How to manage fractured clavicle in a newborn

Mrs. BT brought her 12 –day-old baby to the hospital on Christmas day. She had noticed a swelling on the infant’s right arm which she described as painful. She could not really say the day when the bump first appeared.

The grandma who accompanied the mother and the baby to hospital said she noticed the swelling few days ago and that she had massaged it with methylsalycillate balm and the swelling had reduced.

I had reassured the mother that all would be well and explained that she needed to do an X-ray of the chest to show the extent of possible clavicle fracture.

Unfortunately, she could not get a place to do the X-ray on Christmas Day, but was done the next day. The X-ray shows a formation on the clavicle which is consistent with features of a fractured clavicle.

The clavicle is easily fractured in adults and children because of its subcutaneous, relatively anterior location and frequent exposure to transmitted forces.

The midshaft is the thinnest, least medullous area of the clavicle, and thus the most easily fractured. The lack of muscular and ligamentous support also makes it vulnerable to injury.

A fractured clavicle in a baby that has just been delivered is a broken collar bone.

Babies can easily fracture their clavicle as they pass through the birth canal during delivery. But the clavicle may be broken in newborns even after birth. In some cases, it is so mild that it is not diagnosed until the fracture begins to heal and a bump in the bone (callus) is noticed at the collarbone. In a newborn, a broken clavicle almost always heals with no problems.

Signs and symptoms

Pain, particularly with upper extremity movement or on front part of upper chest. Often, after the swelling has subsided, the fracture can be felt through the skin.

Exams and tests

A chest X-ray will show whether or not there is a broken bone.

Treatment

Generally, there is no treatment other than lifting the child gently to prevent discomfort. Occasionally, the arm on the affected side may be immobilised, most often by simply pinning the sleeve to the clothes.

The infant’s arm is put in a sling or the sleeve is pinned to his or her shirt for seven to 10 days.

After the bone has healed, a bump may remain on the clavicle over the area of the break. This bump will slowly go away over the next year or so.

Medications: Pain relievers are normally prescribed. Care givers are encouraged to follow doctors’ instructions for administering this medication to newborns. Full recovery is possible even without manipulations.

Possible complications

There are usually no complications because infants’ bones heal well. However, some healthcare providers may ask questions about how the child was injured.

Increasing pain (infants often indicate pain with crying that cannot be soothed), if a bump has still not formed over the fracture 14 days after, may suggest a non-union and the baby will need to be re- assessed by an Orthopaedic surgeon.

In conclusion, are you nursing a baby? Have you noticed anything unusual on any part of your baby’s body? Talk to a doctor today.

All you need to know about Acne Vulgaris (PIMPLES)

Acne (Pimples) is the most common skin condition in teenagers. Although it's common, accurate information about acne is scarce. This can make it difficult to get clearer skin.
Acne vulgaris is a skin disease that affects the hair follicles of the face. It is generally affect teenagers due to their increasing hormones level. The acne can be mild until severe and it usually affects face, back, chest or even scalp.

Technically, acne appears when oil (sebum) attaches the hair follicles of the face. Actually, sebum is functioned to protect and lubricate the skin. Gradually, the hair follicles produce bump and make the bacteria reach the deeper skin surface.

There is no single disease which causes more psychic trauma, more maladjustment between parents and children, more general insecurity and feelings of inferiority and greater sums of psychic suffering than does acne vulgaris.

Teenagers are psychologically vulnerable. They are sensitive to modifications in their bodies and appearance. Acne commonly affects young people at a time when they are undergoing maximum psychological, social and physical change.

Despite its apparent cosmetic nature, the effects of acne can go far deeper than the surface of the skin, and place a heavy emotional and psychological burden on patients that may be far worse than its physical impact.

Symptoms of acne

If you have mild or moderate acne, you may have greasy skin and spots (whiteheads or blackheads) on your face, back and chest. Most spots will not cause any other symptoms. Sometimes, spots that have become inflamed and infected (pustules, nodules and cysts) may be painful.

Complications of acne

Most people have a mild form of acne that usually clears up after their teenage years, but sometimes more severe complications may develop if you have moderate or severe acne.

