DOC MY CHILD HAVE ENURESIS
Bedwetting or functional enuresis is the repeated involuntary voiding of urine during day or night at an age where continence or control of urine is expected.
Bedwetting or functional enuresis is common in children.
Prevalence of bedwetting:
5 years old - 7 per cent for boys and 3 per cent for girls
10 years old -3 per cent for boys and 2 per cent for girls
18 years old -1 per cent for boys and 0 per cent for girls
It usually occurs during non rapid-eye-movement (REM) sleep.
The causes of bedwetting are:
1.family history of bedwetting often present
2.prevalence of emotional and mental disorder greater than in general population such as anxiety or rejection
3.slow physical development,
4.an overproduction of urine at night,
5.a lack of ability to recognize bladder filling when asleep
Symptoms
1.day or night involuntary voiding of urine after the age of 5 years at least twice a month or continuously.
2.In older children more than once a month
3.Sometimes a child develops bedwetting in response to jealousy or reduced attention from parents or caretaker after a new child is born into the family
Complications:
Amount of urinary incontinence is related to effect on the child's emotional or psychological well being:
1.self esteem is affected
2.social ostracism by peers
3.anger at caretakers
4.rejection by caretakers
Diagnosis and treatment
1.an underlying condition such as urinary tract infection, developmental bladder abnormalities or nervous system disorders must be ruled out by tests conducted.
2.A "wait and see" approach is the preferred course of action. Record the days when the child is dry and give a reward as a form of motivation.
3.Regulate the amount of fluid taken before bedtime
4.Patient and family counseling will take out the anxiety and fear of rejection by the child
5.Use of urine sensitive device that detects wetness and activate auditory stimulus can help the child condition the response of waking up before he loses control of his bladder. This method is called behavioral conditioning.
6.Medicine such as antidepressant can help to control bedwetting in children but only as as a short-term measure.
Prognosis:
Fairly good with counseling and motivation
Saturday, July 30, 2011
Thursday, July 28, 2011
A Family Doctor's Tale - AMBLYOPIA
DOC I HAVE AMBLYOPIA
Amblyopia, commonly known as ‘lazy eye’, is reduced visual acuity in one eye that appears normal on examination.
It usually develop during early childhood.
If left untreated, amblyopia will usually continue into adulthood.
The Causes of Amblyopia are:
1. Squint
Squint or misalignment of the eyes occurs when one eye is looking straight and the other is looking in another direction.
The vision from the deviating eye is suppressed.
The part of the brain that receives the vision from the deviating eye does not develop normally.
A severe reduction of vision in the deviating eye may occur.
2. Different refractive powers of the eyes
A significant difference in the degree of short-sightedness, long-sightedness or astigmatism between the two eyes may result in failure to form clear image in the eye with the greater refractive error resulting in Amblyopia.
3. Blurred vision in one eye
This occurs with:
1.An opaque cornea
2.Cataract
3.Drooping upper eyelids due to weakness of the muscles that lift the eyelids
4.Toxic causes such as arsenic, lead, smoking,vitamin B1 and B12 deficiency
5.Neurological causes are chiasmal lesions in the brain
Symptoms may include:
1.decreased vision in one eye
2.squint
3.drooping eyelid
Diagnosis and Early detection
1.Amblyopia in young children can only be discovered if vision in each eye is tested separately.
Treatment is usually more successful if amblyopia is detected early especially before the age of four.
2.regular eye and vision tests should be done by the family doctor, paediatrician or ophthalmologist.
Treatment
1.underlying conditions causing the ‘lazy eye’ such as refractive errors, drooping eye lid or squint should be treated.
2.The main purpose of treatment is to cause the part of the brain that reads images from the ‘lazy eye’ to work more harder to read images than the better eye.
The earlier the treatment is started, the better is the results.
Once the child is over 8 years of age, he/she may not respond well to treatment, resulting in permanently impaired vision.
Treatment can be given in two ways:
1.Eye Patch
An opaque, adhesive patch is worn over the better eye for weeks to months. This treatment forces the child to use the weaker eye and stimulate the brain to read the images in the weaker eye.
The main problem with the eye patch is that no child likes to have his eye patched. Parents need to ensure that the eye patch is worn properly as advised by the eye doctor.
2.Atropine eye drops
In some cases where the child cannot tolerate eye patches, a drop of atropine is instilled in the stronger eye once a day to blur the vision temporarily in order that the child will prefer to use the ‘lazy eye’.
Prognosis:
Amblyopia if left untreated can lead to loss of vision in the ‘lazy eye’.
Even with treatment 1% - 2% of the population will remain amblyopic. This occurs especially if:
1.the amblyopic stimuli is excessive
2.detection of amblyopia is too late;
3.the child responds poorly to treatment.
Even with one good eye the child can go about his life provided he/she takes good care of the good eye and protect it from harm.
Amblyopia, commonly known as ‘lazy eye’, is reduced visual acuity in one eye that appears normal on examination.
It usually develop during early childhood.
If left untreated, amblyopia will usually continue into adulthood.
The Causes of Amblyopia are:
1. Squint
Squint or misalignment of the eyes occurs when one eye is looking straight and the other is looking in another direction.
The vision from the deviating eye is suppressed.
The part of the brain that receives the vision from the deviating eye does not develop normally.
A severe reduction of vision in the deviating eye may occur.
2. Different refractive powers of the eyes
A significant difference in the degree of short-sightedness, long-sightedness or astigmatism between the two eyes may result in failure to form clear image in the eye with the greater refractive error resulting in Amblyopia.
3. Blurred vision in one eye
This occurs with:
1.An opaque cornea
2.Cataract
3.Drooping upper eyelids due to weakness of the muscles that lift the eyelids
4.Toxic causes such as arsenic, lead, smoking,vitamin B1 and B12 deficiency
5.Neurological causes are chiasmal lesions in the brain
Symptoms may include:
1.decreased vision in one eye
2.squint
3.drooping eyelid
Diagnosis and Early detection
1.Amblyopia in young children can only be discovered if vision in each eye is tested separately.
Treatment is usually more successful if amblyopia is detected early especially before the age of four.
2.regular eye and vision tests should be done by the family doctor, paediatrician or ophthalmologist.
Treatment
1.underlying conditions causing the ‘lazy eye’ such as refractive errors, drooping eye lid or squint should be treated.
2.The main purpose of treatment is to cause the part of the brain that reads images from the ‘lazy eye’ to work more harder to read images than the better eye.
The earlier the treatment is started, the better is the results.
Once the child is over 8 years of age, he/she may not respond well to treatment, resulting in permanently impaired vision.
Treatment can be given in two ways:
1.Eye Patch
An opaque, adhesive patch is worn over the better eye for weeks to months. This treatment forces the child to use the weaker eye and stimulate the brain to read the images in the weaker eye.
The main problem with the eye patch is that no child likes to have his eye patched. Parents need to ensure that the eye patch is worn properly as advised by the eye doctor.
2.Atropine eye drops
In some cases where the child cannot tolerate eye patches, a drop of atropine is instilled in the stronger eye once a day to blur the vision temporarily in order that the child will prefer to use the ‘lazy eye’.
Prognosis:
Amblyopia if left untreated can lead to loss of vision in the ‘lazy eye’.
Even with treatment 1% - 2% of the population will remain amblyopic. This occurs especially if:
1.the amblyopic stimuli is excessive
2.detection of amblyopia is too late;
3.the child responds poorly to treatment.
Even with one good eye the child can go about his life provided he/she takes good care of the good eye and protect it from harm.
Tuesday, July 26, 2011
A Family Doctor's Tale - DOWN'S SYNDROME
DOC MY CHILD HAS DOWN'S SYNDROME
Down syndrome is a genetic condition in which the affected person is born with mental disability and characteristic features.
These characteristic features have been called mongolism with:
1.obliquely set eyes
2.short stubby nose
3.flattened facies
4.short stature
5.generalized muscular hypotonia
Most people with Down's Syndrome are not able to look after themselves because of their mental diability.
But many of them have gentle and endearing personalities.
There is no medical cure for this condition.
Causes of Down's Syndrome:
Chromosomes are tiny structures in our body cells which can seen only with a special microscope.
They contains the genes which determines the characteristics of a person.
A normal person has 23 pairs of matching chromosomes in each cell.
Each pair is different and given a number except for the sex chromosomes which are named XY in the male and XX in the female.
A person with Down's Syndrome has an extra chromosone no.21
Types of Down Syndrome:
There are three genetic variations that can cause Down syndrome:
1.Trisomy 21
the commonest type in which all the cells have an extra chromosome 21.Here something goes wrong during egg formation in the mother so that the mother has an abnormal egg with extra chromosomes no.21. The child will then get an extra chromosone no.21. The cause of this abnomal egg formation is unknown but occurs more frequency with the mother's age.
2.Translocation Down syndrome
happens when the extra chromosome 21 is attached to another chromosome. During cell division the embryo may get the attached chromosome and so have an extra chromosome no 21 and get Down's Syndrome.
3.Mosaic Down syndrome
a another form of Down's Syndrome in which only some cells have an extra chromosome 21.
Risk factors of getting Down's Syndrome are:
1.maternal age above 35 years.
Most cases of Down's syndrome are born to women aged 35 and above.
The risk of a woman above age 36 conceiving a child with Down syndrome is 1 in 350. The risk increases to 1 in 100 by the age of 40 and to 1 in 25 at the age of 45.
