I recently took care of a young patient who was diagnosed with a large neck mass that was compressing his windpipe and carotid and jugular vessels. He was diagnosed with tongue cancer years ago with a recurrence in 2008. He underwent surgery, radiation, and chemotherapy but unfortunately the neck mass developed. He fought hard. His family provided extraordinary support. However, there was nothing medically that could be performed to cure his cancer.
Reviewing his case, I expected to find the cause of the tongue cancer. I expected to see a tobacco history but he never smoked. He had no significant history of alcohol, drug, or tobacco use including chew tobacco. We looked at environmental and work exposures but found no association. He worked in HVAC. Bad things can happen to healthy people.
In medicine, we assess risk factors, find causes, and prevent potential severe medical conditions. We advise people to stop smoking to reduce the chance of heart disease. We encourage exercise and healthy diets to reduce the obesity epidemic. We vaccinate children to prevent Polio, Measles, Mumps, etc...We advise colonoscopies, pap smears, mammograms to prevent cancer. However, as in life, the unexplainable does occur in medicine.
One of the most frustrating aspects in medicine is when bad things happen to healthy people. This young man had no risk factors for tongue cancer yet he was diagnosed at around thirty years of age. The median age for tongue cancer is sixty. Risk factors include tobacco use, alcohol, HPV, and age. The incidence is about three per 100,000 per year (rare). We can only blame a faulty gene. The thought is always what could we have done to prevent this but unfortunately the answer is nothing.
Does this case reduce the importance of preventative medicine and risk factor stratification? No. It makes me appreciate how delicate and precious human life is and to be more cognizant about medical "zebras" and rarities. It makes preventative medicine more important so people can live life to its fullest. Therefore, eat healthy, drink in moderation, avoid drugs, do not smoke, exercise, and laugh. And if something bad does happen, understand that there is always a silver lining somewhere in the clouds, whether it be improving a physician's skill, bringing a family together, or making people appreciate their own lives.
Also, pray for the citizens of Haiti. It is a devastating situation and I wish to all my colleagues who are going to Haiti a safe journey.
Thank you.
Monday, January 25, 2010
Monday, January 18, 2010
Please Stop Smoking!
The past several months I have had a run on severe tobacco related illnesses. Smoking is very detrimental to the vital organs but yet about 46 million adults smoke in the United States. Here are several patient cases...
50 year old male presented to me with complaints of chest pain and shortness of breath. He smokes 2 packs a day for 30 years. He has a history of high blood pressure but was not taking his medication due to cost (but yet could afford his 2 pack a day habit). He was sent to the ER and was found to have a myocardial infarction (heart attack). He underwent cardiac stenting and is now on multiple medications to prevent another heart attack.
70+ year old female presented to the office with chest pain and back pain. She smoked a pack a day for over forty years. A chest xray was done and a mass was found. After further diagnostics, she was diagnosed with lung cancer and the tumor had wrapped around her heart. Surgery could not be performed. Palliative therapy was done and she passed away.
A young twenty-something adult came to me with complaints of exertional shortness of breath. He was hospitalized for pneumonia several months ago. He continues to wheeze and utilizes two inhalers to stabilize his breathing. The patient began smoking when he was eight and continues despite repeated counselling to quit. He is a laborer but now has difficulty with exertional work. His quality of life is poor and he has difficulty keeping up with his young son.
A 60+ year old male saw me in the office with flu-like symptoms. He had trouble breathing, fever of 104, fatigue, and muscle aches for several days. Supportive care was advised with follow up. Several days later, his relative called and said he was confused. He was admitted to the hospital and diagnosed with pneumonia. Despite aggressive antibiotics, steroids, and oxygen support, he decompensated within 24 hours and was intubated (tube placed into his lungs). Upon further investigation, he had smoked 1 and a half pack a day since childhood and his lungs were in poor shape. Due to his smoking history, he developed COPD (chronic obstructive pulmonary disease) which made him very susceptible for respiratory infections and failure. He is recovering.
A 60+ year old female presented to the office with an oral gum lesion for several weeks. It was a raised mass with ulcerations on her lower gum line. She has poor dentition. She had smoked for many years. The patient was reluctant to go to the specialist but eventually listended to my advice. The biopsy revealed squamous cell carcinoma (cancer) and a total excision was performed. This scare resulted in her quitting tobacco.