• Scarring. Up to one in five people with acne have scarring that is socially noticeable. If you pick and squeeze your spots, you may get 'ice pick' scars.
• Hyperpigmentation. This is when your skin becomes darker in the areas affected by acne. You're more likely to have hyperpigmentation if you have a dark skin tone.
• Psychological problems. Acne may cause one to have low self-esteem or feel angry about the appearance of the skin, especially if one had scarring. Talk to a doctor if the acne on your face is making you feel particularly low.

Causes of acne

• Hormones. At around 8 years of age, the adrenal glands start to produce androgens (male hormone/testosterone) and the amount produced gradually increases during puberty. The sebaceous glands respond to androgens by producing more sebum and sometimes whiteheads (closed comedones) may develop in young children. For teenagers, hormonal changes during menstrual cycle and pregnancy may trigger acne.
• Sebaceous gland blockage. The skin cells lining the upper part of the hair follicle duct are not shed as normal but accumulate and form a plug (comedone).  The oil is trapped behind it.
• Bacteria and inflammation. Increased numbers of acne bacteria (Propionibacterium acnes) accumulate in the duct and contribute to the inflammation that develops in the pimples. If one  perspire much, the skin should be washed immediately. If its not wash on time, the bacteria will grow rapidly causing acne.
• Genetics. Hereditary factors contribute, however it is not known exactly how this works. Acne can be hereditary. For example, if both parents had acne  have an increased chance of having it too.
• Stress. Adrenal glands produce more androgens when an individual is stressed. This can make acne worse. Generally, stressful over something is not good for ones health. Stress also can caused acne or even be able to make it worse.
• Diet. Certain diets may contribute to the development of acne, however good scientific data is lacking.e.g peanuts. Eating junk food can increase the growth of bacteria of the acne.

Diagnosis of acne

The Doctor will examine the skin and may ask about the teenage medical history.

Acne is easily recognisable by the distribution of spots on the body. the doctor will recommend the most appropriate treatment for the severity of the acne.

   Treatment

1.      Self treatment: If you have acne on your face, do not wash it as often as possible. It won’t make it clean but it will make it worse. Just wash your face twice a day only. If you wear make-up, remove it immediately before going to bed. Do not use face scrub for your face because it will damage your face skin..

2.      Oral antibiotic:The doctor may prescribe you antibiotics such as erythromycin, doxycycline and oxytetracycline in case you have severe acne.

3.      Oral Contraceptive: The doctor will advise some to take oral contraceptive pills to cure acne. If they have severe acne,

4.      By keeping the skin clean one can help to prevent spots forming. Gently washing spot-prone areas with a mild soap or an unperfumed cleanser in lukewarm water about twice a day is good. Acne isn't an infection, so extra washing won't help.

5.      Topical prescription treatments may be adequate for mild acne and can be combined with oral medications for moderate to severe disease or if the patient is unresponsive.

6.      Topical antibiotic is used once or twice daily. Solution or gel formulas may be more useful for the trunk as they may cause irritation on facial inflammatory lesions.

7.      Lotions may be more cosmetically appealing for the face. It is generally recommended that antibiotics be used as combination therapy with either a topical retinoid or benzoyl peroxide or both.

8.      A combination of topical product is available for once-daily use. Another combination strategy is to apply a topical antibiotic in the morning and a topical retinoid at night.

9.      Antibiotics, the contraceptive pill for females, anti-androgens for females .

10.  First-line oral antibiotic therapy is doxycycline  or minocycline daily. These drugs should not be given to teenage women who are pregnant or attempting to get pregnant because of toxic effects on fetal bone formation.

11.  A second-line oral antibiotic is a macrolide. Although there is well documented evidence of antibiotic resistance to erythromycin, it is still used.

12.  Oral contraceptives with anti-androgenic properties should be considered for acne in girls and women who find topical therapies and oral antibiotics ineffective or only partially effective. Patients often need topical therapy while they wait for the full benefit of the pill to work, which usually takes three months.