2.Mothers with one Down syndrome child have a 1 in 100 chance of having another child with Down syndrome.
3.Parents who are known to carry the translocated chromosome for Down syndrome can pass the abnormal gene to their offspring.
Symptoms of Down's Syndrome are:
Mongolian features:
1.distinct flat facial profile
2.Upward slanting eyes
3.Flat nose
4.Protruding tongue
5.Flat back of the head
6.Small statue
7.Poor muscle tone
8.Broad, short hands with short fingers and a single crease in the palm
9.dry skin
10.thin fine hair
Mental retardation
1.mental disability
2.unable to look after themselves
Congenital defects:
1.congenital heart disease
2.other birth defects
Screening tests are done for all pregnant women above 35 years of age and include:
1.Triple test - is a blood test done for older pregnant mothers above 35 years which measures specific proteins in the mother’s blood. This may indicates the possibility of Down's Syndrome
2.Nuchal translucency test is an ultrasound scan of the embryo at 10-13 weeks of pregnancy. It measures the width of the spinal cord at the back of the baby’s neck.
If the screening tests suggest a possible high risk of Down syndrome, then the following diagnostic tests may be performed to determine or confirm whether the baby actually has Down syndrome:
1.Amniocentesis. A small amount of the amniotic fluid is obtained through a needle inserted into the mother's womb after 16 weeks of pregnancy. This fluid contains cells shed from the baby and can be examined to see if the chromosomes are normal.
2.Chorionic Villous Sampling (CVS) involves obtaining some cells from the mother's placenta to examine the baby’s chromosones.It is usually done around the 14th week of pregnancy.
3.Percutaneous umbilical blood sampling (PUBS) involves obtaining blood from a vein in the umbilical cord after 18 weeks of pregnancy. The blood cells are examined for chromosomal defects.
Complications of Down's Syndrome are:
1.Heart defects.
2.Leukemia
3.Infectious diseases such as pneumonia
4.Dementia often appear before age 40
5.intestinal obstruction,
6.thyroid problems,
7.hearing loss
8.poor vision.
Treatment of Down's Syndrome:
There is no medical cure for Down syndrome.
However, children with Down syndrome do benefit from medical help and early interventions starting in infancy which improve the life expectancy and quality of life.
Prevention of Down's Syndrome:
Down syndrome cannot be prevented.
1.genetic counselling in high risk translocation genetic group before considering pregnancy.
2.Coping and support from a team of doctors, teachers and therapists who can provide the resources and support to take better care of your child.
3.Joining a Down Syndrome support group and families who are dealing with the same problem
Prognosis:
1.A better understanding of Down syndrome and early interventions have improved the quality of life of children and adults with Down syndrome.
2.If there is no major complications such as heart disease and leukemia, a person with Down Syndrome may have a slightly shortened life span than a normal person.
Down syndrome is a genetic condition in which the affected person is born with mental disability and characteristic features.
These characteristic features have been called mongolism with:
1.obliquely set eyes
2.short stubby nose
3.flattened facies
4.short stature
5.generalized muscular hypotonia
Most people with Down's Syndrome are not able to look after themselves because of their mental diability.
But many of them have gentle and endearing personalities.
There is no medical cure for this condition.
Causes of Down's Syndrome:
Chromosomes are tiny structures in our body cells which can seen only with a special microscope.
They contains the genes which determines the characteristics of a person.
A normal person has 23 pairs of matching chromosomes in each cell.
Each pair is different and given a number except for the sex chromosomes which are named XY in the male and XX in the female.
A person with Down's Syndrome has an extra chromosone no.21
Types of Down Syndrome:
There are three genetic variations that can cause Down syndrome:
1.Trisomy 21
the commonest type in which all the cells have an extra chromosome 21.Here something goes wrong during egg formation in the mother so that the mother has an abnormal egg with extra chromosomes no.21. The child will then get an extra chromosone no.21. The cause of this abnomal egg formation is unknown but occurs more frequency with the mother's age.
2.Translocation Down syndrome
happens when the extra chromosome 21 is attached to another chromosome. During cell division the embryo may get the attached chromosome and so have an extra chromosome no 21 and get Down's Syndrome.
3.Mosaic Down syndrome
a another form of Down's Syndrome in which only some cells have an extra chromosome 21.
Risk factors of getting Down's Syndrome are:
1.maternal age above 35 years.
Most cases of Down's syndrome are born to women aged 35 and above.
The risk of a woman above age 36 conceiving a child with Down syndrome is 1 in 350. The risk increases to 1 in 100 by the age of 40 and to 1 in 25 at the age of 45.
2.Mothers with one Down syndrome child have a 1 in 100 chance of having another child with Down syndrome.
3.Parents who are known to carry the translocated chromosome for Down syndrome can pass the abnormal gene to their offspring.
Symptoms of Down's Syndrome are:
Mongolian features:
1.distinct flat facial profile
2.Upward slanting eyes
3.Flat nose
4.Protruding tongue
5.Flat back of the head
6.Small statue
7.Poor muscle tone
8.Broad, short hands with short fingers and a single crease in the palm
9.dry skin
10.thin fine hair
Mental retardation
1.mental disability
2.unable to look after themselves
Congenital defects:
1.congenital heart disease
2.other birth defects
Screening tests are done for all pregnant women above 35 years of age and include:
1.Triple test - is a blood test done for older pregnant mothers above 35 years which measures specific proteins in the mother’s blood. This may indicates the possibility of Down's Syndrome
2.Nuchal translucency test is an ultrasound scan of the embryo at 10-13 weeks of pregnancy. It measures the width of the spinal cord at the back of the baby’s neck.
If the screening tests suggest a possible high risk of Down syndrome, then the following diagnostic tests may be performed to determine or confirm whether the baby actually has Down syndrome:
1.Amniocentesis. A small amount of the amniotic fluid is obtained through a needle inserted into the mother's womb after 16 weeks of pregnancy. This fluid contains cells shed from the baby and can be examined to see if the chromosomes are normal.
2.Chorionic Villous Sampling (CVS) involves obtaining some cells from the mother's placenta to examine the baby’s chromosones.It is usually done around the 14th week of pregnancy.
3.Percutaneous umbilical blood sampling (PUBS) involves obtaining blood from a vein in the umbilical cord after 18 weeks of pregnancy. The blood cells are examined for chromosomal defects.
Complications of Down's Syndrome are:
1.Heart defects.
2.Leukemia
3.Infectious diseases such as pneumonia
4.Dementia often appear before age 40
5.intestinal obstruction,
6.thyroid problems,
7.hearing loss
8.poor vision.
Treatment of Down's Syndrome:
There is no medical cure for Down syndrome.
However, children with Down syndrome do benefit from medical help and early interventions starting in infancy which improve the life expectancy and quality of life.
Prevention of Down's Syndrome:
Down syndrome cannot be prevented.
1.genetic counselling in high risk translocation genetic group before considering pregnancy.
2.Coping and support from a team of doctors, teachers and therapists who can provide the resources and support to take better care of your child.
3.Joining a Down Syndrome support group and families who are dealing with the same problem
Prognosis:
1.A better understanding of Down syndrome and early interventions have improved the quality of life of children and adults with Down syndrome.
2.If there is no major complications such as heart disease and leukemia, a person with Down Syndrome may have a slightly shortened life span than a normal person.
Sunday, July 24, 2011
A Family Doctor's Tale - CANCER SCREENING 5
DOC DO I NEED TO GO FOR CANCER SCREENING 5
Cancer screening - conclusion
H.Prostate Cancer
Prostate cancer is the third most common cancer in males in Singapore.
It is seldom seen in men less than 50 years of age.
Most prostate cancers are slow growing and may not cause symptoms or shorten life.
Majority of patients diagnosed with prostate cancer do not die from it.
Having said that, there are rare instances where the prostate cancer is aggressive and can cause death very fast.
Men who are at high risk of prostate cancer are those with:
1.Aged 50 years and above
2.family history of prostate cancer diagnsed below the age of 60 years of age
Cancer screening procedures for prostate cancer includes:
1.Digital rectal examination or DRE is a quick and reliable rectal examination of the prostate gland with a gloved finger through the rectum.
If the prostate gland feels enlarged, hard and nodular(lumpy), there is a possibility of prostate cancer unlike the smooth enlargement of benign prostate hypertrophy.
A prostate biopsy will then be needed to eliminate the prostate for cancer cells.
2.Blood test- tumor marker Prostate Specific Antigen(PSA) may be raised indicating a possibility of prostate cancer.
However raised Prostate Specific Antigen (PSA) may also be due to non-cancerous enlargement or inflammation of the prostate gland.
Prostate Specific Antigen therefore serves as a guide to the presence and severity of prostate cancer especially where prostate cancer seldom kill a person being slow growing.
