A Family Doctor's Tale - VITAMIN B12 DEFICIENCY

DOC I HAVE VITAMIN B12 DEFICIENCY

Vitamin B12 (cyanocobalamin) Deficiency is a medical condition caused by the deficiency of the human body of Vitamin B12 as a result of inadequate dietary intake or impaired absorption.

Vitamin B12 is present in all living human tissues as an important  ingredient in the production of red blood cells.

Functions of Vitamin B12:
1.It is important in metabolism of labile methyl groups example biosynthesis of choline and methionine

2.It maintains glutathione in reduced state

3.It is important in the maturation of erythrocytes, neurologic function and growth.

Vitamin B12 is found primarily in
1.animal sources - red meat, liver, milk, egg yolks
2.vegetable sources: Vitamin B12 is found in fresh green and yellow vegetables, cereals

Optimal requirements of Vitamin B12 are:
1.adults and children above puberty: 1 mcg to 2 mcg daily
Pregnant mother and elderly may need double the amount.
2.Infants and children before puberty: 0.5 mcg to 1 mcg daily

Causes:
Vitamin B12 Deficiency occurs
1.when there is Vitamin B12 deficiencies due to
a.diet - starvation, vegetarians

b.malabsorption as in celiac syndrome, sprue or hepatitic cirrhosis


c.intestinal parasites such as diphyllobothrium latum


d.pernicious anemia when the gastric mucosa  cannot produce the intrinsic factor necessary for vitamin B12 absorption

2.Severity of Vitamin B12 deficiency is inversely related to age.
It is more common in elderly people.

Symptoms:
1.Vitamin B12 Deficiency is a silent disease in the early stages.
People with Vitamin B12 Deficiency often do not know that they have the condition.

2.Blood - anemia with pallor, shortness of breath and weakness


3.Brain -subacute combined degeneration of spinal cord and brain

  - numbness of hands and feet

                 -giddiness

                 -developmental delays and failure to thrive in children

4.Mental -depression, fatigue, mental confusion

Diagnosis:
1.Blood Vitamin B12 levels are low

Complications:

Serious complications of vitamin B12 deficiency include:

1.anemia

2.nerve damage

3.abnormalities in growth and development

4.brain dysfunction including depression and dementia

Treatment:
The goal of Vitamin B12 Deficiency treatment is the prevention of pernicious anemia and peripheral neuropathy.

Therefore, prevention of Vitamin B12 Deficiency is as important as treatment. Vitamin B12 Deficiency treatment and prevention measures are:

Medications:
Vitamin B12 supplements
1.Vitamin B12 is given at 100 mcg per day by injection which may be a life long treatment in cases when the body cannot absorb oral Vitamin B12


2.Oral Vitamin B12 tablets can be given in people who can absorb the vitamin in the stomach.

 It can also be given sublingually or through the nasal route.

3.treat the underlying causes such as gastric problems and gastrectomy, malabsorption, decreased intake in the case of vegetarians

Side effects of Vitamin B12 are:
1.Vitamin B12 does not give side effects because being water soluble it is excreted easily in the urine if large doses are ingested

Prognosis:
1.good response to treatment in Vitamin B12 deficiency in early stages.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin B12 Deficiency.

Prevention:
take more red meat, liver, egg yolks, cereals and fresh green vegetables.

Vegetarians should take Vitamin B12 supplements.

A Family Doctor's Tale - VITAMIN B6 DEFICIENCY

DOC I HAVE Vitamin B6 Deficiency

Vitamin B6(pyridoxine) Deficiency is a medical condition caused by the deficiency of the human body of Vitamin B6 as a result of inadequate dietary intake or impaired absorption.

Vitamin B6 is present in all living human tissues as an important  enzymes in amino acid metabolism

Functions of Vitamin B6:
1.It is converted to pyridoxal phosphate a co-enzyme of a seies of enzymes that atalyze tramination, decarboxylation and deamination of amin acids.

Vitamin B6 is found primarily in
1.animal sources - red meat, liver, milk, egg yolks
2.vegetable sources: Vitamin B6 is found in fresh green and yellow vegetables, cereals

It is rare as a isolated Vitamin B6 deficiency.

Optimal requirements of Vitamin B6 are:
1.adults and children above puberty: 1 mg to 2 mg daily
Pregnant mother and elderly may need double the amount.
2.Infants and children before puberty: 0.5 mg to 1 mg daily

Causes:
Vitamin B6 Deficiency occurs
1.when there is Vitamin B6 deficiencies due to
a.diet - starvation,lactating mothers should take more Vitamin B6
b.malabsorption as in celiac syndrome, sprue or hepatitic cirrhosis
c.alcoholism
d.medications such as isoniazid, hydralazine, cycloserine and penicillamine

2.Severity of Vitamin B6 deficiency is inversely related to age.
It is more common in elderly people.

Symptoms:
1.Vitamin B6 Deficiency is a silent disease in the early stages.
People with Vitamin B6 Deficiency often do not know that they have the condition.

2.Skin changes - seborrheic dermatitis of nose, mouth

3.Mucosal changes -oral erosions of the buccal lining

3.peripheral neuropathy

Diagnosis:
1.Blood Vitamin B6 levels are low

Treatment:
The goal of Vitamin B6 Deficiency treatment is the prevention of peripheral neuropathy and skin lesions.

Therefore, prevention of Vitamin B6 Deficiency is as important as treatment. Vitamin B6 Deficiency treatment and prevention measures are:

Medications:
Vitamin B6 supplements
1.Vitamin B6 is given at 5 mg per day orally until the response is adequate.

2.prevention of Vitamin B6 deficiency in people taking isoniazid, hydralazine, cycloserine and penicillinamine

3.Patients with homocystinuria
Side effects are:
1.Vitamin B6 does not give side effects because being water soluble it is excreted easily in the urine if large doses are ingested

2.It should not be given in patients taking levodopa because it antagonizes the effects of the drug.
Prognosis:
1.good response to treatment in Vitamin B6 deficiency in early stages.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin B6 Deficiency.

Prevention:
take more red meat, liver, egg yolks, cereals and fresh green vegetables.

A Family Doctor's Tale - VITAMIN B2 DEFICIENCY

DOC I HAVE Vitamin B2 Deficiency

Vitamin B2(riboflavin) Deficiency is a medical condition caused by the deficiency of the human body of Vitamin B2 as a result of inadequate dietary intake or impaired absorption.

Vitamin B2 is present in all living human tissues as an important anti-oxidant and enzymes in food metabolism

Functions of Vitamin B2:
1.It is necessary for normal growth and development of the fetus

2.It has a role to play in the release of ACTH from the pituitary gland.

3.It share the function with Vitamin A in visual processes.

Vitamin B2 is found primarily in
1.animal sources - liver, milk, egg yolks
2.vegetable sources: Vitamin B2 is found in fresh green and yellow vegetables, cereals

It is rare as a isolated Vitamin B2 deficiency.

Optimal requirements of Vitamin B2 are:
1.adults and children above puberty: 1 mg to 3 mg daily
Pregnant mother and elderly may need double the amount.
2.Infants and children before puberty: 0.5 mg to 1 mg daily

Causes:
Vitamin B2 Deficiency occurs
1.when there is Vitamin B2 deficiencies due to
a.diet - starvation,lactating mothers should take more Vitamin B2
b.malabsorption as in celiac syndrome, sprue or hepatitic cirrhosis

2.Severity of Vitamin B2 deficiency is inversely related to age.
It is more common in elderly people.

Symptoms:
1.Vitamin B2 Deficiency is a silent disease in the early stages.
People with Vitamin B2 Deficiency often do not know that they have the condition.

2.angular stomatitis

3.glossitis

4.cheilosis

5.seborrheic dermatitis

6.corneal lesions

7.In pregnant women, deficiciency of Vitamin B2 can lead to fetal deformities such as shortened bones and deformed growth.

Diagnosis:
1.Blood Vitamin B2 levels are low

Treatment:
The goal of Vitamin B2 Deficiency treatment is the prevention of peripheral neuropathy and heart failure.

Therefore, prevention of Vitamin B2 Deficiency is as important as treatment. Vitamin B2 Deficiency treatment and prevention measures are:

Medications:
Vitamin B2 supplements
1.Vitamin B2 is given at 5 mg per day orally until the response is adequate.

Side effects are:
1.Vitamin B2 does not give side effects because being water soluble it is excreted easily in the urine if large doses are ingested

Prognosis:
1.good response to treatment in Vitamin B2 deficiency in early stages.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin B2 Deficiency.

Prevention:
take more liver, egg yolks, cereals and fresh green vegetables.