This is just a sample of cases I see that are tobacco related problems. Smoking can contribute to many health problems such as COPD, lung cancer, heart disease, oral cancers, asthma, strokes, heart attacks, emphysema, pancreatic cancer, bladder cancer, high blood pressure, cervical cancer, peripheral vascular disease, pneumonia, kidney cancer, impotence, psychological disorders, fetal problems, etc....
Help is out there. Call your health care professional to help quit this deadly habit!
50 year old male presented to me with complaints of chest pain and shortness of breath. He smokes 2 packs a day for 30 years. He has a history of high blood pressure but was not taking his medication due to cost (but yet could afford his 2 pack a day habit). He was sent to the ER and was found to have a myocardial infarction (heart attack). He underwent cardiac stenting and is now on multiple medications to prevent another heart attack.
70+ year old female presented to the office with chest pain and back pain. She smoked a pack a day for over forty years. A chest xray was done and a mass was found. After further diagnostics, she was diagnosed with lung cancer and the tumor had wrapped around her heart. Surgery could not be performed. Palliative therapy was done and she passed away.
A young twenty-something adult came to me with complaints of exertional shortness of breath. He was hospitalized for pneumonia several months ago. He continues to wheeze and utilizes two inhalers to stabilize his breathing. The patient began smoking when he was eight and continues despite repeated counselling to quit. He is a laborer but now has difficulty with exertional work. His quality of life is poor and he has difficulty keeping up with his young son.
A 60+ year old male saw me in the office with flu-like symptoms. He had trouble breathing, fever of 104, fatigue, and muscle aches for several days. Supportive care was advised with follow up. Several days later, his relative called and said he was confused. He was admitted to the hospital and diagnosed with pneumonia. Despite aggressive antibiotics, steroids, and oxygen support, he decompensated within 24 hours and was intubated (tube placed into his lungs). Upon further investigation, he had smoked 1 and a half pack a day since childhood and his lungs were in poor shape. Due to his smoking history, he developed COPD (chronic obstructive pulmonary disease) which made him very susceptible for respiratory infections and failure. He is recovering.
A 60+ year old female presented to the office with an oral gum lesion for several weeks. It was a raised mass with ulcerations on her lower gum line. She has poor dentition. She had smoked for many years. The patient was reluctant to go to the specialist but eventually listended to my advice. The biopsy revealed squamous cell carcinoma (cancer) and a total excision was performed. This scare resulted in her quitting tobacco.
This is just a sample of cases I see that are tobacco related problems. Smoking can contribute to many health problems such as COPD, lung cancer, heart disease, oral cancers, asthma, strokes, heart attacks, emphysema, pancreatic cancer, bladder cancer, high blood pressure, cervical cancer, peripheral vascular disease, pneumonia, kidney cancer, impotence, psychological disorders, fetal problems, etc....
Help is out there. Call your health care professional to help quit this deadly habit!
Monday, January 11, 2010
Acute Sinusitis
In recent months, I have seen many complaints of sinus infections. The typical patient will come to the office and complain of facial pain around the cheeks with a fever and nasal drainage. Acute sinusitis is a very common illness in the primary care setting, accounting for about 16 million office visits per year.
Acute sinusitis is inflammation of the sinuses or cavities around the nasal passages. Sinuses are air chambers that make mucus to clear particles and organisms in the air. Cilia, or tiny hairs, clears out the mucus from the sinuses and helps it drain through the nasal canals. The swelling from sinusitis interferes with drainage an
d mucus builds up in the cavities. The mucus then becomes a breeding ground for infection.
The most commonly affected area in adults is the maxillary sinus. In children, it is the ethmoid sinus.
The causes of sinusitis include:
Risk factors include:
Signs and symptoms (up to 4 weeks) include:
Treatment includes:
If the symptoms do not improve after several days, contact your health care professional.
If the symptoms do not improve after sufficient treatments, diagnostic imaging such as a CT may be taken to confirm diagnosis. Specialist referral to an ENT usually are reserved to persistent sinusitis, mental status changes, severe facial or dental pain, severe swelling or redness around the eyes, visual complaints, high fever, and sinusitis refractory to medical management.
Contact your health care professional for more information.