Summary of Cancer screening:
a.Colorectal Cancer (above 50 years of age)
1.Yearly Fecal Occult Blood Test after the age of 50 years
2.5 years once Colonoscopy if there is a family history of colorectal cancer
b.Lung Cancer (all adult ages)
Yearly CT scan for lung cancer for chronic smokers and family history of lung cancer
c.Liver Cancer (all adult ages)
1.6 monthly Alpha feto-protein blood test for those with chronic hepatitis B, liver cirrhosis or hepatitis C
2.Yearly Ultrasound of liver for those with chronic hepatitis B, liver cirrhosis or hepatitis C
d.Prostate Cancer (above the age of 50)
1.2 yearly Digital Rectal Examination(DRE) for all men with a family history
2.2 yearly PSA blood test
e.Nasopharyngeal Cancer (above the age of 40)
1.2 yearly EBV IgA antibodies test
2.2 yearly nasoendoscopy
f.Breast Cancer (above age of 40)
1.Monthly Breast Self Examination (BSE)
2.2 yearly mammogram and ultrasound of the breasts
g.Ovarian Cancer (all ages above puberty 16 years)
1.Yearly pelvic ultrasound
2.Yearly blood CA 125
h.Cervical Cancer (all ages who had sexual intercourse)
2 yearly Pap's smear test and vaginal examination
Cancer screening - conclusion
H.Prostate Cancer
Prostate cancer is the third most common cancer in males in Singapore.
It is seldom seen in men less than 50 years of age.
Most prostate cancers are slow growing and may not cause symptoms or shorten life.
Majority of patients diagnosed with prostate cancer do not die from it.
Having said that, there are rare instances where the prostate cancer is aggressive and can cause death very fast.
Men who are at high risk of prostate cancer are those with:
1.Aged 50 years and above
2.family history of prostate cancer diagnsed below the age of 60 years of age
Cancer screening procedures for prostate cancer includes:
1.Digital rectal examination or DRE is a quick and reliable rectal examination of the prostate gland with a gloved finger through the rectum.
If the prostate gland feels enlarged, hard and nodular(lumpy), there is a possibility of prostate cancer unlike the smooth enlargement of benign prostate hypertrophy.
A prostate biopsy will then be needed to eliminate the prostate for cancer cells.
2.Blood test- tumor marker Prostate Specific Antigen(PSA) may be raised indicating a possibility of prostate cancer.
However raised Prostate Specific Antigen (PSA) may also be due to non-cancerous enlargement or inflammation of the prostate gland.
Prostate Specific Antigen therefore serves as a guide to the presence and severity of prostate cancer especially where prostate cancer seldom kill a person being slow growing.
Summary of Cancer screening:
a.Colorectal Cancer (above 50 years of age)
1.Yearly Fecal Occult Blood Test after the age of 50 years
2.5 years once Colonoscopy if there is a family history of colorectal cancer
b.Lung Cancer (all adult ages)
Yearly CT scan for lung cancer for chronic smokers and family history of lung cancer
c.Liver Cancer (all adult ages)
1.6 monthly Alpha feto-protein blood test for those with chronic hepatitis B, liver cirrhosis or hepatitis C
2.Yearly Ultrasound of liver for those with chronic hepatitis B, liver cirrhosis or hepatitis C
d.Prostate Cancer (above the age of 50)
1.2 yearly Digital Rectal Examination(DRE) for all men with a family history
2.2 yearly PSA blood test
e.Nasopharyngeal Cancer (above the age of 40)
1.2 yearly EBV IgA antibodies test
2.2 yearly nasoendoscopy
f.Breast Cancer (above age of 40)
1.Monthly Breast Self Examination (BSE)
2.2 yearly mammogram and ultrasound of the breasts
g.Ovarian Cancer (all ages above puberty 16 years)
1.Yearly pelvic ultrasound
2.Yearly blood CA 125
h.Cervical Cancer (all ages who had sexual intercourse)
2 yearly Pap's smear test and vaginal examination
Friday, July 22, 2011
A Family Doctor's Tale - CANCER SCREENING 4
DOC DO I NEED TO GO FOR CANCER SCREENING 4
Cancer screening :
F.Cervical Cancer
Cervical Cancer is the sixth most common cancer in women in Singapore but can be prevented and treated early if regular screening is done.
Women who are at high risk of cervical cancer are those with:
1.sexual intercourse at an early stage
2.sexual intercourse with multiple partners
3.history of sexually transmitted infections
4.infection with certain high risk strains of human papilloma virus (HPV)
5.weakened immune system such as HIV infection
6.prolonged use of combined oral contraceptive (birth control)pills
Cancer screening procedures includes:
1.Pap smear test should be done yearly in women who has sexual intercourse or abnormal vaginal bleeding.
The Pap smear test involve a simple procedure in which the doctor obtains some scraping from the neck of the womb or cervix to detect abnormal cell changes.
Early detection of cancer of the cervix means early treatment and cure.
Patients who had HPV vaccination should also continue to go for regular Pap smear every 3 years
2.Yearly vaginal examination and pelvic examination which involve the Pap smear
G.Nasopharyngeal Cancer
Nasopharyngeal Cancer or NPC is a common cancer of the head and neck region especially common in Chinese men between the age of 40-65.
People who are at risk of developing Nasopharyngeal Cancer or NPC are:
1.family history of nasopharyngeal cancer -common in Chinese males, less so in other races and females
2.Viral infection of the nose-Epstein-Barr (EBV) virus has been shown to be present in most cases of nasopharyngeal cancer
3.Smoking with its 40 or more toxic chemicals in cigarette smoke can stimulate abnormal cells in the nose to mutate and become cancerous
Cancer screening procedures of nasopharyngeal cancer includes:
1.Blood test-tumor marker EBV. Blood is tested for raised level of EBV IgA antibodies against Viral Capsid Antigen(VCA) and Early Antigen).
Patients with raised EBV IgA antibody have a higher risk of developing NPC.
If these antibodies are seen to rise significantly, there is an indication of possibility of NPC in which case an endoscope examination of the upper nose and nasal biopsy can be done to exclude NPC.
VCA IgA test is more sensitive than EBV but remains high for 6 months following a viral upper respiratory tract infection.
EA IgA test is more specific in diagnosing NPC but the levels are also high in cancers of salivary glands, lung and stomach.
2.nasoendoscopy for patients with family history of of nasopharyngeal cancer or NPC.
Cancer screening :
F.Cervical Cancer
Cervical Cancer is the sixth most common cancer in women in Singapore but can be prevented and treated early if regular screening is done.
Women who are at high risk of cervical cancer are those with:
1.sexual intercourse at an early stage
2.sexual intercourse with multiple partners
3.history of sexually transmitted infections
4.infection with certain high risk strains of human papilloma virus (HPV)
5.weakened immune system such as HIV infection
6.prolonged use of combined oral contraceptive (birth control)pills
Cancer screening procedures includes:
1.Pap smear test should be done yearly in women who has sexual intercourse or abnormal vaginal bleeding.
The Pap smear test involve a simple procedure in which the doctor obtains some scraping from the neck of the womb or cervix to detect abnormal cell changes.
Early detection of cancer of the cervix means early treatment and cure.
Patients who had HPV vaccination should also continue to go for regular Pap smear every 3 years
2.Yearly vaginal examination and pelvic examination which involve the Pap smear
G.Nasopharyngeal Cancer
Nasopharyngeal Cancer or NPC is a common cancer of the head and neck region especially common in Chinese men between the age of 40-65.
People who are at risk of developing Nasopharyngeal Cancer or NPC are:
1.family history of nasopharyngeal cancer -common in Chinese males, less so in other races and females
2.Viral infection of the nose-Epstein-Barr (EBV) virus has been shown to be present in most cases of nasopharyngeal cancer
3.Smoking with its 40 or more toxic chemicals in cigarette smoke can stimulate abnormal cells in the nose to mutate and become cancerous
Cancer screening procedures of nasopharyngeal cancer includes:
1.Blood test-tumor marker EBV. Blood is tested for raised level of EBV IgA antibodies against Viral Capsid Antigen(VCA) and Early Antigen).
Patients with raised EBV IgA antibody have a higher risk of developing NPC.
If these antibodies are seen to rise significantly, there is an indication of possibility of NPC in which case an endoscope examination of the upper nose and nasal biopsy can be done to exclude NPC.
VCA IgA test is more sensitive than EBV but remains high for 6 months following a viral upper respiratory tract infection.
EA IgA test is more specific in diagnosing NPC but the levels are also high in cancers of salivary glands, lung and stomach.
2.nasoendoscopy for patients with family history of of nasopharyngeal cancer or NPC.
Wednesday, July 20, 2011
A Family Doctor's Tale - CANCER SCREENING 3
DOC DO I NEED TO GO CANCER SCREENING 3
Cancer Screening:
C. Breast cancer
Breast Cancer is the most common cancer in women.
Women who are at high risk are those with:
1.family history of breast cancer
A gene has been identified which indicates high incidence of breast cancer.
2.family history of other cancers such as ovary and colon
3.women of age 55 years and above
Cancer screening procedures includes:
1.monthly breast self examination(BSE) is recommended for all women from the age of 30 to detect breast lumps which may be early cancer
2.Mammography once every 2 years from the age of 50 years can help to detect breast cancer.
3.Ultrasound of the breasts together with mammogram also helps in the detection of breast cancer.
4.Blood test-tumor markers such as CEA, CA 125 and CA 15.3 may be raised in cancer of the breast but are not significant in making a diagnosis.
D.Liver Cancer
Liver Cancer is the 4th most common cancer in men in Singapore.
Men are more often 4 times affected than women.
