrs
4. very short sighted (myopia usually above 5-6 diopters)
3. history of serious eye injury (injury to orbits)
4. history of eye cataract surgery
5. Sports activities which can cause injuries to the eye (Boxing, karate etc) or increase pressure in the eye( bunjee jumping, diving etc)
6. family history of Retinal detachment -related to family history of diabetes, sickle cell disease and other underlying condition
There are 2 types of retinal detachment:
Primary:
There is a hole in the retina which allows the seepage of vitreous humor between the the neurosensory retinal layer and the retinal pigment eipthelium which cause the separation of the 2 layers.
The holes are usually at the periphery.
It is a degenerative condition which can be aggravated by trauma especially in the severe myopic(short sighted) and senile (old) eyes.
Secondary:
Other eye diseases which can separate the 2 layers are:
1.Choroiditis-
inflammation of the choroid cause exudation of serous fluid under the retina layer
2.Toxemic retinopathy -
inflammation of the retina cause exudation of serous fluid under the retina layer
3.proliferative diabetic retinopathy -
abnormal blood vessels grow within the retina causing the retina to pull away from the wall of the eye
4.vitreous hemorrhage after injury to the orbits -
blood clot and fibrovasular tissue developing from the blood clot can cause separation of the nuerosensory retina and pigmented retina layer.
5.Choroidal melanoma(a malignant tumor) -
a growth below the layers of the retina can push the layer of retina from the back of the eye
Symptoms:
1.transient flashes of light
2.a sudden increase of floaters in one eye
3.a ring of floaters at the temporal region of the central vision
4.a feeling of heaviness in the eye
5.the presence of cloud in front of the eye so that parts of an object are not seen
6.the sensation of a curtain falling over the central vision of eye
7.Straight lines that become curved
8.Central vision intact at first followed by complete and total loss of vision if untreated
Signs:
1. In early stage, direct opthalmoscopy show very little abnormality
2. Indirect opthalmoscopy may show the presence of the detachment.
3. The pale white or grey folds of the detachment can be seen
Diagnosis of retinal detachment is by:
1. Indirect opthalmoscopy with slit-lamp examination is the best method to detect early or shallow detachment and to identify the retinal holes.
2.Transillumination and ultrasound may be useful to detect neoplasm
3.Flourescin angiography may be needed in special cases to establish the presence of retinal detachment.
Complications of Retinal detachment are:
Partial to complete loss of vision.
Retinal detachment is a medical emergency.
The most important part of treatment is finding the holes or tears and closing them.
Primary:
1.Vitrectomy (most common procedure)
Vitrectomy involves the removal of the vitreous gel followed by filling the eye with a gas bubble (SF6 or C3F8 gas).
Side effect is the more rapid progression of a cataract in the operated eye.
2.Cryotherapy and Laser Photocoagulation
Cryotherapy (freezing) and laser photocoagulation are used to create a adhesion around the retinal hole so that fluid cannot enter the hole and accumulate behind the retina resulting in the retinal detachment.
3.Adatomed Silicone Oil
Adatomed Silicone Oil is injected into the eye and mechanically holds the retina in place.
The oil is usually removed within a year.
4.Scleral buckle surgery
The choroid and retina are brought together by buckling the sclera with silicone bands sewn by the eye surgeon to the outside of the eyeball.
The most common side effect of this operation is more short sightedness after the operation.
5.Pneumatic retinopexy
This operation is done under local anesthesia by injecting a gas bubble (SF6 or C3F8 gas) into the eye after which laser or freezing treatment is applied to the retinal hole. The patient may have to keep his head tilted for several days to keep the gas bubble in contact with the retinal hole in order to seal the hole..
6.Ignipuncture
Ignipuncture involves cauterization of the retina with a very hot pointed instrument.It is no longer used.
After treatment the results are usually good and vision is regained over a period of a few weeks.
Secondary:
1.Neoplasm: surgical removal of neoplasm
2.Traction detachment: vitreous surgery, prognosis is poor
3.Others:Fluids usually resorbs as underlying condition is treated.
Retinal detachment must be continuously monitored
1.regular follow up with the eye doctor.
2.examining the retina for further damage
3.analyzing the visual fields.
With proper monitoring and treatment most patients will be less likely to be at risk of blindness.
The prognosis varies depending on the the underlying disease.
Prognosis is good if the condition is diagnosed and treated early although visual acuity may not be as good as before.