Acne Myth No. 1: Poor Hygiene Causes Acne
A lot of people have heard this one — that acne is caused by dirty skin. Some teenagers believe this and end up washing their face numerous times a day, sometimes scrubbing vigorously In fact, washing your skin too frequently and too aggressively can make an acne breakout much worse. Ultimately, this can lead to irritated, traumatized skin that looks worse after treatment, Instead, wash your face only once or twice a day with lukewarm water, a mild cleanser, and gentle motion — no scrubbing or harsh abrasive products needed.
No. 2: Squeeze Those Pimples
When that pimple sprouts, you may not be able to resist the temptation to squeeze it out to try to bring it down to size. Some patients will squeeze pimples in an attempt to try to open up a clogged pore, However, this usually leads to further inflammation, which makes the acne look worse and last longer.
Keep your hands off — and leave that pimple alone. Instead, try using an over-the-counter acne treatment gel, ointment, cream, or lotion to help it shrink.
Acne Myth No. 3: Junk Food Causes Acne
You may have heard that eating greasy foods and candy can cause an acne breakout. Though there are some links between diet and acne, the relationship isn't quite what you may think it is.
"Many people with acne have oily skin, so for a time people thought that greasy foods should also be avoided, However, a number of studies have shown that downing foods like French fries, cheeseburgers, and chocolate doesn’t have any impact at all on the skin's health. But getting that grease on your skin can make an oily complexion worse, clogging pores and leading to an acne breakout.
Acne Myth No. 4: Acne Goes Away on Its Own
You don't have to suffer silently with acne — there are treatments available to clear up acne breakouts and help prevent future pimple problems.
Don't just leave a pimple to swell and mark your skin. There are plenty of treatments — both over-the-counter and prescription — available to help unclog those pores and clear up an acne breakout. Without treatment, dark spots and permanent scars can appear on the skin as acne clears.

Holiday Heart Syndrome

Two years ago, during the festive period, a man was brought in for treatment due to the pounding nature of his heart beat. He complained of chest pain and that the heart was beating too fast.

The patient had earlier that day told me he took over three bottles of beer at a party and this was six hours before he came to the hospital.

The patient was offered admission and given some medications. Although he refused admission, his result was not satisfactory, as electrocardiogram was not normal.

An initial clinical suspicion of holiday heart syndrome was made. The test was repeated on the second day and the same patient had a normal ECG and laboratory result.

“What a miracle,” said the patient. But it was not a miracle. Rather, it is, according to the doctor, a feature of medical condition called holiday heart syndrome.

Holiday heart syndrome is a term used to describe a heart condition associated mainly with excessive alcohol consumption coupled with overeating and possibly lack of sleep.

Despite the term, it does not only occur on holidays, although it is more common during festive seasons such as Christmas, Boxing Day and the New Year.

It is an acute condition that disappears spontaneously when the patient desists from taking alcohol.

Symptoms

There are a number of symptoms of holiday heart syndrome. However, some patients tend to delay seeking medical care as it is the holiday season.

It is therefore important for the family and friends of the patient to note any possible symptoms and compel the person to seek medical attention.

The most common symptom of holiday heart syndrome is palpitations where the person can feel the heart pounding.

There are also breathlessness and chest pain due to ischemia (angina), which can sometimes be confused with heartburn or indigestion.

Dizziness, arrythmias and the feeling that one is about to faint are also part of these.

Causes

Holiday heart syndrome is mainly due to excessive alcohol consumption. It is seen with binge drinking particularly over weekends and holidays.

Usually, you don’t need to have a pre-existing heart disease to get it but in some instances there may be undiagnosed chronic diseases of the heart and liver. Concomitant recreational drug use, like cocaine use, can worsen the condition.

However, these patients tend to have a history of heavy drinking frequently. The combination of overeating and a lack of sleep during these periods may also contribute to holiday heart syndrome in conjunction with alcohol although the exact interplay of factors is not clear.

Another major concern is that the irregular heartbeats can lead to congestive heart failure or even a stroke – although this is rare.

Diagnosis

Holiday heart syndrome is diagnosed with the use of an electrocardiogram and, if necessary, an echocardiograph should be conducted.

These tests not only confirm the diagnosis but also identify other pathological changes of the heart. Blood tests to monitor the electrolyte levels, lipid profiles and urinalysis should also be conducted.