People who are at risk of developing liver cancer are:
1.Chronic hepatitis B carriers and infections
2.Hepatitis C liver cirrhosis and infection
3.Liver cirrhosis from other causes (eg alcohol)
Screening for hepatitis B is recommended for:
1.Healthcare workers because they are exposed to hepatitis patients
2.Pregnant women because the hepatitis infection can spread to her baby at birth
3.Dialysis patients because the fluid or plasma used in dialysis may contain the hepatitis B infection
4.Those people with a history of hepatitis B infection or liver cancer in the family
5.Those people with high risk behaviour having unprotected sex, multiple sex partners, drug addicts who share needles.
Cancer screening procedures includes:
1.Blood test-tumor marker alpha feto-protein level should be done every 3-6 months.
Patients with hepatitis and liver cancer has been found to have raised levels of serum alpha feto-protein.
However patients with germ cell cancers of the testes and ovary also have raised level of alpha feto-protein.
Pregnant women may also have raised alpha feto-protein at certain stage of their pregnancy.
2.Ultrasound of the liver including the gallbladder and bile ducts
should be done every 6 to 12 months.
E.Ovarian Cancer
Ovarian Cancer is the fifth commonest cancer in Singapore and can be potentially fatal if not detected early.
Early ovarian cancer may not have any symptoms and may be undetected unless screening is done.
Women who are at high risk are those with:
1.family history of ovarian cancer
2.abnormal menses
Cancer screening procedures includes:
1.Annual pelvic examination
2.pelvic ultrasound
3.Blood test-tumor markers CA125 and alpha feto-protein level should be done yearly for those with high risk of ovarian tumors
Cancer Screening:
C. Breast cancer
Breast Cancer is the most common cancer in women.
Women who are at high risk are those with:
1.family history of breast cancer
A gene has been identified which indicates high incidence of breast cancer.
2.family history of other cancers such as ovary and colon
3.women of age 55 years and above
Cancer screening procedures includes:
1.monthly breast self examination(BSE) is recommended for all women from the age of 30 to detect breast lumps which may be early cancer
2.Mammography once every 2 years from the age of 50 years can help to detect breast cancer.
3.Ultrasound of the breasts together with mammogram also helps in the detection of breast cancer.
4.Blood test-tumor markers such as CEA, CA 125 and CA 15.3 may be raised in cancer of the breast but are not significant in making a diagnosis.
D.Liver Cancer
Liver Cancer is the 4th most common cancer in men in Singapore.
Men are more often 4 times affected than women.
People who are at risk of developing liver cancer are:
1.Chronic hepatitis B carriers and infections
2.Hepatitis C liver cirrhosis and infection
3.Liver cirrhosis from other causes (eg alcohol)
Screening for hepatitis B is recommended for:
1.Healthcare workers because they are exposed to hepatitis patients
2.Pregnant women because the hepatitis infection can spread to her baby at birth
3.Dialysis patients because the fluid or plasma used in dialysis may contain the hepatitis B infection
4.Those people with a history of hepatitis B infection or liver cancer in the family
5.Those people with high risk behaviour having unprotected sex, multiple sex partners, drug addicts who share needles.
Cancer screening procedures includes:
1.Blood test-tumor marker alpha feto-protein level should be done every 3-6 months.
Patients with hepatitis and liver cancer has been found to have raised levels of serum alpha feto-protein.
However patients with germ cell cancers of the testes and ovary also have raised level of alpha feto-protein.
Pregnant women may also have raised alpha feto-protein at certain stage of their pregnancy.
2.Ultrasound of the liver including the gallbladder and bile ducts
should be done every 6 to 12 months.
E.Ovarian Cancer
Ovarian Cancer is the fifth commonest cancer in Singapore and can be potentially fatal if not detected early.
Early ovarian cancer may not have any symptoms and may be undetected unless screening is done.
Women who are at high risk are those with:
1.family history of ovarian cancer
2.abnormal menses
Cancer screening procedures includes:
1.Annual pelvic examination
2.pelvic ultrasound
3.Blood test-tumor markers CA125 and alpha feto-protein level should be done yearly for those with high risk of ovarian tumors
Monday, July 18, 2011
A Family Doctor's Tale - CANCER SCREENING 2
DOC DO I NEED TO GO FOR CANCER SCREENING 2
Cancer Screening tests:
A.Colorectal cancer
Colorectal cancer is the most common cancer in Singapore and can begin as behign growths (polyps)in the colon.
Early detection of these polyps means they can be removed to prevent colorectal cancer.
People who are at high risk are:
1. all men and women above the age of 50 years
2. those with a family history of colorectal cancer
Cancer screening procedures includes:
1.Faecal Occult Blood Test(FOBT)
This test detects tiny amounts of blood in the stools from bleeding in the colon and rectum.
Those who has a positive test should go for colonoscopy to exclude cancer.
This test should be done yearly.
2.Colonoscopy
A colonoscope has a light, camera and surgical instruments which can be used to examine the entire large intestine and removes polyps found during the procedure.
This test should done at 5 years interval especially for people above the age of 50 with a history of positive blood in the stools and a family history of colorectal cancer.
3.CT Colonography Special X ray equipment is used to create detailed images of the inside of the colon and rectum using computer tomograpghy. It can detect early polyps or cancer in the colon.
4.Blood test-tumor markers such as CEA may be raised in colorectal cancer but are not significant in making a diagnosis as they may be raised in other cancers as well.
CA 19.9 may also be raised in 64% of colorectal cancer.
B.Lung cancer
Lung cancer is the second most common cancer after colorectal cancer.
It is usually associated with smoking, air pollution, chemicals such as asbesto, gasoline.
People who are at high risk are:
1.People with a family history of lung cancer
2.smoking
3.exposure to inhalation of chemicals such as asbesto, gasolines,
They should be screened even at a early age of 25 years and above.
Cancer screening procedures includes:
1.CT scan of the lungs is the best way of determining the presence of cancer of the lungs.
2.Blood test -tumor marker such as CEA(carcinoembryonic antigen) is usually raised but can also be high in other cancers such as lung, stomach, breast, ovary abd cervix and also benign diseases such as inflammations of bowel, lung, pancreas and liver cirrhosis.
Cancer Screening tests:
A.Colorectal cancer
Colorectal cancer is the most common cancer in Singapore and can begin as behign growths (polyps)in the colon.
Early detection of these polyps means they can be removed to prevent colorectal cancer.
People who are at high risk are:
1. all men and women above the age of 50 years
2. those with a family history of colorectal cancer
Cancer screening procedures includes:
1.Faecal Occult Blood Test(FOBT)
This test detects tiny amounts of blood in the stools from bleeding in the colon and rectum.
Those who has a positive test should go for colonoscopy to exclude cancer.
This test should be done yearly.
2.Colonoscopy
A colonoscope has a light, camera and surgical instruments which can be used to examine the entire large intestine and removes polyps found during the procedure.
This test should done at 5 years interval especially for people above the age of 50 with a history of positive blood in the stools and a family history of colorectal cancer.
3.CT Colonography Special X ray equipment is used to create detailed images of the inside of the colon and rectum using computer tomograpghy. It can detect early polyps or cancer in the colon.
4.Blood test-tumor markers such as CEA may be raised in colorectal cancer but are not significant in making a diagnosis as they may be raised in other cancers as well.
CA 19.9 may also be raised in 64% of colorectal cancer.
B.Lung cancer
Lung cancer is the second most common cancer after colorectal cancer.
It is usually associated with smoking, air pollution, chemicals such as asbesto, gasoline.
People who are at high risk are:
1.People with a family history of lung cancer
2.smoking
3.exposure to inhalation of chemicals such as asbesto, gasolines,
They should be screened even at a early age of 25 years and above.
Cancer screening procedures includes:
1.CT scan of the lungs is the best way of determining the presence of cancer of the lungs.
2.Blood test -tumor marker such as CEA(carcinoembryonic antigen) is usually raised but can also be high in other cancers such as lung, stomach, breast, ovary abd cervix and also benign diseases such as inflammations of bowel, lung, pancreas and liver cirrhosis.
Saturday, July 16, 2011
A Family Doctor's Tale - CANCER SCREENING
DOC DO I NEED CANCER SCREENING
Why do I need to go for cancer screening?
Cancer is the top killer in Singapore.
About one quarter of all deaths here are caused by cancer.
Our bodies are made up of billions of cells. Normal healthy cells grow and multiply in an orderly, controlled manner.
Cancer cells on the other hand multiply uncontrollably. They do not function normally and instead form a growth or tumour. These cancerous tumours can spread to nearby tissues and organs as well as to other parts of the body.
Cancer kills by:
1.Destroying important organs
2.Disturbing normal body functions
3.Blocking important blood vessels or air passages.
Not all cancers are the same
Cancer is really a group of diseases.
There are many types of cancer which can arise from the different types of cells in the body.
MOST COMMON TYPES OF CANCER IN SINGAPORE ARE:
Male
1.Lung
2.Colon & rectum
(large intestine)
3.Prostate
4.Liver
5.Stomach
Female
1.Breast
2.Colon & rectum
3.Lung
4.Ovary
5.Cervix
(neck of the womb)
Cancer can be prevented
Cancer is not contagious like the flu or chickenpox.
A person cannot catch cancer from someone who has it.
However some cancer can be inherited hence the need to prevent the cancer in people with a family history of cancer.
Many cancers develop because of lifestyle habits such as
1.smoking,
2.excessive drinking of alcohol
3.eating too much fat (especially animal fat).