A Family Doctor's Tale - VITAMIN B1 DEFICIENCY

DOC I HAVE Vitamin B1 Deficiency

Vitamin B1(thiamine) Deficiency is a medical condition caused by the deficiency of the human body of Vitamin B1 as a result of inadequate dietary intake or impaired absorption.

Vitamin B1 is present in all living human tissues as an important enzyme in the metabolism of carbohydrates.

Functions of Vitamin B1:
1.It is also required for metabolism of alpha-ketoacids and pyruvates in its carbohydrate form,

2.It is also a co-enzyme of pyruvate dehydrogenase and alpha-ketoglutarate both essential in carbohydrate metabolism.

3.It is also essential in production of acetylcholine.

4.It also play a part in energy metabolism for neurons and cardiac muscles.

Vitamin B1 is found primarily in
1.animal sources - liver. egg yolks
2.vegetable sources: Vitamin B1 is found in fresh green and yellow vegetables, cereals, whole grains and potatoes.

Unfortunately most of the active ingredients of Vitamin B1 is lost in cooking.

Optimal requirements of Vitamin B1 are:
1.adults and children above puberty: 1 mg daily
Pregnant mother and elderly may need double the amount.
2.Infants and children before puberty: 0.5 mg daily

Causes:
Vitamin B1 Deficiency occurs
1.when there is Vitamin B1 deficiencies due to
a.diet - starvation,lactating mothers should take more Vitamin B1
b.malabsorption as in celiac syndrome, sprue or hepatitic cirrhosis

2.Severity of Vitamin B1 deficiency is inversely related to age.
It is more common in elderly people.

Symptoms:
1.Vitamin B1 Deficiency is a silent disease in the early stages.
People with Vitamin B1 Deficiency often do not know that they have the condition.

2.Vitamin B1 deficiency can result in 2 major illnesses:
A.Beri Beri
1.peripheral neuropathy affective all the peripheral nerves
2.muscle weakness
3.anorexia
4.heart failure
5.aphonia and absent tendon reflexes in infants

B.Wernicke's Syndrome
1.Occurs in severe Vitamin B1 deficiency
2.brain hemorrhage
3.mental confusion
3.aphonia
4.weakness of sixth nerve
5.total opthalomoplegia (blindness)
6.coma and death

Diagnosis:
1.Blood Vitamin B1 levels are low

Treatment:
The goal of Vitamin B1 Deficiency treatment is the prevention of peripheral neuropathy and heart failure.

Therefore, prevention of Vitamin B1 Deficiency is as important as treatment. Vitamin B1 Deficiency treatment and prevention measures are:

Medications:
Vitamin B1 supplements
1.Vitamin B1 is given at 5 mg to 30 mg per day orally until the response is adequate.

Side effects are:
1.Vitamin B1 may cause anaphylactic reactions when given intravenously.

Prognosis:
1.good response to treatment in Vitamin B1 deficiency in early stages.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin B1 Deficiency.

3.Heart failure in beri beri may not respond to digoxin

4.Cardiac beri beri and Wernicke's disease may be fatal if left untreated.

Prevention:
take more liver, egg yolks, cereals and fresh green vegetables.

A Family Doctor's Tale - FOLIC ACID DEFICIENCY

DOC I HAVE FOLIC ACID DEFICIENCY


Folic acid Deficiency is a medical condition caused by the deficiency of the human body of Folic acid as a result of inadequate dietary intake or impaired absorption.

Every one needs Folic acid which is essential to build the red blood cells of the human body.

Folic acid which is also a B Vitamin is found primarily in
1.animal sources - liver , kidneys, egg yolks


2.vegetable and fruit sources: dark green leafy vegetables such as spinach,asparagus, brocolli ,fresh and dried beans,

fruits such as papaya, oranges , cantaloupe

and yeast

Optimal requirements of Folic acid are:
1.adults and children above puberty: 100mg daily
Pregnant mothers requires more folic acid (400-500mg per day)
2.Infants and children before puberty: 5omg daily

Functions of Folic acid:
1.Folic acid is essential for production of red blood cells together with Vitamin B12, iron, minerals, Vitamin C and protein.

2.Folic acid is also needed for growth and reproduction

3.Folic acid is needed for stimulating the brain cell function and has been used to prevent dementia.

Causes of Folic acid Deficiency:
Folic acid Deficiency occurs
1.when there is Folic acid deficiencies due to
a.diet - folic acid is just sufficient in normal western diet


b.malabsorption as in celiac syndrome, sprue or hepatic cirrhosis


c.malignancy affects the absorption of folic acid


d.oral contraceptive may affect the absorption of folic acid

2.Severity of Folic acid deficiency is inversely related to age.
It is more common in elderly people.

Symptoms of Folic acid deficiency:
1.Folic acid Deficiency is a silent disease.
People with Folic acid Deficiency often do not know that they have the condition.

2.macrocytic anemia - low hemogloblin, enlarged red blood cells, pallor


3.Mucosa - mucosal membrane lesions such as aphthous ulcers .

4.Growth-growth retardation and anemia is common in children with Folic acid deficiency

5.diarrhea - may occurs as a result of mucosal lesions in the intestinal walls


6.Mental-Brain dysfunction may occur in children and elderly with Folic acid deficiency.

Diagnosis of Folic acid deficiency:
1.Blood Folic acid levels are low

Treatment of Folic acid deficiency:
The goal of Folic acid Deficiency treatment is the prevention of anemia and mucosal lesions

Therefore, prevention of Folic acid Deficiency is as important as treatment.

Folic acid Deficiency treatment and prevention measures are:

Medications:
Folic acid supplements
Folic acid is given at 250 to 5000 mg per day orally until the response is adequate.

Side effects are negligible

Prognosis of Folic acid deficiency:
1.good response to treatment in folic acid deficiency.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Folic acid Deficiency.

A Family Doctor's Tale - VITAMIN C DEFICIENCY

DOC I HAVE VITAMIN C DEFICIENCY

Vitamin C Deficiency is a medical condition caused by the deficiency of the human body of Vitamin C as a result of inadequate dietary intake or impaired absorption.

Vitamin C or ascorbic acid is present in all living human tissues as an important antioxidant compound of cell metabolism.

It is unfortunately rapidly destroyed by heating in the presence of air.

Vitamin C is found primarily in
1.animal sources - animal organs such as liver and adrenals.


2.vegetable and fruit sources: Vitamin C is found in fresh green and yellow vegetables and fruits such as tomatoes, papaya, oranges, blackberries etc.

Optimal requirements of Vitamin C are:
1.adults and children above puberty: 70 mg daily
2.Infants and children before puberty: 30 mg  daily

Functions of Vitamin C:
1.Vitamin C together is essential for the formation and maintenance of intercellular substances such as connective tissue, bones and cartilage.

2.Vitamin C is involved in the hydroxylation of proline to hydroxyproline which helps in wound healing.

3.Vitamin C stimulates defenses of the body to form antibodies and activates reticuloendothelial system.(walls of the blood vessels)

It is therefore useful in the prevention of people with low immunity to illnesses.

4.Vitamin C also strengthen the walls of the capillaries and blood vessels preventing bleeding.

5.Vitamin C transport iron from transfer into ferritin a precursor of hemoglobin.

6.Vitamin C also interacts with folic acid, iron, Vitamin B12 and protein and other minerals to form the red blood cells.

Causes of Vitamin C Deficiency :
Vitamin C Deficiency occurs
1.when there is Vitamin C deficiencies due to
a.diet - lactating mothers should take more Vitamin C
b.malabsorption as in celiac syndrome, sprue or hepatic cirrhosis
c.rapid loss of Vitamin C from the body

2.Severity of Vitamin C deficiency is inversely related to age.
It is more common in elderly people.

Symptoms of Vitamin C Deficiency :
1.Vitamin C Deficiency is a silent disease.
People with Vitamin C Deficiency often do not know that they have the condition.

2.Mucous membrane-swelling and bleeding of gums a condition called scurvy.

3.Skin- hyperkeratosis and metaplasia of skin and mucous membrane may occur and lead to increased susceptibility to infection.

4.Body function-weakness and fatigue

5.Mental-Brain dysfunction may occur in children with Vitamin C deficiency.

Diagnosis of Vitamin C Deficiency :
1.Blood Vitamin C levels are low

Treatment of Vitamin C Deficiency :
The goal of Vitamin C Deficiency treatment is the prevention of bleeding mucosa,gum and skin problems, and general immunity to illnesses.

Therefore, prevention of Vitamin C Deficiency is as important as treatment. Vitamin C Deficiency treatment and prevention measures are:

Medications:
Vitamin C supplements
Vitamin C is given at 50 mg to 100 mg per day orally until the response is adequate.