Retinal detachment can be prevented by:
1.educating people of the symptoms suggestive of a posterior vitreous detachment.
2.Eye examination to detect retinal tears which can be treated with laser or cryotherapy.
3.Avoid known risk factors for retinal detachment.
a.Cataract surgery
b.Trauma (boxing, kickboxing, karate, etc.)
c.high level of myopia
d.activities that increase pressure in the eye, including diving, skydiving, bungee jumping
Retinal detachment can be a very difficult condition to diagnose and treat.
In severe cases the risk of blindness is very high.
Treatment with Vitrectomy which involves the removal of the vitreous gel followed by filling the eye with a gas bubble is painful and need a long period to recover.
Retinal detachment is a condition in which there is a separation of the neurosensory retina from the underlying retinal pigment epithelium.
Retinal detachment is a medical emergency.
The following are at risk from Retinal detachment:
1. age above 55 yrs
4. very short sighted (myopia usually above 5-6 diopters)
3. history of serious eye injury (injury to orbits)
4. history of eye cataract surgery
5. Sports activities which can cause injuries to the eye (Boxing, karate etc) or increase pressure in the eye( bunjee jumping, diving etc)
6. family history of Retinal detachment -related to family history of diabetes, sickle cell disease and other underlying condition
There are 2 types of retinal detachment:
Primary:
There is a hole in the retina which allows the seepage of vitreous humor between the the neurosensory retinal layer and the retinal pigment eipthelium which cause the separation of the 2 layers.
The holes are usually at the periphery.
It is a degenerative condition which can be aggravated by trauma especially in the severe myopic(short sighted) and senile (old) eyes.
Secondary:
Other eye diseases which can separate the 2 layers are:
1.Choroiditis-
inflammation of the choroid cause exudation of serous fluid under the retina layer
2.Toxemic retinopathy -
inflammation of the retina cause exudation of serous fluid under the retina layer
3.proliferative diabetic retinopathy -
abnormal blood vessels grow within the retina causing the retina to pull away from the wall of the eye
4.vitreous hemorrhage after injury to the orbits -
blood clot and fibrovasular tissue developing from the blood clot can cause separation of the nuerosensory retina and pigmented retina layer.
5.Choroidal melanoma(a malignant tumor) -
a growth below the layers of the retina can push the layer of retina from the back of the eye
Symptoms:
1.transient flashes of light
2.a sudden increase of floaters in one eye
3.a ring of floaters at the temporal region of the central vision
4.a feeling of heaviness in the eye
5.the presence of cloud in front of the eye so that parts of an object are not seen
6.the sensation of a curtain falling over the central vision of eye
7.Straight lines that become curved
8.Central vision intact at first followed by complete and total loss of vision if untreated
Signs:
1. In early stage, direct opthalmoscopy show very little abnormality
2. Indirect opthalmoscopy may show the presence of the detachment.
3. The pale white or grey folds of the detachment can be seen
Diagnosis of retinal detachment is by:
1. Indirect opthalmoscopy with slit-lamp examination is the best method to detect early or shallow detachment and to identify the retinal holes.
2.Transillumination and ultrasound may be useful to detect neoplasm
3.Flourescin angiography may be needed in special cases to establish the presence of retinal detachment.
Complications of Retinal detachment are:
Partial to complete loss of vision.
Retinal detachment is a medical emergency.
The most important part of treatment is finding the holes or tears and closing them.
Primary:
1.Vitrectomy (most common procedure)
Vitrectomy involves the removal of the vitreous gel followed by filling the eye with a gas bubble (SF6 or C3F8 gas).
Side effect is the more rapid progression of a cataract in the operated eye.
2.Cryotherapy and Laser Photocoagulation
Cryotherapy (freezing) and laser photocoagulation are used to create a adhesion around the retinal hole so that fluid cannot enter the hole and accumulate behind the retina resulting in the retinal detachment.
3.Adatomed Silicone Oil
Adatomed Silicone Oil is injected into the eye and mechanically holds the retina in place.
The oil is usually removed within a year.
4.Scleral buckle surgery
The choroid and retina are brought together by buckling the sclera with silicone bands sewn by the eye surgeon to the outside of the eyeball.
The most common side effect of this operation is more short sightedness after the operation.
5.Pneumatic retinopexy
This operation is done under local anesthesia by injecting a gas bubble (SF6 or C3F8 gas) into the eye after which laser or freezing treatment is applied to the retinal hole. The patient may have to keep his head tilted for several days to keep the gas bubble in contact with the retinal hole in order to seal the hole..