4.sexual intercourse with multiple partners
Others are caused by factors in the environment such as
1.sunlight,
2.radiation
3.industrial chemicals.
4.bacterial infection like hylobacter pylori in stomach cancer
5.viral infections like hepatitis B and C, Epstein Barr virus in liver cancer and nasopharyngeal cancer
By leading a healthy lifestyle and avoiding certain risk factors, about one-third of all cancers can be prevented from occurring.
Cancer can be cured
Many people are afraid of cancer because they think it is incurable. In fact, about one-third of all cancers can be cured if they are detected and treated early enough.
Recognising the early warning signs and going for regular check-ups can save your life if cancer strikes.
What is cancer screening?
Cancer screening consists of various tests and procedures done at regular intervals:
1.once a year
2.once in 2 years
3.once in 5 years
4.when a person reach a certain age
Who should go for cancer screening?
Cancer screening helps to discover if a person is suffering from cancer even though the person has no symptoms.
In particular cancer screening should be done if there is a family history of cancer.
Why do I need to go for cancer screening?
Cancer is the top killer in Singapore.
About one quarter of all deaths here are caused by cancer.
Our bodies are made up of billions of cells. Normal healthy cells grow and multiply in an orderly, controlled manner.
Cancer cells on the other hand multiply uncontrollably. They do not function normally and instead form a growth or tumour. These cancerous tumours can spread to nearby tissues and organs as well as to other parts of the body.
Cancer kills by:
1.Destroying important organs
2.Disturbing normal body functions
3.Blocking important blood vessels or air passages.
Not all cancers are the same
Cancer is really a group of diseases.
There are many types of cancer which can arise from the different types of cells in the body.
MOST COMMON TYPES OF CANCER IN SINGAPORE ARE:
Male
1.Lung
2.Colon & rectum
(large intestine)
3.Prostate
4.Liver
5.Stomach
Female
1.Breast
2.Colon & rectum
3.Lung
4.Ovary
5.Cervix
(neck of the womb)
Cancer can be prevented
Cancer is not contagious like the flu or chickenpox.
A person cannot catch cancer from someone who has it.
However some cancer can be inherited hence the need to prevent the cancer in people with a family history of cancer.
Many cancers develop because of lifestyle habits such as
1.smoking,
2.excessive drinking of alcohol
3.eating too much fat (especially animal fat).
4.sexual intercourse with multiple partners
Others are caused by factors in the environment such as
1.sunlight,
2.radiation
3.industrial chemicals.
4.bacterial infection like hylobacter pylori in stomach cancer
5.viral infections like hepatitis B and C, Epstein Barr virus in liver cancer and nasopharyngeal cancer
By leading a healthy lifestyle and avoiding certain risk factors, about one-third of all cancers can be prevented from occurring.
Cancer can be cured
Many people are afraid of cancer because they think it is incurable. In fact, about one-third of all cancers can be cured if they are detected and treated early enough.
Recognising the early warning signs and going for regular check-ups can save your life if cancer strikes.
What is cancer screening?
Cancer screening consists of various tests and procedures done at regular intervals:
1.once a year
2.once in 2 years
3.once in 5 years
4.when a person reach a certain age
Who should go for cancer screening?
Cancer screening helps to discover if a person is suffering from cancer even though the person has no symptoms.
In particular cancer screening should be done if there is a family history of cancer.
Thursday, July 14, 2011
A Family Doctor's Tale - GOITER
DOC I HAVE GOITER
Goiter is the abnormal diffuse enlargement of the thyroid gland.
People who are at risk of Goiter are:
1.Goiter are more common in females than in male.
2.Goiter occurs in all edge groups but is more common in the 30- 60 age group.
3.Goiter may be endemic in areas of deficient iodine intake.
The causes of Goiter are:
1.Toxic goiter caused by hyperthyroidism usually diffuse with signs of hyperthyroidism
2.Autoimmune bacterial or viral thyroiditis(Hashimoto's disease) also presents with smooth diffuse goiter.
3.Benign tumors of the thyroid such as adenoma, cyst may presents more of nodular form of goiter.
4.Malignant tumors of the thyroid may be nodular or diffuse
5.Inherited disorders of thyroid gland metabolism may also manifest as goiter
6.Nontoxic or simple goiter is common in those people deficient in iodine intake.
7.Some goiters are caused by ingestion of goiter stimulating agents or medicines such as thyroxine
The symptoms and signs of Goiter are:
Symptoms:
1.Obvious swelling in the thyroid gland present for some time
2.Painful swelling are suggestive of bacterial or viral infection-
3.Hoarseness of voice may occur if there is pressure on the vocal cord or recurrent nerve to vocal cord
4.Dyspnea or breathlessness if there is pressure on the trachea
5.Dysphagia or difficuly in swallowing due to pressure on the oesophagus
Signs:
1.Goiter or swelling of thyroid may be smooth, diffuse or nodular.
The swelling moves on swallowing.
2.Cystic nodules may feel hard while solid nodules may be soft to firm.
3.Thyroid hormones may be normal, increased or decreased
4.Neck lymph nodes are enlarged
The diagnosis of Goiter is made using:
1.blood test for thyroid hormones(T$ and T3), TSH levels and thyroid stimulating immunoglobulins
2.fine needle aspiration biopsy is a simple way to determine if a nodule is benign or malignant.
3.ultrasound scans are done to differentiate between solid, diffuse and cystic nodules,
4.thyroid scans which help to show if a nodule is producing excessive thyroid hormone(hot) or not.
5.CT Scan or MRI are not routine to Goiter investigation except where there is suspected compression of teachea.
The Treatment of Goiter is:
Benign lumps can be monitored by doctors at regular intervals.
If there are symptoms of compressing a neighbouring organ or the nodule is cancerous, surgery is required.
Patients who has symptoms of hyperthyroidism are advised to go for medical treatment with carbimazole, radioactive iodine treatment or surgery.
Beta blockers are given in hyperthyroid cases where the heart beat is very fast.
Iodine deficient goiter patients may require iodine supplements.
Goiter due to Hashimoto disease or simple nontoxic goiter may become smaller with thyroxine treatment.
Prognosis of Goiter is good in all benign cases.
Malignant Goiter are slow growing and have good prognosis.
The prognosis of the more serious carcinoma will depend on any spread to other organs.
Hyperthyroid patients recovers after 2 years of anti-thyroid medications and 30 per cent remains in remission after withdrawal of anti-thyroid medications
Goiter is the abnormal diffuse enlargement of the thyroid gland.
People who are at risk of Goiter are:
1.Goiter are more common in females than in male.
2.Goiter occurs in all edge groups but is more common in the 30- 60 age group.
3.Goiter may be endemic in areas of deficient iodine intake.
The causes of Goiter are:
1.Toxic goiter caused by hyperthyroidism usually diffuse with signs of hyperthyroidism
2.Autoimmune bacterial or viral thyroiditis(Hashimoto's disease) also presents with smooth diffuse goiter.
3.Benign tumors of the thyroid such as adenoma, cyst may presents more of nodular form of goiter.
4.Malignant tumors of the thyroid may be nodular or diffuse
5.Inherited disorders of thyroid gland metabolism may also manifest as goiter
6.Nontoxic or simple goiter is common in those people deficient in iodine intake.
7.Some goiters are caused by ingestion of goiter stimulating agents or medicines such as thyroxine
The symptoms and signs of Goiter are:
Symptoms:
1.Obvious swelling in the thyroid gland present for some time
2.Painful swelling are suggestive of bacterial or viral infection-
3.Hoarseness of voice may occur if there is pressure on the vocal cord or recurrent nerve to vocal cord
4.Dyspnea or breathlessness if there is pressure on the trachea
5.Dysphagia or difficuly in swallowing due to pressure on the oesophagus
Signs:
1.Goiter or swelling of thyroid may be smooth, diffuse or nodular.
The swelling moves on swallowing.
2.Cystic nodules may feel hard while solid nodules may be soft to firm.
3.Thyroid hormones may be normal, increased or decreased
4.Neck lymph nodes are enlarged
The diagnosis of Goiter is made using:
1.blood test for thyroid hormones(T$ and T3), TSH levels and thyroid stimulating immunoglobulins
2.fine needle aspiration biopsy is a simple way to determine if a nodule is benign or malignant.
3.ultrasound scans are done to differentiate between solid, diffuse and cystic nodules,
4.thyroid scans which help to show if a nodule is producing excessive thyroid hormone(hot) or not.
5.CT Scan or MRI are not routine to Goiter investigation except where there is suspected compression of teachea.
The Treatment of Goiter is:
Benign lumps can be monitored by doctors at regular intervals.
If there are symptoms of compressing a neighbouring organ or the nodule is cancerous, surgery is required.
Patients who has symptoms of hyperthyroidism are advised to go for medical treatment with carbimazole, radioactive iodine treatment or surgery.
Beta blockers are given in hyperthyroid cases where the heart beat is very fast.
Iodine deficient goiter patients may require iodine supplements.
Goiter due to Hashimoto disease or simple nontoxic goiter may become smaller with thyroxine treatment.
Prognosis of Goiter is good in all benign cases.
Malignant Goiter are slow growing and have good prognosis.
The prognosis of the more serious carcinoma will depend on any spread to other organs.