In fact the Chemistry nobel laureate Linus Pauling has advocated the daily dosage of Vitamin C of 1000mg to 5000mg daily as a prevention to colds and influenza.
However such high dosage treatment has been known to have strong side effects and is still controversial.

Side effects are:
1.Vitamin C is only excreted in the urine and such high dosage of Vitamin C being acidic can damage the kidneys.

2.Precipitation of uric acid stones can also occur

3.Gastric problem may occur as Vitamin C is a strong acid

Prognosis of Vitamin C Deficiency :
1.good response to treatment in vitamin C deficiency.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin C Deficiency.

Prevention of Vitamin C Deficiency :
take more fresh fruits and vegetables.

A Family Doctor's Tale - VITAMIN E DEFICIENCY

DOC I HAVE VITAMIN E DEFICIENCY

Vitamin E Deficiency is a medical condition caused by the deficiency of the human body of Vitamin E as a result of inadequate dietary intake or impaired absorption.

Vitamin E is present in all living human tissues as an important fat soluble antioxidant compound of cell metabolism.

It also help to control membrane premeabilty and stability.

It may have a role in the normal differentiation of fetal tissues.

In laboratories it has been found to increase fertilty in mice.

Vitamin E is found primarily in
1.animal sources - eggs, butter and milk.
2.vegetable sources: Vitamin E is found in fresh green and yellow vegetables and cereals.

Optimal requirements of Vitamin E are:
1.adults and children above puberty: 30 mg to 60 mg daily
Pregnant mother and elderly may need double the amount.
2.Infants and children before puberty: 0.5 mg per kgm daily
Infants can get sufficient Vitamin E in breast milk

Functions of Vitamin E:
1.Vitamin E together is essential for the formation and maintenance of intercellular substances such as connective tissue, bones and cartilage.

2.Vitamin E is involved in the skin wound healing

3.Vitamin E improves the blood circulation in the human body

It is therefore useful in the prevention of people with low immunity to illnesses.

4.Vitamin E also interacts with Vitamin C, folic acid, iron, Vitamin B12 and protein and other minerals to form the red blood cells.

Causes of Vitamin E Deficiency:
Vitamin E Deficiency occurs
1.when there is Vitamin E deficiencies due to
a.diet - lactating mothers should take more Vitamin E
b.malabsorption as in celiac syndrome, sprue or hepatitic cirrhosis

2.Severity of Vitamin E deficiency is inversely related to age.
It is more common in elderly people.

Symptoms of Vitamin E Deficiency:
1.Vitamin E Deficiency is a silent disease.
People with Vitamin E Deficiency often do not know that they have the condition.

2.Mucous membrane-mucosa of the internal organs is affected by deficiency of Vitamin E

3.Skin- hyperkeratosis and metaplasia of skin  may occur and lead to increased susceptibilty to infection.

4.Body function-weakness and fatique

Diagnosis of Vitamin E Deficiency:
1.Blood Vitamin E levels are low

Treatment of Vitamin E Deficiency:
The goal of Vitamin E Deficiency treatment is the prevention of increased fragility of red blood cells and low Vitamin E.

Therefore, prevention of Vitamin E Deficiency is as important as treatment. Vitamin E Deficiency treatment and prevention measures are:

Medications:
Vitamin E supplements
Vitamin E is given at 37.5 mg to 45 mg per day orally until the response is adequate.

There is no proof that Vitamin E is useful to prevent heart disease or help in fertilty.

Side effects are:
1.Vitamin E may enhance anticoagulant activity and cause hemorrhage in bleeding prone patients.

2.nausea

3.headache

4.poor vision

5.fatique

Prognosis of Vitamin E Deficiency:
1.good response to treatment in Vitamin E deficiciency.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin E Deficiency.

Prevention of Vitamin E Deficiency:
take more diary products,cereals and vegetables.

A Family Doctor's Tale - VITAMIN A DEFICIENCY

DOC I HAVE VITAMIN A DEFICIENCY

Vitamin A Deficiency is a medical condition caused by the deficiency of the human body of Vitamin A as a result of inadequate dietary intake or impaired absorption.

Vitamin A (retinol) is found primarily in
1.animal sources - fish liver oil, liver , dairy products and meat.
2.vegetable sources: Vitamin A precursor (carotene) is found in green and yellow vegetables and fruits such as tomatoes, carrots. papaya, etc.
However only one third of the carotene is converted to Vitamin A.

Optimal requirements of Vitamin A are:
1.adults and children above puberty: 5000IU daily
2.Infants and children before puberty: 1500-2500 IU daily

Functions of Vitamin A:
1.Vitamin A together with protein opsin form the light-sensitive
pigments in the cones and rods of the retina and is thus important for clear vision.

2.Vitamin A also acts to maintain the integrity of epithelial tissues and mucous membranes by preventing metaplasia of the squamous type. It is therefore important for good skin function.

3.Vitamin A is also peripheral antagonist to estrogen.
It is therefore useful in the treatment of people with overly high
estrogens.

Causes of Vitamin A Deficiency:
Vitamin A Deficiency occurs
1.when there is vitamin A deficiencies due to
a.diet - insufficienct vitamin C in diet
b.malabsorption as in celiac syndrome, sprue or hepatitic cirrhosis
c.Failure to convert carotene to Vitamin A
d.rapid loss of Vitamin A from the body

2.Severity of Vitamin A deficiency is inversely related to age.
It is more common in elderly people.

Symptoms of Vitamin A Deficiency:
1.Vitamin A Deficiency is a silent disease.
People with Vitamin A Deficiency often do not know that they have the condition.

2.Vision-Initial manifestation of inadequate Vitamin A may be night blindness with progression to xeropthalmia and keratomalacia.
Corneal perforation may occur followed by blindness.

Bitot's spots which are superficial patches exposed bulbar conjunctiva are a pathognomic changes of Vitamin A deficiciency in the eye.

3.Skin- hyperkeratosis and metaplasia of mucous membrane may occur and lead to increased susceptibilty to infection.

Reversal of corticosteroid induced impairment of wound healing has been reported after topical application of Vitamin A.

4.Growth-growth retardation, loss of appetite and anemia is common in cildren with Vitamin A deficiciency

5.Mental-Brain dysfunction may occur in children with Vitamin A deficiciency.

Diagnosis of Vitamin A Deficiency:
1.Blood Vitamin A levels are low

Treatment of Vitamin A Deficiency:
The goal of Vitamin A Deficiency treatment is the prevention of vision defects and skin problems.

Therefore, prevention of Vitamin A Deficiency is as important as treatment. Vitamin A Deficiency treatment and prevention measures are:

Medications:
Vitamin A supplements
Vitamin A is given at 25.000 to 50,000 IU per day orally until the response is adequate.

Side effects are:
1.painful and tender swellings of the bones

2.dry rough skin

3.headache

4.weakness

5.liver and spleen enlargement

6.Massive overdosage of Vitamin A may lead cerebral edema, liver failure, convulsions and death

Prognosis of Vitamin A Deficiency:
1.good response to treatment in vitamin A deficiciency.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin A Deficiency.

3.eye damage may not be reversible

4.Overdosage symptoms usually disappear within 1-4 weeks after stopping high vitamin A dosage.

A Family Doctor's Tale - OSTEOMALACIA

DOC I HAVE OSTEOMALACIA

Osteomalacia is a metabolic bone condition in adults characterized by the lack of nineralization of the bone or osteoid matrix although the osteoid is otherwise normal and the osteoid bone is unaltered.

Causes:
Osteomalacia occurs
1.when there is vitamin D deficiencies due to
a.diet
b.malabsorption

2.Vitamin D deficiecy is common in the elderly especially people who have dark skin and are not exposed to the sun

3.Malabsorption of Vitamin D may occur in gluten enreropathy or post gastectomy

4.Renal disease and anticonvulsant drugs may reduce the formation of active metabolites of vitamin D

5.Certain medications can cause Osteomalacia. These include long-term use of heparin (a blood thinner), anti-seizure medications phenytoin (Dilantin) and phenobarbital, and long term use of oral corticosteroids (such as Prednisone).

6.Rarely calcium deficiecy is a cause of osteomalacia

Symptoms:
1.Osteomalacia is a silent disease.
People with Osteomalacia often do not know that they have the condition.

2.Fractures from Osteomalacia commonly occur in the wrist, spine and hip.
Persons with fractures may complain of pain and deformities as a result of the fractures.