Acute sinusitis is inflammation of the sinuses or cavities around the nasal passages. Sinuses are air chambers that make mucus to clear particles and organisms in the air. Cilia, or tiny hairs, clears out the mucus from the sinuses and helps it drain through the nasal canals. The swelling from sinusitis interferes with drainage an
d mucus builds up in the cavities. The mucus then becomes a breeding ground for infection.The most commonly affected area in adults is the maxillary sinus. In children, it is the ethmoid sinus.
The causes of sinusitis include:
1. Viral (Rhinovirua, Influenza, Adenovirus, Parainfluenza)
2. Bacteria (Streptococcus, Haemophillus, Moraxella)
3. Fungal (Aspergillus, Mucormycosis) in immunocompromised patients (Diabetics, HIV, cancer patients)
Risk factors include:
1. Allergies
2. Nasal passage abnormalities (deviated septum, polyps)
3. Trauma
4. Dental infections
5. Recurrent upper respiratory infections
6. Nasal dryness
7. Inhaled irritants (tobacco smoke)
8. Immune disorder
9. Inflammatory disorder
10. Hormones
Signs and symptoms (up to 4 weeks) include:
1. Pain/pressure in the cheeks, between the eyes, forehead, or nose (worse when leaning forward)
2. Upper teeth pain
3. Headache
4. Fever
5. Bad breath
6. Nasal drainage (yellow/green)
7. Trouble breathing through the nose
8. Reduced ability to taste or smell
9. Cough at night
10. Nausea
11. Fatigue
12. "Double sickening" (Patient begins with a cold, gets better, then gets worse again)
Treatment includes:
1. Saline nasal spray (Ayr or Ocean spray)
2. Short term decongestant (Sudafed)
3. Anti-inflammatory (ibuprofen)
4. Fluids
5. Rest
6. Moist heat on the sinuses (warm compresses)
7. Humidifier
8. Avoid anti-histamines
If the symptoms do not improve after several days, contact your health care professional.
Typically viral sinus infections will improve after 5-7 days. Acute bacterial sinus infections usually require antibiotics.
If the symptoms do not improve after sufficient treatments, diagnostic imaging such as a CT may be taken to confirm diagnosis. Specialist referral to an ENT usually are reserved to persistent sinusitis, mental status changes, severe facial or dental pain, severe swelling or redness around the eyes, visual complaints, high fever, and sinusitis refractory to medical management.
Major complications are extremely rare.
Contact your health care professional for more information.
Thank you and have a nice day.
Sunday, January 3, 2010
Tobacco Cessation
The new year always brings resolutions such as weight loss, exercising, improving relationships, etc. Another very common one is tobacco cessation or trying to quit smoking. Here are some strategies to help with this difficult yet attainable resolution.
1. Go cold turkey if possible. It can be done, especially in cases where an individual smokes less than a pack a day.
2. You need to really want it!!! Daily commitment is a requirement when trying to quit.
3. Set a quit date. Make it a meaningful date such as a wedding anniversary, birthday, or holiday.
4. Take advantage of counselling programs to keep motivated. It can range from phone sessions to group meetings.
5. Understand the positives when quitting such as improved breathing, lower risk for heart disease, whiter teeth, better breath, lower risk for lung cancer, more available money, etc...
6. Utilize social support from friends and family members. If other people smoke, make it a group goal and support one another.
7. Remove cigarettes, ash trays, other related items to reduce the urges.
8. Avoid or change habits that trigger tobacco use (i.e. alcoholic drink at a bar).
9. Avoid smoking environments and eat at non-smoking restaurants.
10. Reward yourself in successful weekly or monthly intervals.
11. Do it for the children...second hand smoke increases asthma attacks, allergies, ear infections, sinus infections, etc.
12. Talk to your physician about medications such as Chantix, bupropion, or nortriptyline, especially if smoking more than one pack a day.
13. Utilize nicotine replacement supplements to help with the cravings and withdrawal symptoms such as the gum, patch, nasal spray, lozenge, or inhaler.