Hyperthyroid patients recovers after 2 years of anti-thyroid medications and 30 per cent remains in remission after withdrawal of anti-thyroid medications
Tuesday, July 12, 2011
A Family Doctor's Tale - EAR CANAL POLYPS
DOC I HAVE EAR CANAL POLYPS
Ear canal polyps or aural polyps are benign swellings that grow from the skin or glands of the external ear canal or from the lining of the ear drum.
Ear canal polyps occurs as a result of chronic irritation of the skin of the ear canal or eardrum usually from infections of the external ear canal.
The symptoms and signs of ear canal polyps are:
Symptoms:
1.pain in the ear
2.Itchiness
3.ear discharge
4.loss of hearing
Signs:
1.Presence of polyps in the ear canal
2.Infection in the ear canal
Diagnosis or ear canal polyps:
1.Otoscopy usually show the presence of pedunculated soft fleshy swellings in the ear canal
2.Infection may be present in ear canal with pus and debris
3.MRI or CAT SCAN may be done to exclude the presence of cholesteatoma (also a chronic infected ear cyst in the middle ear or inner ear) which can damage the bone in the inner ear and spread to the brain causing infection.
4.Ear canal polyp biopsy to exclude malignancy
The complications of ear canal polyps are:
1.Rarely Ear canal polyps may become malignant
2.In diabetes or immune deficient patients severe infections called malignant otitis externs may spread to the mastoid and spread to the brain causing brain abscess, facial paralysis, deafness, meningitis, and osteomyelitis of the base of the
skull
Treatment of ear canal polyps is by:
1.Topical steroid cream and antibiotic ear drops
2.For chronic or repeat infections, steroid creams and white table vinegar (5% acetic acid) usually help to dissolve the polyps
3.Antifungal drops and creams are used for fungal infection.
4.Surgery of ear tubes may be necessay for ear canal Polyps developing from ear tubes if eardrop treatment is not effective.
5.Cholesteatoma-generated polyps may require drops and oral antibiotics
Some side effects of the medications used are:
1.allergic reaction
2.severe itching,
3.blistering,
4.redness,
5.thickening of the ear canal skin.
These medicines must be stopped if any of these symptoms develop.
Surgical removal of ear canal polyps may have pain and bleeding as side effects.
Prognosis of Ear canal polyp is:
In most cases, the infection and the ear canal polyp should resolve with treatment
Recurrence of the ear infection is common.
Reappearance of symptoms of ear discharge, hearing loss, bleeding, and itching may indicate the underlying infection has recurred.
In these cases, maintenance steroid drops, vinegar irrigations, or antifungal agents may be needed.
Ear canal polyps or aural polyps are benign swellings that grow from the skin or glands of the external ear canal or from the lining of the ear drum.
Ear canal polyps occurs as a result of chronic irritation of the skin of the ear canal or eardrum usually from infections of the external ear canal.
The symptoms and signs of ear canal polyps are:
Symptoms:
1.pain in the ear
2.Itchiness
3.ear discharge
4.loss of hearing
Signs:
1.Presence of polyps in the ear canal
2.Infection in the ear canal
Diagnosis or ear canal polyps:
1.Otoscopy usually show the presence of pedunculated soft fleshy swellings in the ear canal
2.Infection may be present in ear canal with pus and debris
3.MRI or CAT SCAN may be done to exclude the presence of cholesteatoma (also a chronic infected ear cyst in the middle ear or inner ear) which can damage the bone in the inner ear and spread to the brain causing infection.
4.Ear canal polyp biopsy to exclude malignancy
The complications of ear canal polyps are:
1.Rarely Ear canal polyps may become malignant
2.In diabetes or immune deficient patients severe infections called malignant otitis externs may spread to the mastoid and spread to the brain causing brain abscess, facial paralysis, deafness, meningitis, and osteomyelitis of the base of the
skull
Treatment of ear canal polyps is by:
1.Topical steroid cream and antibiotic ear drops
2.For chronic or repeat infections, steroid creams and white table vinegar (5% acetic acid) usually help to dissolve the polyps
3.Antifungal drops and creams are used for fungal infection.
4.Surgery of ear tubes may be necessay for ear canal Polyps developing from ear tubes if eardrop treatment is not effective.
5.Cholesteatoma-generated polyps may require drops and oral antibiotics
Some side effects of the medications used are:
1.allergic reaction
2.severe itching,
3.blistering,
4.redness,
5.thickening of the ear canal skin.
These medicines must be stopped if any of these symptoms develop.
Surgical removal of ear canal polyps may have pain and bleeding as side effects.
Prognosis of Ear canal polyp is:
In most cases, the infection and the ear canal polyp should resolve with treatment
Recurrence of the ear infection is common.
Reappearance of symptoms of ear discharge, hearing loss, bleeding, and itching may indicate the underlying infection has recurred.
In these cases, maintenance steroid drops, vinegar irrigations, or antifungal agents may be needed.
Sunday, July 10, 2011
A Family Doctor's Tale -DEMENTIA
DOC I HAVE DEMENTIA
Dementia is a disease in which brain tissue degenerates to the extent of loss of memory and other intellectual abilities serious enough to interfere with daily life.
In Dementia there is a severe and progressive decline in mental function.
It affects a person's ability to:
1.think,remember and reason
2.learn new information and skills
3.solve problems and make judgement
The causes of Dementia are :
There are several different factors which may contribute to its development.
They can be divided into:
1.Irreversible conditions
a.Aging is one important risk factor.
Alzeimer's Disease
b.Stroke
c.Parkinson's disease
2.Reversible conditions
a.Hypothyroidism
b.Vitamin B12 deficiency
c.Alcohol dependence diseases
Irreversible Dementia cannot be cured but it may be possible to slow down the progression of the disease.
It may be possible treat the cognitive symptoms.
Potentially reversible dementia may be curable.
The Symptoms of Dementia are:
1.Memory loss or Forgetfulness is often one of the earliest symptoms (Patients may forget dates, names of common objects and familiar people)
2.Confusion(Disorientation in time and place) ,
3.Trouble with organizing
4.Misplacing things,
5.Difficulty in expressing thoughts,
6.Difficulty performing familiar tasks
7.Difficulty understanding others
8.Poor or decreased judgment
9.Wandering and getting lost in familiar places
10.Changes in mood and behaviour (They may become easily agitated or depressed)
a.Changes in personality
b.paranoia
c.hallucinations
d.agitation
e.anxiety
f.sleep problems
Dementia should be assessed and investigated.
Diagnosis can be based on :
1.History of depression, anxiety, hallucination, paranoia, agitation or sleep problems
2.Various tests may be done to exclude other conditions that may be causing the same problems:
a.blood sugar, thyroid hormone, vitamin B12 level
b.CT Scan or MRI of the brain to exclude tumors or stroke
The family doctor can refer the patient to a psychiatrist for further assessment if dementia is suspected.
The Management of Dementia is by:
Dementia is quite common in old people.
Referral to a psychiatrist may then be necessary for assessement and advice on management.
Management of dementia usually involve :
1.Treatment of reversible causes and risk factors:
a.treatment of any reversible causes such as hypothyroidism(thyroxine tabs), Vitamin B12 deficiency(injections of Vitamin B12 or B12 oral tablets)
b.reduction of risk facors for stroke such as diabetes, hypertension, high cholesterol
c.Use of blood thinning medicines such aspirin, plavix, ticlid, warfarin to prevent stroke
2.At the present moment there is no cure for non reversible Dementia but there are many ways to reduce the behavioural and psychological symptoms.
These including having
a.a fixed routine daily,
b.making the home and surroundings safe and familiar
c.using memory aids like diaries and calendars.
d.social interactions and contacts with other patients
e.activity programs
3.There are now drugs available to help delay or prevent symptoms from becoming worse:
a.One group of drugs helps improve the ability to think, understand, and remember.(Donepezil, Rivastigmine, Galantamine, Memantine) .
There may be improvement of the symptoms but ultimately they do not prevent the disease from getting worse.
b.Another group of drugs is also to help with behavioural problems associated with Dementia, such as aggressiveness, agitation, depression, and anxiety.(Prozac, Seroxat, Zoloft)
4.Caring for a patient with dementia can be frustrating and stressful.
It gets worse as the disease progresses.
There are now support groups and organisations which can help caregivers providing:.
a.education on dementia and caretaker skills
b.individual and family couseling
c.caretaker support groups
d.dementia day care service
Dementia is a disease in which brain tissue degenerates to the extent of loss of memory and other intellectual abilities serious enough to interfere with daily life.
In Dementia there is a severe and progressive decline in mental function.
It affects a person's ability to:
1.think,remember and reason
2.learn new information and skills
3.solve problems and make judgement
The causes of Dementia are :
There are several different factors which may contribute to its development.
They can be divided into:
1.Irreversible conditions
a.Aging is one important risk factor.
Alzeimer's Disease
b.Stroke
c.Parkinson's disease
2.Reversible conditions
a.Hypothyroidism
b.Vitamin B12 deficiency
c.Alcohol dependence diseases
Irreversible Dementia cannot be cured but it may be possible to slow down the progression of the disease.
It may be possible treat the cognitive symptoms.
Potentially reversible dementia may be curable.