3.Muscle weakness may occur when serum calcium is very low

Diagnosis:
1.Blood calcium and organic phiosphates are low or low normal

2.Blood alkaline phosphatase is increased

3.Blood Vitamin D levels are low

4.X-rays showed typical fractures (Looser zones) in pelvis, long bones, metacarpals and metatarsals

Treatment:
The goal of Osteomalacia treatment is the prevention of bone fractures by stopping bone loss and by increasing bone density and strength.

Therefore, prevention of Osteomalacia is as important as treatment. Osteomalacia treatment and prevention measures are:

A.Lifestyle Changes:
Exercise has a wide variety of beneficial health effects. However, exercise does not bring about substantial increases in bone density.

B.Medications:
1.Vitamin D
An adequate calcium intake and adequate body stores of vitamin D are important foundations for maintaining bone density and strength.
Vitamin D is important in several respects:

Vitamin D helps the absorption of calcium from the intestines.
A lack of vitamin D causes calcium-depleted bone (osteomalacia), which further weakens the bones and increases the risk of fractures.
Vitamin D, along with adequate calcium (1200 mg of elemental calcium), has been shown in some studies to increase bone density and decrease fractures in older postmenopausal, but not in premenopausal or perimenopausal women.
Vitamin D comes from the diet and the skin.
Vitamin D production by the skin is dependent on exposure to sunlight. Active people living in sunny regions can produce most of the vitamin D they need from their skin.

2.Calcium Supplements
Building strong and healthy bones requires an adequate dietary intake of calcium and exercise beginning in childhood and adolescence for both sexes.
Calcium supplements are safe and generally well tolerated. Side effects are indigestion and constipation.

3.Medications that stop bone loss and increase bone strength, such as
alendronate (Fosamax),
risedronate (Actonel),
raloxifene (Evista),
ibandronate (Boniva),
calcitonin (Calcimar);

Prognosis:
1.good response to treatment in vitamin D deficiciency.

2.treat underlying cause such as malabsorption to get a good response in the treatment of osteomalacia.

A Family Doctor's Tale - ROTATOR CUFF INJURIES

DOC I HAVE A ROTATOR CUFF INJURY


Rotator Cuff Injuries is a common disorder of the shoulder characterized by the injury and damage to the rotator cuff muscles or tendon resulting in pain and restriction of movement.

The rotator cuff muscles consists of 4 muscles that are used to stabilize the shoulder and move the shoulder.

It is more common in people above the age of 40.

The risk of injury increases with age.

The causes of Rotator Cuff Injuries are:
Several conditions has been blamed:
1.Repetitive movements of the shoulder- Swimmers, rowers and tennis players who use repetitive movements are at higher risk of rotator cuff injuries.

2.Heavy lifting or pulling:lifting and pulling an object that is too heavy or lifting in the wrong way can cause a strain or tear to the rotator cuff muscle or tendon.

Household tasks such as carrying a heavy load, lifting things overhead or hanging the clothes out may also cause rotator cuff injury.

3.Normal wear and tear- with age the blood supply to the tendons of the rotator cuff muscles is reduced resulting in degeneration of the cuff muscles and tendons.
This degeneration can be aggravated if there is repetitive shoulder movements resulting in a tear in the tendons or muscles.

4.trauma - injury to the rotator muscles such as a fall or direct hit to the shoulder muscles may cause a tear in the muscles resulting in tightening of the injured muscles around the shoulder joint.

5.Poor posture. Sloughing forward of the head and neck cause the rotator muscles to be strained leading to inflammation and tears.

Symptoms:
1.Pain in the shoulder when lifting the arm

2.Pain can occur when trying to comb the hair

3.Certain movements makes the pain worse

4.weakness and tenderness of the the shoulder with pain when sleeping on the affected arm

5.complaints of stiffness of the shoulder and loss of range of movement of the shoulder

6.inability to wear a shirt or blouse because of restricted movements

Signs:
1.apprehensive patient who holds the arm protectively

2.Generalized tenderness of rotator cuff

3.Limited shoulder movement

4..Range of muscle movement is reduced in all directions

Diagnosis:
1.history of a fall or injury followed by limitation of movement of the shoulder

2.Ultrasound and MRI will show if there a tear is present as it can identify all rotator tears from degeneration to partial or complete tears

The Treatment of Rotator Cuff Injuries are:
Conservative treatment:
1.rest of the shoulder

2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

3.Muscle relaxant to relax muscles

4.injection of local anesthetic and long acting steroid into the rotator cuff muscle may help to relieve pain.

5.Physiotherapy such as traction, shortwave diathermy help to increase shoulder strength and improve flexibility

6.gradual mobilization and exercises to loosen the tight muscles surrounding the shoulder

Surgery is usually indicated in Rotator Cuff Injuries if the condition does not improve with conservative treatment.

A keyhole or arthroscopic repair is done to remove the torn edges of the cuff muscles and retach them to the bone using absorbable or metal anchors.

After surgery patients are put in a sling or brace.

Physiotherapy starts the day after surgery.

Prognosis depends on the underlying cause.

In most cases Rotator Cuff Injuries may resolve itself with conservative treatment

A Family Doctor's Tale - SEPTIC ARTHRITIS

DOC I HAVE SEPTIC ARTHRITIS

Septic Arthritis is an infection of the joint by pyogenic bacteria.

The most common causes of Septic Arthritis is

1.Staphylococcus aureus bacteria(80%).

Other bacteria involved are:

2.Streptococci Group A & B

3.Enterobacter species

4.Haemophilus influenzae

5.Pneumococci

6.Pseudomonas

Anerobic infections may also cause Septic Arthritis.

Predisposing conditions of Septic Arthritis are:
1.injury to the joint is the most common cause.

The joint injury is exposed to local infection in the skin or environment.

Staphylococcus aureus is the most common bacteria in Septic Arthritis resulting from bone injury and infection.

2.Diabetes mellitus in adults.

3.rheumatoid arthritis

4.steroid therapy

5.Joint infection in adults are usually due to their lower resistance from
a.debilitation,


b.intravenous drug abuse,


c.infectious root-canaled teeth,


d.other disease or drugs (e.g. immunosuppressive therapy).

Symptoms of Septic Arthritis:
1.pain and swelling of the joint  

Joint is hot, swollen with effusion, very tender and limited mobility

2.fever and chills

3.systemic signs of infection

Signs of Septic Arthritis:
1.Hot tender joints

2.Throbbing pain of bones in joints

3.Abscess and swelling

Diagnosis of Septic Arthritis is often based on

1.Blood ESR is raised and high polymorph leucocytes

2.Blood and joint fluid cultures are normally required to identify the specific pathogen

3.X-rays are normal at first but later show osteoporotic changes

The complications of Septic Arthritis are:

1.damage of the bones in the joint,

2.osteomyelitis

3.sepsis

Treatment of Septic Arthritis:
1.antibiotic therapy  - must be started immediately even before culture results are back and continued usually as prolonged treatment lasting a matter of weeks or months until the infection is clear.

2.Splinting or immobilization of the affected joint to prevent movement

3.Aspirations of the infected joint fluids

4.Hyperbaric oxygen therapy has helped in the treatment of refractory Septic Arthritis.

5..Septic Arthritis may also need open surgical debridement to remove pus and damaged bone tissues if infection do not respond to antibiotics.

6.Physiotherapy may be required to restore joint range and muscles once the infection has cleared up.

6.Severe cases may lead to the loss of a limb.

Prognosis of Septic Arthritis depends on the rapidity of onset of treatment.

The faster the treatment the faster the cure.

Otherwise the condition may become a chronic illness requiring multiple surgical procedures.

Prevention of Septic Arthritis is to avoid infection of the skin near the joints or injury to the joints.

Treatment of underlying conditions such as diabetes is important.

A Family Doctor's Tale - GANGLION

DOC I HAVE A GANGLION

GANGLION or ganglion cyst is a cyst found next to tendon sheath or joint.

It may occur at any part of the body but is most common on the dorsum of the hand or foot.

The cause of the ganglion is unknown but the cyst contains a mucinous material like from a tendon sheath or joint.

It has a stalk that can be traced to a tendon sheath or joint.

Ganglion cysts are seen in children but frequently disappear spontaneously in this age group in 2 to 3 years.

Symptoms of the ganglion cyst:
1.The onset is usually related to a history of trauma.

2.local pain and swelling at the dorsum of affected hand or foot

3..feeling of weakness of the affected hand or foot

4.swelling usually increase in size in relation to activity of patient.

Physical examination of the ganglion cyst:
1.hard swelling on the dorsum of hand or foot often described as a small bony swelling

2.the ganglion is freely movable on the affected hand or foot

3.the ganglion is most obvious when the hand or foot is flexed.