14. Do not let smokers smoke in your house or car.
15. Exercise and eat healthy to keep your weight stable.
16. Chew gum, eat carrot sticks or pretzels, suck on lollipops, to keep your mouth busy.
17. Try alternative therapies such as hypnosis, acupuncture, or acupressure.
18. It is OK to "slip." Try again and get back on track.
19. Stop the excuses.
20. It is all about "one day at a time."
21. Try Quit Meters (available online) to keep track of your success
22. Find a healthy passion to replace smoking such as leading a tobacco cessation group.
23. NEVER GIVE UP!!!
24. Talk to your health care professional...use them as a resource.
Check out the QuitNow website or call 1-800-QuitNow (free service)
Thank you and have a Great New Year!!!
1. Go cold turkey if possible. It can be done, especially in cases where an individual smokes less than a pack a day.
2. You need to really want it!!! Daily commitment is a requirement when trying to quit.
3. Set a quit date. Make it a meaningful date such as a wedding anniversary, birthday, or holiday.
4. Take advantage of counselling programs to keep motivated. It can range from phone sessions to group meetings.
5. Understand the positives when quitting such as improved breathing, lower risk for heart disease, whiter teeth, better breath, lower risk for lung cancer, more available money, etc...
6. Utilize social support from friends and family members. If other people smoke, make it a group goal and support one another.
7. Remove cigarettes, ash trays, other related items to reduce the urges.
8. Avoid or change habits that trigger tobacco use (i.e. alcoholic drink at a bar).
9. Avoid smoking environments and eat at non-smoking restaurants.
10. Reward yourself in successful weekly or monthly intervals.
11. Do it for the children...second hand smoke increases asthma attacks, allergies, ear infections, sinus infections, etc.
12. Talk to your physician about medications such as Chantix, bupropion, or nortriptyline, especially if smoking more than one pack a day.
13. Utilize nicotine replacement supplements to help with the cravings and withdrawal symptoms such as the gum, patch, nasal spray, lozenge, or inhaler.
14. Do not let smokers smoke in your house or car.
15. Exercise and eat healthy to keep your weight stable.
16. Chew gum, eat carrot sticks or pretzels, suck on lollipops, to keep your mouth busy.
17. Try alternative therapies such as hypnosis, acupuncture, or acupressure.
18. It is OK to "slip." Try again and get back on track.
19. Stop the excuses.
20. It is all about "one day at a time."
21. Try Quit Meters (available online) to keep track of your success
22. Find a healthy passion to replace smoking such as leading a tobacco cessation group.
23. NEVER GIVE UP!!!
24. Talk to your health care professional...use them as a resource.
Check out the QuitNow website or call 1-800-QuitNow (free service)
Thank you and have a Great New Year!!!
Sunday, December 27, 2009
Car Seats
Recently, the news reported on the importance of car seats for toddlers. Here are the some of the child passenger safety recommendations.
Rear Facing in the back seat:
Rear Facing in the back seat:
- Birth to one year of age and
- 20 lbs or under
Forward Facing in the back seat:
- Toddlers from one year to four years of age and
- 20 lbs to 40 lbs
- It is best to keep the toddler rear facing as long as possible
Booster seat in the back seat:
- Children from four years of age to about eight years
- 4' 8" tall or under
- Children should stay in a booster seat until the adult seatbelt fits correctly over the lap and shoulder
Seatbelts in the back seat:
- Children at least eight years old
- 4' 9" and taller
Seatbelts in either the back or front seat:
- Teenagers 13 years old and older
Here are some enlightening statistics:
1. Children riding in the front seat are 40% more likely to be injured in a crash than those riding in the back seat.
2. Children in the back seat are about 38 percent less likely to be injured in a crash.
3. Car seats reduce the risk of death by 71% for infants and by 54% for children ages 1-4.
4. Booster seats reduce injury to 4-8 year olds by about 59%.
5. 42% of all unintentional childhood deaths are due to crashes.
6. Motor vehicle crashes claims nearly 1,800 children's lives and results in more than 274,000 injuries each year.
7. Approximately 80 percent of car seats are not installed and/or used correctly.
8. Seat belt use among young children often depends upon the driver’s seat belt use. Almost 40% of children riding with unbelted drivers were also unbelted.
Motor vehicle injuries are the leading cause of death among children in the United States!!!
Please follow the car seat recommendation, confirm proper installation, and always wear seatbelts. Talk to your health care professional for more information.
Excellent resources include the Healthy Children website and the NHTSA site.
Thank you.