Treatment

Young patients with no observable heart disease may not require any specific treatment. The condition resolves on its own, usually within 24 hours, and the patient needs to be advised against excessive alcohol use.

If the arrhythmia is severe or persists for longer than 24 hours, then medical intervention is necessary. Medication and electrical cardio version are the main treatment options for holiday heart syndrome.

Prevention

Binge drinking should be avoided irrespective of the time of the year. Occasionally having an extra drink may not be harmful but holiday heart syndrome can occur in people who are moderate drinkers as well.

In conclusion, heart disease is the number one killer in men and women. We can prevent it by maintaining a healthy weight, exercising, watching salt and fat intake, not smoking, avoiding alcohol and controlling blood pressure.

Enjoy the holidays, but make sure you enjoy them in moderation. Think of your heart!

How to treat community-acquired pneumonia

A popular boxer once said, “I quit school in the sixth grade because of pneumonia. Not because I had it, but because I couldn’t spell it.”

This is to elaborate the serious impact of pneumonia in the community, although it’s about the meaning of the word, not the spelling.

Pneumonia is an inflammation of the lungs. It can be easily be overlooked as the cause of an illness because it often resembles a cold or the flu.

Community-acquired pneumonia is the most common type of pneumonia. It occurs outside of hospitals and other conventional health care facilities.

Other types of pneumonia are:

Hospital-acquired pneumonia: Some people catch pneumonia while receiving treatment for another ailment in a hospital. This type of pneumonia can be serious because the bacteria causing it may be more resistant to antibiotics.

Health care-acquired pneumonia: Health care-acquired pneumonia is a bacterial infection that occurs in people who are living in long-term care facilities or have been treated in outpatient clinics.

Aspiration pneumonia: It occurs when one inhales food, drink or saliva into the lungs.

Causes of pneumonia

Bacteria: Streptococcus pneumonia, mycoplasma pneumonia. Tuberculosis is also a form of pneumonia

Viruses: Some of the viruses that cause colds and the flu can cause pneumonia. Viruses are the most common cause of pneumonia in children under the age of five.

Fungi: This type of pneumonia is most common in people with chronic health problems or weak immune systems and it can be found in people who have inhaled large doses of the microbes.

Diagnosis

The doctor hears abnormal breathing sounds in different areas of the chest while auscultating with the stethoscopes.

Crackling and bubbling sounds in the chest during inhalation are usually indicators of pneumonia. Wheezing may also be present.

Signs

Symptoms of pneumonia may include fever, sweating and shaking chills, cough, which may produce phlegm, chest pain when you breathe or cough, shortness of breath, fatigue, nausea, vomiting or diarrhoea, wheezing, muscle aches, rapid breathing, rapid heartbeat, difficulty breathing.

Some symptoms like bluish tone (from lack of oxygen), blood in sputum (coughed-up mucus), laboured breathing, very high fever, may indicate a medical emergency and require immediate medical attention.

Newborns and infants may develop fever and cough, appear restless or tired or have difficulty breathing and eating. Some may not show any sign of the infection.

Symptoms of pneumonia in the elderly

There are challenges to the diagnosis of pneumonia in elderly people because they may not suffer the classic symptoms like fever, chills and cough, according to the Infectious Disease Clinics of North America.

Keep an eye on for non respiratory symptoms like weakness, confusion, delirium, or dizziness, or other more vague symptoms—especially in those with dementia or Alzheimer’s disease, which can impair the accurate reporting of pneumonia symptoms.

Also, it may be more difficult to notice pneumonia symptoms in seniors with pre-existing conditions. So be alert to any changes in your loved one’s health,and see a doctor if any unusual symptoms occur.

Practice good hygiene

Ordinary respiratory infections, colds, and influenza can sometimes lead to pneumonia; the Mayo Clinic advises that you wash your hands regularly or use hand sanitiser to help prevent the spread of these illnesses. Other types of infections, like oral or dental infections, can also lead to pneumonia, so good dental hygiene is a must.

Lastly, if you want to prevent pneumonia in the elderly loved ones, make sure you help them avoid others who are ill, whether it’s routine illnesses like colds, flu, and respiratory infections, or more serious diseases like measles or chickenpox. All of these can lead to pneumonia.