6.Ignipuncture
Ignipuncture involves cauterization of the retina with a very hot pointed instrument.It is no longer used.
After treatment the results are usually good and vision is regained over a period of a few weeks.
Secondary:
1.Neoplasm: surgical removal of neoplasm
2.Traction detachment: vitreous surgery, prognosis is poor
3.Others:Fluids usually resorbs as underlying condition is treated.
Retinal detachment must be continuously monitored
1.regular follow up with the eye doctor.
2.examining the retina for further damage
3.analyzing the visual fields.
With proper monitoring and treatment most patients will be less likely to be at risk of blindness.
The prognosis varies depending on the the underlying disease.
Prognosis is good if the condition is diagnosed and treated early although visual acuity may not be as good as before.
Retinal detachment can be prevented by:
1.educating people of the symptoms suggestive of a posterior vitreous detachment.
2.Eye examination to detect retinal tears which can be treated with laser or cryotherapy.
3.Avoid known risk factors for retinal detachment.
a.Cataract surgery
b.Trauma (boxing, kickboxing, karate, etc.)
c.high level of myopia
d.activities that increase pressure in the eye, including diving, skydiving, bungee jumping
Thursday, December 16, 2010
A Family Doctor's Tale -ASTIGMATISM
DOC I HAVE ASTIGMATISM
Astigmatism is quite common in many patients . It is a common cause of blurred vision in children and adults. Some patients diagnosed as myopia (short sightedness) actually have astigmatism and must be treated correctly to improve their vision.
Astigmatism is a condition in which the cornea of the eye is curved differently leading to blurred and distorted at all distances.
The eyeball is flattened usually from above downwards or sometimes sideways or along an oblique axis.
It is different from short or long sightedness.
It is therefore important to recognize Astigmatism and seek the correct treatment for it.
Astigmatism is generally an inherited condition where the curvature of the cornea of the eye is different from a normal person.
Because of the curvature, the eye is seeing the objects in front of it at a different angle. Light is entering the eye at a different angle which cast shadows and cause blurring of vision.
Besides inheritance it is also possible to get Astigmatism from eye surgery or sport injuries.
Symptoms of Astigmatism
1.Blurred and distorted vision of near and distant objects
2.blurring of vertical, horizontal and diagnonal lines
3.eye strain and fatigue
4.sensitivity to light
5.Tired and dry eyes
6.Headaches
Astigmatism can be diagnosed easily by your optometrist or eye specialist.
A eye examination followed by vision tests and computerized testing of the curvature of eye, short sight ness, long sight ness and any other abnormality of eye vision.
Prescription spectacles and contact lens can be prescribed to correct the Astigmatism.
Other methods of treatment include LASIK, wavefront eye surgery, lens implants especially in older patients
Astigmatism is quite common in many patients . It is a common cause of blurred vision in children and adults. Some patients diagnosed as myopia (short sightedness) actually have astigmatism and must be treated correctly to improve their vision.
Astigmatism is a condition in which the cornea of the eye is curved differently leading to blurred and distorted at all distances.
The eyeball is flattened usually from above downwards or sometimes sideways or along an oblique axis.
It is different from short or long sightedness.
It is therefore important to recognize Astigmatism and seek the correct treatment for it.
Astigmatism is generally an inherited condition where the curvature of the cornea of the eye is different from a normal person.
Because of the curvature, the eye is seeing the objects in front of it at a different angle. Light is entering the eye at a different angle which cast shadows and cause blurring of vision.
Besides inheritance it is also possible to get Astigmatism from eye surgery or sport injuries.
Symptoms of Astigmatism
1.Blurred and distorted vision of near and distant objects
2.blurring of vertical, horizontal and diagnonal lines
3.eye strain and fatigue
4.sensitivity to light
5.Tired and dry eyes
6.Headaches
Astigmatism can be diagnosed easily by your optometrist or eye specialist.
A eye examination followed by vision tests and computerized testing of the curvature of eye, short sight ness, long sight ness and any other abnormality of eye vision.
Prescription spectacles and contact lens can be prescribed to correct the Astigmatism.
Other methods of treatment include LASIK, wavefront eye surgery, lens implants especially in older patients
Wednesday, December 15, 2010
A Family Doctor's Tale - DEPRESSION
DOC I HAVE DEPRESSION
Depression is a very common mental ilness seen in a family doctor's clinic.