Treatment of the ganglion cyst:
1.Aspiration of the ganglion cyst under local anesthesia.

2.Punctuate the ganglion with a large sterile needle in many areas in the hope that the mucinous fluid may be forced out through the many needle holes

3.injection of the ganglion cyst can be done with a steroid compound

4.After the above procedures, a compression dressing is applied for 48 to 72 hours.

5.Some alternative medical advocates even suggest hitting the ganglion cyst with a wooden hammer to burst the cyst and allow the fluid to flow out under the skin.

Surgery:
1.Surgery is done only as a last resort or if symptoms persist.
Excision of the ganglion is done under local anesthesia however occasional damage to the nerve or tendon may complicate the surgery.

Prognosis:
generally good but recurrence are not uncommon.

A Family Doctor's Tale - ARTICULAR CARTILAGE INJURY

DOC I HAVE ARTICULAR CARTILAGE INJURY

Articular Cartilage Injury is a common disorder of the knee caused by damage of the surface of the cartilage covering of the knee.

It can also occur from wear and tear through repeated friction of the cartilage resulting in chronic wear and tear or direcr trauma.

The carticular cartilage acts to allow frictionless movement of the bone against another and performs also as a shock absorber during weight bearing activities.

The causes of Articular Cartilage Injury are:
Several conditions has been blamed:
1.Repetitive movements of the knee-soccer players who use repetitive movements are at higher risk of Articular Cartilage Injury as well as meniscus tears.

2.Chronic wear and tear- with age the blood supply to the knee is reduced resulting in degeneration of the the articular cartilage of the knee.

3.trauma - injury to the articular cartilage such as a fall or direct hit to the knee

4.Obesity cause more weight bearing effect on the articular cartilage

The symptoms and signs of Articular Cartilage Injury are:
Symptoms:
1.Recurrent Pain in the knee

2.Swelling of the knee

3.Difficulty in bending or straightening the knee

4.audible clicks on knee movement

5.difficulty in walking because of the pain

Diagnosis:
1.history of a fall or injury followed by limitation of movement of the knee

2.MRI will show if there is articular cartilage damage

The Treatment of Articular Cartilage Injury is:
Conservative treatment:
1.rest,elevation and ice compress treatment of the knee upon injury

2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain relief and reducing inflammation

3.Muscle relaxant to relax muscles

4.crutches can reduce the weight off the affected limb

5.Physiotherapy such as traction, shortwave diathermy help to increase knee muscle strength and improve flexibility of movement of the knee

Surgery is usually indicated in Articular Cartilage Injury if the condition does not improve with conservative treatment.
1.A keyhole or arthroscopic microfracture repair is done to fill the defect in the cartilage with stem cells

2.Osteochondral graft transfer techniques where plugs of cartilage together with the bone foundation are taken from a less critical of the knee and transplanted to cover the defect in the cartilage.

3.Autologous cartilage implantation techniques where cartilage cells harvested from the knee , grown and multiplied in the laboratory are tranfered back into the joint to cover the defect.

Physiotherapy starts the day after surgery.

Prognosis depends on the severity of the cartilage injury

In most cases Articular Cartilage Injury may recover with conservative methods.
Some cases however may require surgical treatment

Prognosis is good after surgical treatment.

Prevention is to avoid weight bearing, reduce obesity and muscle strengthening exercises.

A Family Doctor's Tale - FLAT FOOT

DOC I HAVE FLAT FOOT

Flat Foot is a common disorder of the foot characterized by the depression or loss of the medial longitudinal arch of the foot.

It is usually associated with valgus of the foot or eversion of the heel and abduction of the forefoot.

It is also associated with a tight Achilles tendon.
 
The cause of Flat Foot is :
1.hereditary and associated with hypermobilty of the other joints

2.a rupture of the posterior tibial tendon

Symptoms:
1.Pain in the foot especially when standing for a prolonged period

2.easy fatigabilty of the foot.
 
3.Certain weight bearing exercises like jogging or brisk walking makes the pain worse

Signs:

1.absence of the medial arch is present

2.hypermobility of the foot is apparent

3.mild genu valgum (knock knee) or internal tibial torsion is also present.

4.Xrays of the foot usually show a loss of the normal arch and plantar flexion of the talus.

Complications:
1.mild deformity of the foot

2.strain on the back (lumbar spine) with prolonged standing

3.heel cord contractures

Conservative treatment:
1.no treatment is usually necessary if mild

2.shoe correction may help temporarily

3.Exercises to stretch and loosen tigh heel cords

4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

5.Muscle relaxant to relax muscles especially the back

Surgery:

Surgery is usually not indicated in Flat Foot.
Rarely surgery is to tighten the muscles supporting the medial arch of the foot only for severe cases with symptoms of pain and to prevent complcations.

Prognosis:
There is no cure for flat foot but surgery may help in severe cases to prevent complcations.

Prevention:
avoid prolonged standing

use shoes with medial arch correction pads

A Family Doctor's Tale - ACHILLES TENDINITIS

DOC I HAVE ACHILLES TENDINITIS

Achilles Tendinitis is the inflammation and swelling of the Achilles tendon .

The cause of Achilles Tendinitis is due:

1.Injury or trauma to the Achilles tendon-minor tears in the tendon of these muscles are always present in injury

2.Repetitive over usage of Achilles tendon especially in a runner

The symptoms and signs of Achilles Tendinitis are:

Onset is usually gradual unless due to injury

Symptoms:
--------------

1.Pain on movement of the Achilles tendon

2.Swelling of the Achilles tendon affected at the lower leg and heel
 
3.Stiffness of the Achilles tendon  - inability to stretch

4.Pain often radiates into the foot

Signs:

1.swelling of the affected Achilles tendon

2.pain and local tenderness of the affected Achilles tendon

3.dry crepitus on movement of the Achilles tendon is present
 
4. X-rays are usually normal although an ultrasound may show minor tears in the tendon.

The complications of Achilles Tendinitis are:

Fibrosis and rupture of the inflammed Achilles tendon of the heel area may occur leading to loss of function of the tendon in lifting the foot resulting in a drop foot.
The Treatment of Achilles Tendinitis is:

Conservative treatment:
1.rest of the tendon

2.hot compress may help reduce inflammation

3.Splints or bandaging of the tendon and heel area and ankle to rest the tendons

4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

5.Muscle relaxant to relax muscles

6.local injection of local anesthetic and long acting steroid should be avoided because of danger of rupture of tendon.

7.Avoid overusage of the Achilles tendon

Surgery :

Surgical reattachment of Achilles tendon may be necessary if torn .
The prognosis of Achilles Tendinitis is:

Prognosis is usually good although recurrence may occur.

The prevention of Achilles Tendinitis is by:

1. Avoiding any strenuous exercises

 

A Family Doctor's Tale - COCCYX INJURIES

DOC I HAVE A COCCYX INJURY

Coccygeal Injuries consist of Dislocation and fractures.

Dislocation of the coccyx is the dislocation of the coccyx bone forward following falls on the coccyx or repetitive injury to the coccyx.

The coccyx is the tail end of the spine and consists of 3-5 segments which angulates forward to a variable degree.

Fractures of the coccyx may occur as a result of traumatic separation of the segments of the coccyx due to injury.

The cause of Coccygeal Dislocation and fractures is due to:

1.Injury or trauma to the coccygeal bone from falls on the buttocks

2.Repetitive pressure on the coccyx during delivery of the baby during chuildbirths. Fibrosis and stiffness of the coccyx may result from the pressure on the coccyx.

3.Sitting in a slumping position may cause the tip of the coccyx to press upwards giving rise to pain.

The symptoms and signs of Coccygeal Injuries are:

Onset is usually gradual unless due to acute injury

Symptoms:

1.Pain on sitting on the coccyx

2.pain is aggravated by slumping or sitting on a hard seat
 
3.pain is also aggravated by constipation

4. the symptoms are more common in women.

Signs:

1.local tenderness on palpation of the coccyx bone and the side soft tissues

2.deformity of the cocygeal bone

3.rectal examination often reveal pain on sacrococcygeal movements
 
4.X-rays may show dislocation of the coccygeal bone inwards or bony ankylosis with the sacral bone.
Sometimes fractures of the tip of the coccygeal bone may be present.
Osteoarthritis may be noted at the sacrococcygeal joint.

The complications of Coccygeal Injuries are:
Fibrosis and inflammation of the coccyx bone.

The Treatment of Coccygeal injuries is:
Conservative treatment:
1.reduction of the dislocation or fractures of the coccyx bone can be done under local anesthesia

2.Pain can be relieved by sitting a warm sitz bath and a soft doughnut shaped pillow

3.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) are given for pain

4.Muscle relaxant to relax muscles

5.local injection of local anesthetic and long acting steroid can be given for chronic strain or osteoarthritis.