Make sure seniors get immunised

The Mayo Clinic and the National Heart, Lung and Blood Institute both advise seniors and others at risk for pneumonia to get vaccinated against bacterial pneumococcal pneumonia. It’s a one-time vaccine that can prevent or reduce the severity of pneumonia. Your doctor may also suggest a booster vaccine after five years. It’s also a good idea to vaccinate seniors against other illnesses that can lead to pneumonia, particularly influenza.

Don’t smoke

Smoking is a major risk factor for pneumonia—it greatly increases a person’s likelihood of getting the disease, because it harms the ability of the lungs to defend against infection. Quitting smoking can help at-risk seniors defend against pneumonia.

Stay in good general health

Good overall health habits are critical to preventing pneumonia in seniors and in everybody because they keep the immune system strong and able to fight off infection. Make sure your loved one follows appropriate nutrition guidelines for seniors, as well as getting plenty of rest and physical exercise.

HOW TO MANAGE ANAEMIA

A woman in her late 40s once presented herself in the hospital with features of extreme weakness, tiredness, headache and abdominal pain.

She said she had not enjoyed her life for a single day in the two years she had had them, due to lethargy.

She had been treating malaria and typhoid fever via self-medication, and given intravenous fluids (drips) but all symptoms persisted.

She had also taken several iron injections, blood transfusions and self-administered medications.

A comprehensive test done suggested that she had a fibroid which made her to see her menstrual period occur earlier than expected every month.

This was the cause of her low blood level. She was encouraged to have the fibroid removed surgically since it was affecting her day-to-day activities.

She initially refused on account of fear and likely poor outcome of the surgery, but after much counselling and support she had the surgery done.

Her blood level is stable now, she no longer visits the hospitals; neither does she have to take blood capsules, iron injections and blood transfusions.

The import of this woman’s story is that patients who develop low blood levels need to have a comprehensive test done to find out why the blood level is low and should not be ingesting blood supplements.

Anaemia is a medical condition in which a person’s red blood cell count is below normal, causing a range of health concerns and risks.

Human blood is made up of both red and white cells. While white blood cells fight infection, red blood cells are responsible for transporting oxygen throughout the body.

When red blood cell levels drop too low, the body feels tired due to lack of oxygen, which is why people with anaemia are sometimes said to have “tired blood.”

Those who take the risk of anaemia include vegetarians, teenage girls and women with heavy menstrual cycles, children especially during rapid growth, premature babies, pregnancy, cancer, immunosupression, elderly, sickle cell disease.

Causes of anaemia

There are many causes of anaemia, including: blood loss, stomach or colon bleeding or heavy periods, poor dietary intake or illness, worm infestations, malaria, infections like HIV, side effects of medication and cancers.

Signs and symptoms

The symptoms are paleness, tiring quickly or easily, dizziness, pain in the chest, cold hands and feet, confusion, fatigue, headaches, increased heartbeat, the desire to eat or chew ice.

Most of these symptoms are relatively harmless at first, but can lead to serious problems if left untreated.

In worst-case scenarios, anaemia can create a serious oxygen deficiency in bodily organs. And this can lead to heart attack.

Types of anaemia

The most common types of anaemia include iron deficiency (low iron levels), low vitamin B12 levels, chronic lead poisoning, low folic acid levels and haemolytic – the body destroys your red blood cells at an earlier time than it should.

How do I know I have anaemia?

To diagnose anaemia, a doctor conducts a physical examination, check your lungs and heart, refer you for tests that include full blood count, perform tests to determine the size and shape of your red blood cells.

Treatment of anaemia

Treatment depends on the underlying cause of your anaemia. If it is due to an iron deficiency, your doctor may recommend a supplement and changes to your diet.

A healthy iron-rich diet includes lean red meat, poultry, iron-enriched cereals, fish green vegetables, wholegrain breads and cereals and nuts.

Treatment for anaemia might also include: antibiotics – to treat infections, iron injections or infusions, blood transfusion, hormones – for women and teenage girls who experience heavy menstrual cycles.

Anaemia may also result from an enlarged or a diseased spleen. In severe cases, the spleen may be surgically removed.