There is an alteration of mood which exceeds normal sadness.
Everyone has felt sad at one time or another.
It may be due to a disappointment, frustration or losing someone.
Time heals, the mood lifts and people continue to get on with their lives.
In some people, depression can be so severe that it dominates their lives, preventing them from living their lives as they used to.
Depression of this degree is a medical illness and needs treatment.
The severe form of depression may take 2 forms:
1.Major depression is manifested by a combination of symptoms that affect our work, interests and feelings towards family and friends.
2.Dysthymia is a lesevere type of long term depression with symptoms that prevents them from functioning at an optimal level.
Many patients suffer from Depression because of:
1.hereditary or genetic factors in the transmission of depressive disorders.
2.biological component in depression. It may be associated with having too little or too much chemicals in the brain.
3. medications have mood altering properties. Antidepressant medication act by altering and normalizing the biochemical imbalances in the brain.
4. Life events such as loss of a job, retirement, divorce, death of a loved one or moving to a new house can precipitate a depressive illness. Social circumstances also play a part. If we are alone, have few or no friends, suffer from a chronic illness, then we may be more vulnerable to depression.
5. People with life threatening or long-term physical illness such as cancer, stroke, arthritis or heart disease are also more vulnerable to depression.
6. Personality may also play a part in depression. Some of us are more vulnerable than others because of the individual make-up or early life experiences.
Very often, a combination of genetic, psychological and environmental factors is involved in the onset of depression.
The good news is that whatever the cause, depression is treatable.
Certain characteristic symptoms can give you or your family a clue that you are depressed:
1.Depressed mood
2.lethargy and fatigue
3.loss of interest and enjoyment in life
4.lack of drive or motivation that makes even simple tasks or decisions difficult or impossible
5.loss of concentration
6.Loss of self confidence, avoiding people
7.Sleeplessness or excessive sleeping
8.Agitation or restlessness
9.ideas of being useless, inadequate, helpless or hopeless
10.Feeling guilty or worthless
11.Loss or gain in appetite with loss or gain in weight,libido
12.Thoughts of suicide;
These symptoms are very common in depression and they are much better admitted than covered up.
The most important part of treatment of depression is:
Reassurance and support is most important in treatment of depression.
Recognition of suicide risk must be remembered when treating a depressed person.
Treatment for depression is well established.
Majority up to 90% of people with major depression have fairly good treatment outcome.
Treatment consists of drug (antidepressant medication) and non-drug therapy.
Usually, a combined treatment is best:
1.medication to gain relatively quick relief and
2.psychotherapy to learn more effective ways to deal with life stresses.
Antidepressant Medication
--------------------------
All antidepressant medications are equally effective but they have different side effects. The most often used antidepressants include tricyclics, monoamine oxidase inhibitors, lithium and selective serotonin inhibitors (SSRI).
Antidepressant medications do not begin working the day you take them but your mood will improve after one to two weeks. However, you may notice some improvement on the first day, especially in your sleep and feeling less tense and anxious.
The medications are compatible with painkillers, antibiotics and contraceptives. However, you should avoid alcohol as the medication and alcohol combined can make you too drowsy.
Do not stop the medication once you start to feel better as you may relapse into depression again. You should discuss this with your doctor and let him advise you when to stop.
Antidepressants like all drugs have some side effects, though these are usually mild and tend to wear off as treatment goes on.
The common side effects and their remedies are:
Dry mouth - drink more water
Constipation - eat more fruits, cereals, prunes and vegetables
Drowsiness - this will pass soon; do not drive or operate heavy machinery if feeling sedated
Dizziness - rise from bed or chair slowly
Some side effects with the newer medications:
Headache - this will usually go away
Nausea and stomach discomfort - transient; take medication with food
Nervousness and insomnia - these may occur during the first few weeks, reducing the dose will usually resolve them.
Non Drug Therapy
------------------
Psychotherapy
Psychotherapy involves talking things through with a trained counselor or therapist. Talking to someone who can really listen and understand you without passing judgement can be a tremendous relief. You learn how to solve problems and cope with life stresses better.
Exercise Exercise not only improves your health but it also gives you a sense of accomplishment. Endorphins ('feel good' hormones) are released during exercise and this can elevate your mood.
Relaxation Therapy
This involves deep breathing exercises and progressive muscle relaxation.