6.constipation should be avoided

All acute injuries of the coccyx are treated conservatively for at least 6 months even with significant angulation of the coccyx bone.

Surgery :

Surgical excision of the coccyx is done only if there is severe pain or in patients who do respond to conservative treatment.

The prognosis of Coccygeal Dislocation is:

Prognosis is usually good although recurrence may occur.

The prevention of Coccygeal Injuries are:
1. Avoid any falls on buttocks

2. sitting in a slumping position.

A Family Doctor's Tale - OLECRANON BURSITIS

DOC I HAVE OLECRANON BURSITIS

Olecranon Bursitis is the inflammation or infection of the bursa at the olecranon which form part of the elbow joint.
 
The cause of Olecranon Bursitis is:

The Olecranon bursa overlies the olecranon process and is extremely vulnerable to:
1.Direct Injury or trauma to the bursa resulting in a painful swelling in the olecranon tip.

The bursa sac fills up with blood or clear fluid giving rise to swelling and pain.

Infection of the bursa may then occur with pus formation.

2.Repeated irritation of the bursa from rubbing of the elbow against the table or desk or wall.

With repetitive trauma or irritation a chronic inflammatory reaction may occur that results in the formation of a thickened rubbery bursa .

This swelling is usually not painful.

The symptoms and signs of Olecranon Bursitis are:

Symptoms:
1.Painful swelling at the tip of the elbow

2.Hardened Rubbery Swelling at the olecranon.
 
3.Stiffness of the elbow - inability to stretch

Signs:

1.swelling localized at the olecranon of the elbow

2.Palpation of swelling may be a tender fluid filled swelling in the acute case

3.In the chronic bursa palpation may reveal multiple small hard nodules that feel like loose bodies.

These are not loose bones but are villous thickenings of the bursa.

4. X-rays are usually normal.

The complications of Olecranon Bursitis are:

Olecranon bursitis can give rise to a chronic infection of the elbow which if not treated properly may lead to infection of the bone and generalized sepsis.

The Treatment of Olecranon Bursitis is:

Conservative treatment:
1.Aspiration of the bursa's fluid or blood under local anesthesia.
Sometimes pus may be aspirated.
Recurrence of bursitis is quite common
Sometimes the bursa may dry up by itself.

2.Aspiration followed by compression dressing or splinting may help to prevent recurrence of formation of the fluid.

3.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) can be given for pain in acute infections of the bursa

4.Antibiotics are given to stop infections and inflammation

Surgery :
Surgical removal of the bursa may be necessary if conservative treatment does not work.

Incision and drainage usually do not help because a chronic draining infection often results.

The prognosis of Olecranon Bursitis is:

Prognosis is usually good with repeated aspirations of the bursa or through surgical removal of the bursa.

The prevention of Olecranon Bursitis is :

1. Avoid any physical exercises which can cause injury to the bursa area of the elbow 

A Family Doctor's Tale - TENNIS ELBOW

DOC I HAVE TENNIS ELBOW

Tennis Elbow (also known as epicondylitis) is the inflammation and swelling of the tendon sheaths (called the synovium) and the enclosed tendons at the origin of the flexor muscles at the medial epicondyle or extensor muscles at the lateral epicondyle of the elbow.

The lateral epicondyle of the elbow is more commonly affected.


The cause of Tennis Elbow is unknown.

Some possible causes are:
1.Injury or trauma to the tendon-minor tears in the tendon attachment of these muscles are always present

2.Repetitive usage of extensor or flexor muscles of the forearm

3.Arthritis of the elbow joints may predispose to Tennis Elbow

4.Systemic diseases such as multiple sclerosis ,amyloidosis, rheumatoid arthritis

The symptoms and signs of Tennis Elbow are:

Onset is usually gradual.
Symptoms:
1.Pain on movement of the tendon of the muscles of elbow

2.Swelling of part of the tendon affected at the elbow joint

3.Stiffness of the tendon of the elbow - inability to stretch

4.Pain often radiates into the forearm

Signs:
1.swelling and pain localized at the epicodyle of the elbow

2.Rotation and grasping such as using a screwdriver or opening a jar aggravates the pain

3.There may be local tenderness of the inflammed tendon.

4.Extension or flexion of the hand against resistance can cause pain at the affected epicondyle of the elbow

5. X-ray s are usually normal although a traction spur may be present.

The complications of Tennis Elbow are:
Fibrosis and rupture of the inflammed tendon of the muscles of the elbow may occur leading to loss of function of the elbow.

The Treatment of Tennis Elbow is:

Conservative treatment:
1.rest of the tendon

2.Cold or ice may help reduce inflammation

3.Splints over the hand, wrist and elbow may help to rest the tendons

4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

5.Muscle relaxant to relax muscles

6.injection of local anesthetic and long acting steroid into the affected area may help to reduce inflammation

7.Avoid overusage of the tendons and muscles of the elbow

Surgery :
Surgical reattachment of torn muscles of the elbow may be necessary if conservative treatment does not work.

The prognosis of Tennis Elbow is:
Prognosis is usually good although recurrence may occur after cortisone injection.

Surgery usually give excellent results.

The prevention of Tennis Elbow is:
1. Avoid any physical exercises such as tennis or golf which causes repetitative usages of the tendons and muscles of the elbow.

2.Avoid rotation or twisting movement of the muscles of the forearm which can cause minor tears of the tendons or muscles of the elbow.

A Family Doctor's Tale - DISLOCATION OF ELBOW

DOC I HAVE DISLOCATION OF THE ELBOW

Dislocation of the Elbow is a common injury of the elbow.

It is usually posterior in direction and results from a fall on the outstretched hand with the elbow extended.

It is more likely to occur in people who do strenuous physical activities.

The cause of Dislocation of Elbow is:

1.Injury or trauma to the elbow bones from a fall resulting in the humerus end sliding out of the olecranon socket.

2.Somtimes when a child is lifted by the hand or wrist, subluxation of the elbow bones may occur

The symptoms and signs of Dislocation of Elbow are:Symptoms:
Symptoms:

1.Pain and deformity of the  affected elbow

2.Swelling of the affected elbow joint
 
3.Pain often radiates into the forearm

Signs:

1.swelling and difficulty in movement of the elbow

2.typically the other arm is holding on to the affected arm
 
3. X-rays show usually normal bones with displacement of the  locations of the humerus and radius at the elbow joint.
No fractures are seen

The complications of Dislocation of Elbow is:

Deformity and loss of function of the elbow if left untreated.

The Treatment of Dislocation of Elbow is:

Conservative treatment:
1.reduction of the dislocation is done under local anesthesia

2.Use a gentle steady traction on the wrist with counter action on the shoulder.

3.Extend the elbow to unlock the olecranon

4.Bend the elbow slowly and keep it immobilized at 90 degree of flexion in plaster of paris or bandage for at least 3 weeks to allow for ligaments and capsular healing.

5.Do another x-ray to check the position of the elbow joint and exclude fracture during reduction.

5.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) may be given for pain

6.Gentle range of movement exercises are instituted after removal of bandage or plaster of paris

7.Temporary stiffness may be present and recovery may take several months. Motion should never be forced

8.There should be a gradual return of the elbow  to normal movement
and weight bearing.

Surgery :
surgery is never necessary

The prognosis of Dislocation of Elbow is:

Prognosis is usually good  with proper treatment.

The prevention of Dislocation of Elbow is:

1. Avoid any traumatic injury to elbow.

2.Avoid pulled elbow in children

A Family Doctor's Tale -DISLOCATION OF SHOULDER

DOC I HAVE DISLOCATION OF THE SHOULDER

Dislocation of Shoulder is a common injury of the Shoulder.
It is usually anterior in direction and results from a fall on the externally rotated abducted arm.


This forces the humerus out of the glenoid cavity of the shoulder blade into its anterior position.


Posterior dislocation is less common and may results from a force directed against the internally rotated arm.
It may occur during a seizure in patients with convulsive orders.

The cause of anterior Dislocation of Shoulder is:

Injury or trauma to the Shoulder bones from an anterior force directed on the externally rotated abducted arm.

The symptoms and signs of Dislocation of Shoulder are:

Symptoms:
1.Pain and deformity of the Shoulder

2.Acromial protrusion of the Shoulder joint
 
3.Absense of the normal fullness of the humeral head beneath the deltoid and acromial process

Signs:

1.Little and painful movement of the Shoulder

2.typically the other arm is holding on to the affected arm
 
3.With anterior dislocations the arn is held externally rotated, the shoulder is full and internal rotation is painful.