Preventions

You may be able to prevent some forms of anaemia, particularly if they are related to dietary or vitamin deficiency.

Sickle cell anaemia is preventable through premarital and genetic counselling. Severe malaria, worm infestations and other infections are preventable.

Make it a date next week on my piece on Family Physician. A family physician is a multi-competent specialist who is trained to provide comprehensive health care both at first contact and in continuity.

Recognizing Post Traumatic Stress Disorder

Recognizing Post Traumatic Stress Disorder

A middle aged man with signs and symptoms suggestive of Angina pectoris was seen a week earlier at the outpatient of one of the public hospitals with history of chest pain.

He said the chest feels like it is being pressed or squeezed by a heavy object, and also had pain on the arms.

The man was sent for various tests to rule out coronary heart disorders. Among the tests done are ECG, Chest X- ray, Lipid profile, urinalysis, echo cardiography.

While he was waiting for the results ordered which will take about a week, he stumbled into another consulting room.

The tests all came out normal and was also scheduled to see a cardiologist for review.

During the consultation which took about 40 minutes, it was discovered that the patient’s condition was more of an effect of a disagreement between him and the wife and not the Angina pectoris.

He said the symptoms of chest pain started a day after the wife packed out of the house with some vital documents.

He was now diagnosed of Post Traumatic Stress Disorder (PTSD) and placed on some anxiolytics which he responded well to. Most of the symptoms were gone after few days.

A new thinking

There is a paradigm shift in medical diagnosis, Clinical care now go beyond biomedicine because illness can now be fully understood in the context of psychologic, biologic, and social factor and not just the biomedical factor.

Biomedical factors (the physical illness) are but a small part of what patients bring to their physicians.

Effective treatment requires attention to these complex interactions and to integration of biologic and psychosocial factors. 

History

Five to 10 per cent of people will suffer from posttraumatic stress disorder (PTSD) at some point in their lives.

Frightening situations happen to everyone at some point. People can react in many different ways: they might feel nervous, have a hard time sleeping well, or go over the details of the situation in their mind.

These thoughts or experiences are a normal reaction. They usually decrease over time and the people involved can go back to their daily lives.

Post-traumatic stress disorder, on the other hand, lasts much longer and can seriously disrupt a person’s life.

Post-traumatic stress disorder (PTSD) is a particular set of reactions that can develop in people who have been through a traumatic event.

That is, they have experienced or witnessed an event which threatened their life or safety, or that of others around them, and led to feelings of intense fear, helplessness or horror.

This can be a car or other serious accident, failure from exams, divorce, death of loved ones, physical or sexual assault, rape, loss of job war or torture, armed robbery attacks, or disasters such as fires floods etc.

Signs and symptoms of PTSD

People with PTSD often experience feelings of panic or extreme fear, similar to the fear they felt during the traumatic event. A person with PTSD experiences four main types of difficulties.

There may be intense emotional or physical reactions, such as sweating, heart palpitations or panic when reminded of the event.

The person experiences sleeping difficulties, irritability and lack of concentration, becoming easily startled and constantly on the lookout for signs of danger.

The person deliberately avoids activities, places, people, thoughts or feelings associated with the event because they bring back painful memories.

The person loses interest in day-to-day activities, feels cut off and detached from friends and family, or feels emotionally flat and numb.

Anyone can develop PTSD following a traumatic event, but people are at greater risk if the event involved deliberate harm such as physical or sexual assault.
If a person experiences symptoms of PTSD that persist beyond two weeks, a doctor or a mental health professional may recommend starting treatment for PTSD.

Treatment helps deal with the symptoms so that people are able to get on with their life again.

Treatment usually involves psychological (talking) therapy with the person directly affected (and sometimes their family) by a qualified health professional such as a doctor or psychologist.

The sooner someone is diagnosed and receives treatment, the more likely it is they will recover sooner.

With help, a person can learn to manage their response in unavoidable situations that previously would have triggered a flashback.

 Medication can also be helpful for a time. With appropriate treatment and support people with PTSD are able to recover and get on with their lives.

In conclusion, a person who feels very distressed at any time after a traumatic event should talk to a doctor or other health professional.

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