The Symptoms of Dementia are:
1.Memory loss or Forgetfulness is often one of the earliest symptoms (Patients may forget dates, names of common objects and familiar people)
2.Confusion(Disorientation in time and place) ,
3.Trouble with organizing
4.Misplacing things,
5.Difficulty in expressing thoughts,
6.Difficulty performing familiar tasks
7.Difficulty understanding others
8.Poor or decreased judgment
9.Wandering and getting lost in familiar places
10.Changes in mood and behaviour (They may become easily agitated or depressed)
a.Changes in personality
b.paranoia
c.hallucinations
d.agitation
e.anxiety
f.sleep problems
Dementia should be assessed and investigated.
Diagnosis can be based on :
1.History of depression, anxiety, hallucination, paranoia, agitation or sleep problems
2.Various tests may be done to exclude other conditions that may be causing the same problems:
a.blood sugar, thyroid hormone, vitamin B12 level
b.CT Scan or MRI of the brain to exclude tumors or stroke
The family doctor can refer the patient to a psychiatrist for further assessment if dementia is suspected.
The Management of Dementia is by:
Dementia is quite common in old people.
Referral to a psychiatrist may then be necessary for assessement and advice on management.
Management of dementia usually involve :
1.Treatment of reversible causes and risk factors:
a.treatment of any reversible causes such as hypothyroidism(thyroxine tabs), Vitamin B12 deficiency(injections of Vitamin B12 or B12 oral tablets)
b.reduction of risk facors for stroke such as diabetes, hypertension, high cholesterol
c.Use of blood thinning medicines such aspirin, plavix, ticlid, warfarin to prevent stroke
2.At the present moment there is no cure for non reversible Dementia but there are many ways to reduce the behavioural and psychological symptoms.
These including having
a.a fixed routine daily,
b.making the home and surroundings safe and familiar
c.using memory aids like diaries and calendars.
d.social interactions and contacts with other patients
e.activity programs
3.There are now drugs available to help delay or prevent symptoms from becoming worse:
a.One group of drugs helps improve the ability to think, understand, and remember.(Donepezil, Rivastigmine, Galantamine, Memantine) .
There may be improvement of the symptoms but ultimately they do not prevent the disease from getting worse.
b.Another group of drugs is also to help with behavioural problems associated with Dementia, such as aggressiveness, agitation, depression, and anxiety.(Prozac, Seroxat, Zoloft)
4.Caring for a patient with dementia can be frustrating and stressful.
It gets worse as the disease progresses.
There are now support groups and organisations which can help caregivers providing:.
a.education on dementia and caretaker skills
b.individual and family couseling
c.caretaker support groups
d.dementia day care service
Friday, July 8, 2011
A Family Doctor's Tale - ROSEOLA INFANTUM
DOC I HAVE ROSEOLA INFANTUM
Roseola Infantum is usually a contagious childhood infection caused by the Roseola Infantum virus.
It is also known as "false measles" because of the appearance of its rashes which appear from the face and spread down to the legs and fever.
It is characterized by typical prodromal symptoms of fever, runny nose , cough, generalised rash and cervical lymphadenopathy
Any one at any age can contract Roseola Infantum but it usually occurs before the age of 2 years old because by that time most of the children has immunity to the virus.
Spread is usually by infected persons either from mucous discharges from their coughing and sneezing, or from contact with their skin rash,contaminated items and surfaces.
Usually a person is contagious for about two days before symptoms appear, and up to five days after appearance of the rash.
There is a prodromal peroid of 5 to 7 days after contact with a infected person.
Early symptoms include:
1.high fever
2.coughing,
3.runny nose, stuffy nose,
4.tiredness,
5.red eyes, tearing. ,
6.Roseola Infantum rash usually occurs after the onset of fever.
The rash is typically red,maculopapular, and starts from behind the ears and face, then spreads downward to the neck, trunk, limbs, palms and soles.
The rash begins to fade in about four days .
There may be a brownish discoloration in areas of affected skin rahes but this is only temporary.
7. enlarged lymph glands may be felt in the neck and groins
8.inflammation of the eyes (conjunctivitis) with tearing may also occurs.
9. diarrhoea and vomiting may occurs in some patients.
Children who have had Roseola Infantum develop a natural immunity and cannot contract it again.
Complications are rare and include:
1.Ear infection (Otitis Media) is a common complication of Roseola Infantum.
2.pneumonia in very young children may be dangerous.
3.encephalitis (brain infection)may occur in rare cases
There is no cure for Roseola Infantum.
Treatment is therefore symptomatic.
1.Fever symptoms are treated with acetaminophen (Paracetamol).
Children should not be given aspirin due to the risk of Reye's Syndrome which affects the brain
2.Itch may be controlled by antihistamines which can also help to relieve the runny nose.
3.Antibiotics may be given if there is superimposed secondary bacterial infection such as otitis emdia and pneumonia..
4.Cough mixtures may be given to relieve the cough.
5.Plenty of bed rest is necessary.
6.Lots of fluids helps to prevent dehydration.
Most patients recover completely from Roseola Infantum.
Roseola Infantum is usually a contagious childhood infection caused by the Roseola Infantum virus.
It is also known as "false measles" because of the appearance of its rashes which appear from the face and spread down to the legs and fever.
It is characterized by typical prodromal symptoms of fever, runny nose , cough, generalised rash and cervical lymphadenopathy
Any one at any age can contract Roseola Infantum but it usually occurs before the age of 2 years old because by that time most of the children has immunity to the virus.
Spread is usually by infected persons either from mucous discharges from their coughing and sneezing, or from contact with their skin rash,contaminated items and surfaces.
Usually a person is contagious for about two days before symptoms appear, and up to five days after appearance of the rash.
There is a prodromal peroid of 5 to 7 days after contact with a infected person.
Early symptoms include:
1.high fever
2.coughing,
3.runny nose, stuffy nose,
4.tiredness,
5.red eyes, tearing. ,
6.Roseola Infantum rash usually occurs after the onset of fever.
The rash is typically red,maculopapular, and starts from behind the ears and face, then spreads downward to the neck, trunk, limbs, palms and soles.
The rash begins to fade in about four days .
There may be a brownish discoloration in areas of affected skin rahes but this is only temporary.
7. enlarged lymph glands may be felt in the neck and groins
8.inflammation of the eyes (conjunctivitis) with tearing may also occurs.
9. diarrhoea and vomiting may occurs in some patients.
Children who have had Roseola Infantum develop a natural immunity and cannot contract it again.
Complications are rare and include:
1.Ear infection (Otitis Media) is a common complication of Roseola Infantum.
2.pneumonia in very young children may be dangerous.
3.encephalitis (brain infection)may occur in rare cases
There is no cure for Roseola Infantum.
Treatment is therefore symptomatic.
1.Fever symptoms are treated with acetaminophen (Paracetamol).
Children should not be given aspirin due to the risk of Reye's Syndrome which affects the brain
2.Itch may be controlled by antihistamines which can also help to relieve the runny nose.
3.Antibiotics may be given if there is superimposed secondary bacterial infection such as otitis emdia and pneumonia..
4.Cough mixtures may be given to relieve the cough.
5.Plenty of bed rest is necessary.
6.Lots of fluids helps to prevent dehydration.
Most patients recover completely from Roseola Infantum.
Wednesday, July 6, 2011
A Family Doctor's Tale - SCARLET FEVER
DOC I HAVE SCARLET FEVER
Scarlet Fever is an acute febrile infectious disease of the upper respiratory tract caused by the erythrogenic toxin associated with the bacillus Group A Streptococcus(GAS).
Scarlet Fever is transmitted through the air through
1.droplets from the infected tonsillar or pharyngeal area of infected patients.
2.infected articles or food,
3.infected wounds or
4.infected umbilical stumps of neonates
It is highly infectious, being communicable from 24 hours before onset of symptoms to 2 to 3 weeks after onset of symptoms.
Asymptomatic carriers can also spread the disease.
Incubation period is 2 - 5 days.
The organism enters the blood from the throat and produce an erythrogenic toxin which causes the symptoms of fever and rash.
The rash is the main symptom which gives rise to the scarlet appearance, hence the name Scarlet Fever.
The infections occur in persons of all ages but peak incidence is 5- 15 years. Males are affected equally as females.
Usually 1 attack will confer permanent immunity to the erythrogenic toxin of GAS streptococcus.
The Signs and Symptoms of Scarlet Fever are:
Symptoms start off with:
1. sudden onset of headache
2. high fever 39-40 degrees centigrades
3. chills and rigors
4. sore throat(infected tonsils)
5. vomiting
6. cervical lymphadenopathy
Subsequent symptoms follows:
1.punctate erythrematous rash appearing 12 to 24 hours later after the fever, starting from the neck and chest then spreads rapidly.
The face is not affected.
2.Facial flushing and pale area around the mouth
3.Dark red lines along skin creases (Pastia's lines)
4.Rash blanches when pressed
5.Tongue coated with white fur with occasional red papillae (white strawberry tongue) The white fur peels on the third day and becomes red by the fourth day (red strawberry tongue)
How to diagnose Scarlet Fever?
-------------------------------------------------------------
1.Symptoms of fever , rash and strawberry tongue
2.ESR raised very high sometimes > 80
3.moderate leucocytosis
4.Throat swab for culture ans sensitivity
The complications of Scarlet Fever are:
1.otitis media
2.rheumatic fever
3.glomerulonephritis
4.henoch-schonlein purpura
The Treatment of Scarlet Fever is:
Isolation in hospital may be needed.
1.Antibiotics (penicillin or amoxicillin) are used in the treatment of Scarlet Fever. Treatment is for at least 10 days.