Support groups offer fellowship and you get to hear first hand accounts of how others with depression, like you, have learnt to cope. Presently SAMH, IMH and the Behavioural Medicine Clinic at HPB run support groups. The group at IMH is a psychoeducation group, i.e. you learn about the depressive illness and methods of coping.
Electroconvulsive Theraphy (ECT)
ECT is only indicated for those with severe depression who have not responded to treatment or are highly suicidal.
It involves giving a light general anaesthetic and an electric current is passed through the brain for a few seconds.
The whole procedure takes only about 15 minutes and the patient is only aware of having gone to sleep.
We should try to prevent depression through :
1.try to talk to close friends about bad news
2. Be realistic. Set priorities and do what you can.
3. Do something - get out of the house for a walk or some exercise. While you may not be able to work, it is always good to try to keep up with some light activities such as housework. This will help take your mind off those painful feelings.
4. Eat a good balanced diet, even though you may not feel like eating.
5. Resist the temptation to drown your sorrows with alcohol. Alcohol actually depresses the mood, so while it may give you immediate relief, this is very temporary and you may end up more depressed. It is also bad for your physical health.
6. Remind yourself that you are suffering from depression, something that many other people have gone through, and that you will eventually come out of it, as they did.
7.Get a friend or relative to help you make appointments to see the doctor and provide support both emotional or encouragement to take medication
Depression is a very common mental ilness seen in a family doctor's clinic.
There is an alteration of mood which exceeds normal sadness.
Everyone has felt sad at one time or another.
It may be due to a disappointment, frustration or losing someone.
Time heals, the mood lifts and people continue to get on with their lives.
In some people, depression can be so severe that it dominates their lives, preventing them from living their lives as they used to.
Depression of this degree is a medical illness and needs treatment.
The severe form of depression may take 2 forms:
1.Major depression is manifested by a combination of symptoms that affect our work, interests and feelings towards family and friends.
2.Dysthymia is a lesevere type of long term depression with symptoms that prevents them from functioning at an optimal level.
Many patients suffer from Depression because of:
1.hereditary or genetic factors in the transmission of depressive disorders.
2.biological component in depression. It may be associated with having too little or too much chemicals in the brain.
3. medications have mood altering properties. Antidepressant medication act by altering and normalizing the biochemical imbalances in the brain.
4. Life events such as loss of a job, retirement, divorce, death of a loved one or moving to a new house can precipitate a depressive illness. Social circumstances also play a part. If we are alone, have few or no friends, suffer from a chronic illness, then we may be more vulnerable to depression.
5. People with life threatening or long-term physical illness such as cancer, stroke, arthritis or heart disease are also more vulnerable to depression.
6. Personality may also play a part in depression. Some of us are more vulnerable than others because of the individual make-up or early life experiences.
Very often, a combination of genetic, psychological and environmental factors is involved in the onset of depression.
The good news is that whatever the cause, depression is treatable.
Certain characteristic symptoms can give you or your family a clue that you are depressed:
1.Depressed mood
2.lethargy and fatigue
3.loss of interest and enjoyment in life
4.lack of drive or motivation that makes even simple tasks or decisions difficult or impossible
5.loss of concentration
6.Loss of self confidence, avoiding people
7.Sleeplessness or excessive sleeping
8.Agitation or restlessness
9.ideas of being useless, inadequate, helpless or hopeless
10.Feeling guilty or worthless
11.Loss or gain in appetite with loss or gain in weight,libido
12.Thoughts of suicide;
These symptoms are very common in depression and they are much better admitted than covered up.
The most important part of treatment of depression is:
Reassurance and support is most important in treatment of depression.
Recognition of suicide risk must be remembered when treating a depressed person.
Treatment for depression is well established.
Majority up to 90% of people with major depression have fairly good treatment outcome.
Treatment consists of drug (antidepressant medication) and non-drug therapy.
Usually, a combined treatment is best:
1.medication to gain relatively quick relief and
2.psychotherapy to learn more effective ways to deal with life stresses.
Antidepressant Medication
--------------------------
All antidepressant medications are equally effective but they have different side effects. The most often used antidepressants include tricyclics, monoamine oxidase inhibitors, lithium and selective serotonin inhibitors (SSRI).
Antidepressant medications do not begin working the day you take them but your mood will improve after one to two weeks. However, you may notice some improvement on the first day, especially in your sleep and feeling less tense and anxious.