4. X-rays should be taken at different angles and will show usually dislocations of the humerus ball from its socket of the shoulder blade.
No fractures are seen if it is a pure dislocation

The complications of Dislocation of Shoulder are:

Deformity and loss of function of the Shoulder if left untreated.

The Treatment of Dislocation of Shoulder is:

Conservative treatment:
1.reduction of the dislocation is done under local anesthesia
No general anesthesia is needed.

2.Use a gentle steady straight traction on the arm with counter action on the shoulder.

3.Extend the Shoulder under traction to loosen the muscles

4.Flex the Shoulder slowly forward and keep it immobilized at 90 degree of flexion in a sling for 1 to 2 weeks to allow for ligaments and capsular healing.

5.Do another x-ray to check the position of the Shoulder joint and exclude fracture during reduction.

5.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) may be given for pain

6.Gentle range of movement exercises are instituted after symptoms have subsided

7.Temporary stiffness may be present and recovery may take a few months. Movements should never be forced

8.There should be a gradual return to normal movement

Another method of reduction is called the Stimson's method for anterior dislocation:
1.Patient is placed in a prone position on the bed with the affected arm hanging over the side of the bed.

2.A 5kg to 10 kg weight is tied to the wrist for traction.

3.As the shoulder muscle relax, spontaneous reduction frequently occurs.

4.The patient's shoulder is placed in a sling for 1 to 2 weeks to allow for ligaments and capsular healing and the shoulder joint immobilized until it recovers with rehabilitation.

Surgery :
1.Surgery is seldom necessary and requires open reduction under general or regional anesthesia

2.Surgery is also done for correction of recurrent dislocations of the shoulder.

These procedures usually restrict the rotation of the shoulder joint or reinforce the weakened shoulder joint capsule.

The prognosis of Dislocation of Shoulder is:

Prognosis is usually good .

Recurrences of dislocation of the shoulder can occur due to the loosening of the capsule of the shoulder and weakening of its ligaments.

The prevention of Dislocation of Shoulder is:

 Avoid any traumatic injury to Shoulder.

 

A Family Doctor's Tale - KNEE LIGAMENTS INJURY

DOC I HAVE A KNEE LIGAMENT INJURY


Knee Ligaments Injury is a common disorder of the knee caused by damage of the ligaments of the knee.

There are 4 ligaments, 4 bands of tough tissues in the knee to stabilize the joint :

1.Anterior Cruciate Ligaments (ACL) - starts from front of middle of lower tibia to middle of the back of femur
2.Posterior Cruciate Ligaments (PCL)- starts from middle of front of femur to the middle of back of tibia.
3.Medial Collateral ligaments (MCL) located on the inside of the knee
4.Lateral Collareral Ligaments (LCL) located on the outside of the knee

The causes of Knee Ligaments Injury are:
Injury to the knee ligaments are the main cause.

1.Anterior Cruciate ligament of the knee-soccer players who use rapid twisting movements of the knee (as when the knee stops and changes directions suddenly) are at higher risk of Knee Ligaments Injury .
The anterior Cruciate ligaments can also be injured when the twists on landing or as a direct result of a direct contact or collision during a soccer tackle.

2.Posterior Cruciate Ligament of the the Knee- injury to the posterior Cruciate Ligaments of the knee occurs when direct force is applied to the the front of the knee especially when the knee is bent.
The ligament can also be pulled or stretched in a twisting or hyperextension injury.

3.Collateral ligaments - injury to the Collateral Ligaments such as a fall or direct hit to the knee.
It can also occur as a twisting injury.
It can also occur together with ACL and PCL ligaments injury.

4.Obesity cause more strain on the Knee Ligaments

The symptoms and signs of Knee Ligaments Injury are:
Symptoms:
1.Immediate Pain in the knee after injury

2.Swelling of the knee within 1 to 12 hours

3.Difficulty in bending or straightening the knee

4.A popping sound occurs when the anterior cruciate ligament ruptures

5.difficulty in walking because of the pain

6.instability in the knee with the joint giving way during sport or daily activities.

Diagnosis:
1.history of a fall or injury followed by limitation of movement of the knee

2.MRI will show if there is Knee Ligaments damage

3. An X-ray is done to exclude fracture of the bone

The Treatment of Knee Ligaments Injury is:
Conservative treatment:
1.rest,elevation and ice compress treatment of the knee upon injury

2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain relief and reducing inflammation

3.Muscle relaxant to relax muscles

4.crutches can reduce the weight off the affected limb

5.Physiotherapy such as traction, shortwave diathermy help to increase knee muscle strength and improve flexibility of movement of the knee

Surgery is usually indicated in Knee Ligaments Injury if the condition does not improve with conservative treatment.
1.A keyhole or arthroscopic repair is done to repair the torn ligaments

2. A cast is placed around the knee to protect followed by physiotherapy 1-2 days after surgery.

Prognosis depends on the severity of the ligament injury

In most cases Knee Ligaments Injury may recover with conservative methods.

Some cases however may require surgical treatment

Prognosis is good after surgical treatment.

Prevention is to avoid weight bearing, reduce obesity and muscle strengthening exercises.

A Family Doctor's Tale - MENISCUS TEARS

DOC I HAVE A MENISCUS TEAR


Meniscus tear is a common disorder of the knee caused by contact or non-contact activity when a weight bearing knee moves or twists suddenly resulting in a tear of the meniscus.

It can also occur from wear and tear through repeated usage of the meniscus which is a cartilage acting as a shock absorber during weight bearing activities.

The meniscus helps to maintain the knee stability .

It is more common in footballers especially above the age of 30.

The causes of Meniscus tears are:
Several conditions has been blamed:
1.Repetitive movements of the knee-soccer players who use repetitive movements are at higher risk of Meniscus tears.

2.Normal wear and tear- with age the blood supply to the knee is reduced resulting in degeneration of the meniscus.

3.trauma - injury to the meniscus such as a fall or direct hit to the knee

4.Obesity cause more weight bearing effect on the meniscus

Symptoms of Meniscus tears:
1.Pain in the knee

2.swelling of the knee

3.inability to bend or straighten the knee

4.locking of the knee

5.difficulty in walking because of the pain

Diagnosis:
1.history of a fall or injury followed by limitation of movement of the knee

2.MRI will show if there is a meniscus tear in the knee joint


The Treatment of meniscus tears is:

Conservative treatment:
1.rest,elevation and ice compress treatment of the knee

2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

3.Muscle relaxant to relax muscles

4.crutches can reduce the weight off the affected limb

5.Physiotherapy such as traction, shortwave diathermy help to increase knee muscle strength and improve flexibility of movement of the knee

Surgery is usually indicated in Meniscus tears if the condition does not improve with conservative treatment.

A keyhole or arthroscopic repair is done to remove the torn meniscus

Physiotherapy starts the day after surgery.

The prognosis of meniscus tears is:
Prognosis depends on the severity of the meniscus tear.

In most cases Meniscus tears may require surgical treatment

Prognosis is good after surgical treatment.

Prevention of Meniscus tears is:

Avoid obesity and weight bearing on the knee

Avoid strenuous physical activity of the knee

Avoid sudden turning and twisting of the knee

A Family Doctor's Tale - MALE MENOPAUSE

DOC  I HAVE MALE MENOPAUSE

Male menopause or andropause is a condition which is due to lack of or absence of testosterone in men especially at the age above 50 years .

There are two types of andropause found in adult men:
1.Normal hormone levels through puberty and adulthood with normal sexual development is presented with the rapid drop of testosterone levels around the age of 50
2.Psychological type of andropause occurs gradually with gradual drop of male hormones, DHEA and human growth hormones.
This usually occur in older patients such as in the 60 to 70 age group.

What are the causes of Male Menopause?
Common causes for male menopause are:
1.age related lowering of blood testesterone
2.injury to the testes and male reproductive system
3.Surgical removal of testes and male reproductive system due to cancer
4.auto-immune diseases such as systemic lupus erythrematosis
5.geneteic abnormalities which cause premature testicular failure such as chromosomal mosiacism
6.generalized vascular conditions such as diabetes
7.orchitis or infections of the testes such as mumps(which is fortunately almost eradicated by immunization)
8.heavy smoking reduce blood flow to testes
9.chemotherapy which destroy the production of male hormones
10.pituitary tumors which control the production of male hormones.