Alternatives are cephalosporins such as cephelexin in penicillin sensitive patients
2.Paracetamol is given for fever and pain
3.Bed rest , fluids and general supportive care
The Prevention for Scarlet Fever is by:
Avoiding infected patients
Use a mask in clouded places
General personal hygiene including washing hands after contact with possible contact with mucous discharge from nose, infected items or clothing and after meals
Recently in June 2011 there is an outbreak of new cases of Scarlet Fever in Hong Kong.
Prognosis of Scarlet Fever is good.
In fact after the introduction of antibiotics, there is very few cases of Scarlet Fever.
Early therapy with antibiotics produce excellent recovery
In rare cases complications such as rheumatic fever and glomerulonephritis can occur
Scarlet Fever is an acute febrile infectious disease of the upper respiratory tract caused by the erythrogenic toxin associated with the bacillus Group A Streptococcus(GAS).
Scarlet Fever is transmitted through the air through
1.droplets from the infected tonsillar or pharyngeal area of infected patients.
2.infected articles or food,
3.infected wounds or
4.infected umbilical stumps of neonates
It is highly infectious, being communicable from 24 hours before onset of symptoms to 2 to 3 weeks after onset of symptoms.
Asymptomatic carriers can also spread the disease.
Incubation period is 2 - 5 days.
The organism enters the blood from the throat and produce an erythrogenic toxin which causes the symptoms of fever and rash.
The rash is the main symptom which gives rise to the scarlet appearance, hence the name Scarlet Fever.
The infections occur in persons of all ages but peak incidence is 5- 15 years. Males are affected equally as females.
Usually 1 attack will confer permanent immunity to the erythrogenic toxin of GAS streptococcus.
The Signs and Symptoms of Scarlet Fever are:
Symptoms start off with:
1. sudden onset of headache
2. high fever 39-40 degrees centigrades
3. chills and rigors
4. sore throat(infected tonsils)
5. vomiting
6. cervical lymphadenopathy
Subsequent symptoms follows:
1.punctate erythrematous rash appearing 12 to 24 hours later after the fever, starting from the neck and chest then spreads rapidly.
The face is not affected.
2.Facial flushing and pale area around the mouth
3.Dark red lines along skin creases (Pastia's lines)
4.Rash blanches when pressed
5.Tongue coated with white fur with occasional red papillae (white strawberry tongue) The white fur peels on the third day and becomes red by the fourth day (red strawberry tongue)
How to diagnose Scarlet Fever?
-------------------------------------------------------------
1.Symptoms of fever , rash and strawberry tongue
2.ESR raised very high sometimes > 80
3.moderate leucocytosis
4.Throat swab for culture ans sensitivity
The complications of Scarlet Fever are:
1.otitis media
2.rheumatic fever
3.glomerulonephritis
4.henoch-schonlein purpura
The Treatment of Scarlet Fever is:
Isolation in hospital may be needed.
1.Antibiotics (penicillin or amoxicillin) are used in the treatment of Scarlet Fever. Treatment is for at least 10 days.
Alternatives are cephalosporins such as cephelexin in penicillin sensitive patients
2.Paracetamol is given for fever and pain
3.Bed rest , fluids and general supportive care
The Prevention for Scarlet Fever is by:
Avoiding infected patients
Use a mask in clouded places
General personal hygiene including washing hands after contact with possible contact with mucous discharge from nose, infected items or clothing and after meals
Recently in June 2011 there is an outbreak of new cases of Scarlet Fever in Hong Kong.
Prognosis of Scarlet Fever is good.
In fact after the introduction of antibiotics, there is very few cases of Scarlet Fever.
Early therapy with antibiotics produce excellent recovery
In rare cases complications such as rheumatic fever and glomerulonephritis can occur
Monday, July 4, 2011
A Family Doctor's Tale - HYPOPARATHYROIDISM
DOC I HAVE HYPOPARATHYROIDISM
Hypoparathyroid disease is a condition when the parathyroid gland produces too little parathyroid hormones resulting in hypocalcemia.
Hypoparathyroid disease is caused by:
Primary
Primary Hypoparathyroid disease is a rare congenital condition which usually occurs in children below the age of sixteen but can persists throughout adult life
Secondary.
Secondary Hypoparathyroid disease is usually related to surgical resection of the thyroid during which partial to total removal of the parthyroid gland occurs.
As a result of better surgical techniques , less permanent loss of the parathyroid glands occurs during throidectomy.
Instead transient deficiency may occur due to injuries to the parathyroid glands during the surgery, temporary reduction of blood supply to the parathyroid gland and hemorrhage during the surgery.
Neither the administration of radfioactive iodine or radiation to the thyroid gland has been known to cause Secondary Hypoparathyroid disease.
Symptoms:
1.tetany from lowered blood calcium
Tetany which appeared in 70 per cent of cases appears as a carpopedal spasm where the stiff hollowed hand with rigid fingers is flexed at the second metacarpal-phalangeal joint, wrist and elbow joints and the legs and feet are extended.
2.epileptic fits and tonic convulsions occurs in 40 per cent of cases
3.laryngeal spasm of muscles (may be dangerous)
4.spasm of the smooth muscle of blood vessel causing numbness due to poor blood circulation
5.diarrhea due to spasm of the smooth muscles of the gastrintestinal tract
6.mental changes including anxiety, depression, psychoses
Signs:
1.neuromuscular excitabilty may show up as contraction of the facial muscles in response to a light tap on the facial nerve in front of the ear(Chvostek's sign)
2.Dorsal flexion and abduction of the foot may occur by a tapping the lateral surface of the fibula just below its heal(Peroneal sign)
3.Inflation of a blood pressure cuff above the systolic pressure may cause the hand the typical position seen in carpopedal spasm(Trousseau's sign)
4.Skin is dry rough and scaly with patchy or generalised erythema
5.Nails may be brittle with transverse ridges
Diagnosis:
1. blood test is done for presence of low parathyroid hormone levels.
2. Blood calcium is low in hypoparathyroidism
3. Blood phosphate is high in primary
Treatment:
1.Hypocalcemia is treated with intravenous injections of calcium gluconate under cardiac monitoring as excess calcium may affect the heart
2.oral Calcium supplements(Calcium Chloride is the most effective) is given in most cases as a long term treatment usually with improvement of blood Calcium level
3.Large doses of Vitamin D may be necessary in some cases.
4.Treat underlying cause.
5.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
surgery of thyroid gland should be done carefully so as not to remove the parathyroid gland or damage it
Hypoparathyroid disease is a condition when the parathyroid gland produces too little parathyroid hormones resulting in hypocalcemia.
Hypoparathyroid disease is caused by:
Primary
Primary Hypoparathyroid disease is a rare congenital condition which usually occurs in children below the age of sixteen but can persists throughout adult life
Secondary.
Secondary Hypoparathyroid disease is usually related to surgical resection of the thyroid during which partial to total removal of the parthyroid gland occurs.
As a result of better surgical techniques , less permanent loss of the parathyroid glands occurs during throidectomy.
Instead transient deficiency may occur due to injuries to the parathyroid glands during the surgery, temporary reduction of blood supply to the parathyroid gland and hemorrhage during the surgery.
Neither the administration of radfioactive iodine or radiation to the thyroid gland has been known to cause Secondary Hypoparathyroid disease.
Symptoms:
1.tetany from lowered blood calcium
Tetany which appeared in 70 per cent of cases appears as a carpopedal spasm where the stiff hollowed hand with rigid fingers is flexed at the second metacarpal-phalangeal joint, wrist and elbow joints and the legs and feet are extended.
2.epileptic fits and tonic convulsions occurs in 40 per cent of cases
3.laryngeal spasm of muscles (may be dangerous)
4.spasm of the smooth muscle of blood vessel causing numbness due to poor blood circulation
5.diarrhea due to spasm of the smooth muscles of the gastrintestinal tract
6.mental changes including anxiety, depression, psychoses
Signs:
1.neuromuscular excitabilty may show up as contraction of the facial muscles in response to a light tap on the facial nerve in front of the ear(Chvostek's sign)
2.Dorsal flexion and abduction of the foot may occur by a tapping the lateral surface of the fibula just below its heal(Peroneal sign)
3.Inflation of a blood pressure cuff above the systolic pressure may cause the hand the typical position seen in carpopedal spasm(Trousseau's sign)
4.Skin is dry rough and scaly with patchy or generalised erythema
5.Nails may be brittle with transverse ridges
Diagnosis:
1. blood test is done for presence of low parathyroid hormone levels.
2. Blood calcium is low in hypoparathyroidism
3. Blood phosphate is high in primary
Treatment:
1.Hypocalcemia is treated with intravenous injections of calcium gluconate under cardiac monitoring as excess calcium may affect the heart
2.oral Calcium supplements(Calcium Chloride is the most effective) is given in most cases as a long term treatment usually with improvement of blood Calcium level
3.Large doses of Vitamin D may be necessary in some cases.
4.Treat underlying cause.
5.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
surgery of thyroid gland should be done carefully so as not to remove the parathyroid gland or damage it
Saturday, July 2, 2011
Subscribe to:
Posts (Atom)
Subscribe to my RSS:
Subscribe in a reader
Share and Enjoy: These icons link to social bookmarking sites where readers can share and discover new web pages.
Click on:
Search Engine Optimization and SEO Tools
Submit URL Free to Search Engines