The medications are compatible with painkillers, antibiotics and contraceptives. However, you should avoid alcohol as the medication and alcohol combined can make you too drowsy.
Do not stop the medication once you start to feel better as you may relapse into depression again. You should discuss this with your doctor and let him advise you when to stop.
Antidepressants like all drugs have some side effects, though these are usually mild and tend to wear off as treatment goes on.
The common side effects and their remedies are:
Dry mouth - drink more water
Constipation - eat more fruits, cereals, prunes and vegetables
Drowsiness - this will pass soon; do not drive or operate heavy machinery if feeling sedated
Dizziness - rise from bed or chair slowly
Some side effects with the newer medications:
Headache - this will usually go away
Nausea and stomach discomfort - transient; take medication with food
Nervousness and insomnia - these may occur during the first few weeks, reducing the dose will usually resolve them.
Non Drug Therapy
------------------
Psychotherapy
Psychotherapy involves talking things through with a trained counselor or therapist. Talking to someone who can really listen and understand you without passing judgement can be a tremendous relief. You learn how to solve problems and cope with life stresses better.
Exercise Exercise not only improves your health but it also gives you a sense of accomplishment. Endorphins ('feel good' hormones) are released during exercise and this can elevate your mood.
Relaxation Therapy
This involves deep breathing exercises and progressive muscle relaxation.
Support groups offer fellowship and you get to hear first hand accounts of how others with depression, like you, have learnt to cope. Presently SAMH, IMH and the Behavioural Medicine Clinic at HPB run support groups. The group at IMH is a psychoeducation group, i.e. you learn about the depressive illness and methods of coping.
Electroconvulsive Theraphy (ECT)
ECT is only indicated for those with severe depression who have not responded to treatment or are highly suicidal.
It involves giving a light general anaesthetic and an electric current is passed through the brain for a few seconds.
The whole procedure takes only about 15 minutes and the patient is only aware of having gone to sleep.
We should try to prevent depression through :
1.try to talk to close friends about bad news
2. Be realistic. Set priorities and do what you can.
3. Do something - get out of the house for a walk or some exercise. While you may not be able to work, it is always good to try to keep up with some light activities such as housework. This will help take your mind off those painful feelings.
4. Eat a good balanced diet, even though you may not feel like eating.
5. Resist the temptation to drown your sorrows with alcohol. Alcohol actually depresses the mood, so while it may give you immediate relief, this is very temporary and you may end up more depressed. It is also bad for your physical health.
6. Remind yourself that you are suffering from depression, something that many other people have gone through, and that you will eventually come out of it, as they did.
7.Get a friend or relative to help you make appointments to see the doctor and provide support both emotional or encouragement to take medication
A Family Doctor’s Tale – Best Yahoo Answer – MUSCLE RELAXANT
Is it possible to gain immunity to muscle relaxants?
when a person gains imunity to medacation can that medication still cause organ failure if still used my friend gained imunity to muscle relaxants but she still takes them can they cuase her organ failure or damage?
Best Answer - Chosen by Voters
No one can get immunity to muscle relaxant. Immunity occurs when you develops antibodies against a virus or bacteria.
If you friend is addicted to muscle relaxant then frequent taking of muscle relaxant may have side effect on your friend. One possibility is organ damage or failure if the muscle relaxant is taken for a long time.
Source(s):
Tuesday, December 14, 2010
A Family Doctor’s Tale – Best Yahoo Answer – UTI
My Doctor Said I Don't have a UTI but...?
I went to the doctors yesterday and I took a urine test and everything looked fine. She said I didn't have a UTI, so I went home and drank cranberry juice like she said. I just woke up this morning and it feels like Iike I have to pee, but I don't.
Thanks.
Best Answer - Chosen by Asker
A urine test at the doctor should normally detect any Urinary Tract Infection. Drinking at least 2 liters of water is the best way to prevent any urine infection.
Source(s):
Monday, December 13, 2010
A Family Doctor’s Tale – Best Yahoo Answer – VITAMIN E
Is there any side effect(kidney stone) for use of vitamin e gel capsules?
any side effect(kidney stone) of using this capsules gels below 400.IU
if not what is the side effect of using unnatural vitamin e
http://images.jupiterimages.com/common/detail/15/08/23040815.jpg
- 2 years ago
Best Answer - Chosen by Voters
No side effects of kidney stones from taking vitamin E. Side effects of excessive Vitamin E may cause damage to the liver as excess Vitamin E may be stored in the liver
Source(s):
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