What are the symptoms and signs of male menopause?
Symptoms of andropause:
1.Tiredness, general weakness
2.Reduced libido
3.Reduced sexual potency
4.Hot flushes
5.Sleep problem
6.Joint pain
7.Irritability and anger
8.depression
9.Changes in skin and hair growth
10.Pre-aging

 How is the diagnosis of Male Menopause made?
Male menopause is a simple endocrine problem which causes the testosterone in the blood to diminish with age.
The diagnosis is made by measuring
1. free testosterone blood levels (mean=700ng/dl , range =300-1100ng/dl)
2. computing the free androgen index (FAI) (total testosterone x 100 /sex hormone binding globulin). (range=70-100%).
If the free androgen index is less than 50% , symptoms of male menoopause appears.
3.A comprehensive medical and psychological assessment should also be done

What is the treatment of Male Menopause?
Testosterone Replacement Therapy like the Hormone Replacement Therapy of female menopause is the main form of treatment:
1.Tablets:
Methyltestosterone (Android,Virilon,Testred, Oreton) 10mg,
Testosterone undecanoate (Restandol, Andriol) 40mg, essentially a testosterone in oil preparation (not available in the USA)
Mesterolone (Proviron) 25mg -- less potent
2.Transdermal therapy
Testosterone--transdermal (Testoderm, Testoderm TTS, Androderm)
3.Injections
Testosterone cyprionate 100mg/dl
Testosterone Propionate in oil 100mg/ml
Testosterone Enaanthanate 200mg/dl
The usual dose is 1cc injected weekly or bi-weekly. This method of administration removes the risk of liver damage which may be caused by oral methyl testosterone .
4.Sub dermal Pellets
Testosterone pellets for male hormone deficiencies are inserted under the skin and dissolve slowly over a period of approximately three to four months.

What are the risks?
1.Prostate cancer-- There is no evidence in the medical literature that testosterone replacement therapy increases the risk of prostate cancer.

2.Heart disease-- increasing male androgen levels would also increase serum cholesterol and serum LDL-Cholesterol levels. .
3.Liver Disease--the only orally available forms of testosterone for men contain methyl testosterone.
If used for sustained periods of time, it can damage the liver.

4.Suppression of testicular function-- whenever any hormone is administered, the gland which normally produces it ceases to function.
Patients with borderline low testosterone levels may commit themselves to lifelong therapy if they start with testosterone replacement.

What are the benefits?
The administration to testosterone to men with true testosterone deficiency states will improve their health and sense of well being.

A Family Doctor's Tale - SLEEPING SICKNESS

DOC I HAVE SLEEPING SICKNESS

Sleeping Sickness is a acute infection of humans and cattle caused by the protozoan hemoflagellate of the genus Trypanosoma.

The trypanosoma brucei protozoan is an elongated protozoan hemoflagellate with prominent nucleus kinetoplast and flagellum (hair).

It can occur in 2 forms:
1.West African caused by T.gambiense
This protozoan has a human host and is spread by the tsetse fly (also known as Glossina palpalis)
These flies inhabit shady areas by rivers or streams.

2.East African caused by T.rhodesiense
This protozoan is mainly a parasite of the wild animals especially the the bushbuck.
Humans are incidental hosts.

When the tsetse fly bites an infected host the trypanasomes pass into the midgut , migrates to the salivary glants, muliply in 2 bto 5 weeks and pass out in the saliva when feeding on a new host.

Early in the human disease, the lymph nodes and spleen are enlarged, infiltrated with plasma cells and macrophages (enlarged neutrophils and lymphocytes).

The disease can spread to the brain and result in swelling and damage of the brain.

Symptoms:
Incubation period is usually 10 days.

1.Anodular lesion (chancre) occur at the site of the bite of the tsetse fly and persist for 2-3 weeks.

2.Systemic invasion of the trypanosomes occur months after the bite resulting in:
a.fever
b.lymphadenopathy - nodes are firm but not tender usually
c.spleen enlargement
d.rashes erythematous and urticarial forms
e.localized edema

3.Months after the first symptoms:
a.mild behavior changes
b.mild personality changes
c.hallucinations
d.delusions
e.drowsiness during the day
f.manic depression
g.chorea
h.convulsions
i.coma

In Rhodesian sleeping sickness, the symptoms are more acute in onset:
1.fever
2.jaundice
3.malaise
4.heart failure
Rhodesian sleeping sickness is more rapidly fatal and occur in outbreaks.

Diagnosis:
1.characteristic fever, jaundice and drowsiness

2.Fluid from chancre and enlarged lymph nodes are taken to test for trypanosomes

3.Blood test for trypanosomes using thick blood film especially in Rhodesian Sleeping Sickness

4.Cerebrospinal fluid is taken to examine for trypanosomes in advanced stage of the diesease.
The IgM antibodies may be markedly increased with only moderate increase in total protein.

5.MRI of the brain my be necessary to find cause of drowsiness

The complications of Sleeping Sickness Fever are:
1.Psychiatric disease may affect victims

2.neurological disturbances(seizures,cranial nerve signs and coma) may indicate damage in the brain

3.Coma and death

Treatment:
1.Sleeping Sickness can be treated with Suramin an anti-protozoan drug if the central nervous system is not affected.

2.Melarsoprol with or without suramin is given if the central nervous system is infected.

Both medicines have serious side effects but their use can be life saving.

Other medicines include:

1.Eflornithine (for gambiense only)

2.Pentamidine

3.General measures which are mainly supportive:
1. Rest
2. drinking lots of water to prevent dehydration will help.
3. Paracetamol for fever, severe headaches and body aches to reduce the discomfort.
4. Intravenous fluids for hytopotension and dehydration.
5. Dietary supplements to build up nutrition and health

Prognosis:
1.depends on the virulence of the strain of trypanosome infecting the patient

2.depends on the stage of disease when treatment is instituted.
The earlier the stage of illness, the better will be the effect of the treatment.

Prevention:
Sleeping Sickness Fever is spread only through the bite of the infected tsetse fly.

To prevent Sleeping Sickness fever, you must prevent the breeding of its carrier, the tsetse fly.

1.THe use of mosquito nets prevents bites from the tsetse flies at night.

2.Wear clothes that are not brightly colored and covers the wrists and ankles.

Pentamidine injections protect against Trypanosome gambiense, but not against rhodesiense.

A Family Doctor's Tale - YELLOW FEVER

DOC I HAVE YELLOW FEVER

YELLOW FEVER fever is a acute viral infection caused by the YELLOW FEVER virus which is usually transmitted by the bite of an infected female Aedes msoquito.

The YELLOW FEVER virus is a flavivirus which are spherically enveloped RNA-containing particles.

2 epidemiologic forms of Yellow fever are present:
1.urban which has a human-mosquito-human cycle


2.jungle whivh has a monkey-mosquito-monkey cycle.
Humans get infected when accidentally bitten by the mosquito.

The incubation period in mosquito is 8-12 days and 3-6 days in humans.
Symptoms usually last 3-14 days.

A.Mild form:

1.Mild non specific fever
2.Headache
3.Pain behind the eyes
4.Muscle and joint pains
5.Nausea , vomiting
6.last several days with eventual recovery

B.Severe form

1.High, acute, prolonged fever  
2.Severe headache
3.Myalgia and bodyaches
4.nausea, vomiting
5.loss of appetite
6.anxious and distressed
7.Abdominal discomfort
8.gum hemorrhages and epistaxis
9.Fatigue

This stage called the viremic stage lasts about 3 days folled by a period of remission for 24 hours.

C.Recurrent Stage:

1.The fever then returns even higher
2.severe vomiting
3.epigastric pain
4.jaundice (hence the name yellow fever)
5.hematemesis
6.melena

Diagnosis of Yellow Fever:
1.characteristic fever, jaundice and vomiting in the later stages

2.inflammation of nerves and meninges

3.contraction of muscles of face, scalp and neck

4.neuralgia

5.MRI of the brain

6.blood tests for antibodies

The complications of YELLOW FEVER  are:
1.Hemorrhages in the stomach
a.hematemesis
b.melena

2.neurological disturbances(seizures,cranial nerve signs and coma) may indicate bleeding in the brain

3.Dilatation and distension of the cranial arteries

4.Inflammation of the cranial nerves, meninges, neuralgia

Treatment of Yellow Fever:
There is no specific anti-viral drug to treat the disease or a vaccine to prevent a person from being infected with the YELLOW FEVER 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 hyto 10 days, but complete recovery can take as long as a month.potension and dehydration.
5. Antidepressant medicines are helpful

The illness can last up to one month before recovery

Prevention of Yellow Fever:

1.A vaccine against Yellow Fever was developed in 1951 and is effective against Yellow Fever for 10 or more years.

2.YELLOW FEVER Fever is spread only through the bite of the infected Aedes mosquitoes.

To prevent YELLOW FEVER fever, it is important to 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