Monday, December 21, 2009
Sunday, December 20, 2009
Water and Infants
During my infant well child exams, I advise mothers not to give water to infants. I usually get a perplexed face from the mother and sometimes a few words from the grandmother. During residency, I rotated through AI DuPont Children's Hospital emergency room. One evening, a young infant boy came to the ER with a seizure. He had no medical problems and no history of seizures. His family history was unremarkable. The family denied any high fevers or any accidental ingestions. Upon further investigation, the baby was recovering from a viral cold and the parents were giving water to prevent dehydration. Labs revealed a critically low sodium (hyponatremia). The baby was treated and released and the parents were counselled on not to give water to infants.
Providing water to infants to prevent dehydration increases the risk of seizure by diluting and then decreasing the sodium count in the blood. The low sodium then causes altered brain activity. The reasons why this occurs are 1) kidneys are not mature to flush out the excess water and 2) the infant diet does not contain enough salt to balance the excess water. Water intoxication can lead to several signs and symptoms including drowsiness, irritability, facial swelling, low body temperature, poor coordination, nausea and vomiting, irregular breathing, and then seizures.
Treatment is giving infants anti-seizure medications and salt containing fluids. Prognosis is excellent. Babies typically recover without any problems.
The best way to prevent water intoxication seizure is to not give water to babies. This includes tap water and commercially bottled water. Also, there have been reported cases of water intoxication from repeated dunking during swimming lessons. If the baby shows signs of dehydration, continue to give formula and/or breast milk. An oral rehydration solution such as Pedialyte can also be utilized.
Contact your primary care physician for more information. Thank you and have a nice day.
Providing water to infants to prevent dehydration increases the risk of seizure by diluting and then decreasing the sodium count in the blood. The low sodium then causes altered brain activity. The reasons why this occurs are 1) kidneys are not mature to flush out the excess water and 2) the infant diet does not contain enough salt to balance the excess water. Water intoxication can lead to several signs and symptoms including drowsiness, irritability, facial swelling, low body temperature, poor coordination, nausea and vomiting, irregular breathing, and then seizures.
Treatment is giving infants anti-seizure medications and salt containing fluids. Prognosis is excellent. Babies typically recover without any problems.
The best way to prevent water intoxication seizure is to not give water to babies. This includes tap water and commercially bottled water. Also, there have been reported cases of water intoxication from repeated dunking during swimming lessons. If the baby shows signs of dehydration, continue to give formula and/or breast milk. An oral rehydration solution such as Pedialyte can also be utilized.
Contact your primary care physician for more information. Thank you and have a nice day.
Sunday, December 13, 2009
Cocaine and the Heart
A 40 year old male presented to the ER with complaints of severe chest pressure and trouble breathing. The symptoms began earlier in the day and progressively worsened. His medical history was remarkable for tobacco use but no cardiac problems. Diagnostic tests were performed which confirmed his heart attack. He was also found to have a positive drug test. Typically, young males do not have a heart attack unless there is a precipitating factor such as cocaine use.
Cocaine is the most abused illegal stimulant in the United States. About 15% of adults have tried cocaine. About 34 million people age 12 or older have experimented with this highly addictive drug and about 1.5 million are regular users. Recently, the percentage of college students using this substance has increased.
Cocaine is a powerful stimulant of the central nervous system. It comes from the leaves of the Erythroxylum coca bush located in South America. Cocaine can be injected, snorted, swallowed, smoked, or rubbed onto gums. Its effect is immediate and wears off in about thirty to sixty minutes.
The signs and symptoms of cocaine use include:
1. Euphoria
2. Increasing sense of alertness
3. Elevated mood
4. Paranoia
5. Restlessness
6. Anxiety
7. Dilated pupils
8. Excited speech
9. Decreased appetite
10. Sense of power
11. Hallucinations
There are many more symptoms....here are some of the detrimental health effects
1. Increase risk for heart attacks
2. Abnormal and life threatening heart rhythms
3. Stroke
4. Emphysema
5. Stomach ulcers
6. Kidney failure
7. Impair sexual function
8. Psychosis
The risk of heart attack in the first hour after using cocaine is 24 times normal!!!
Nearly one-fourth of heart attacks in people ages 18 to 45 are cocaine related.
The patient underwent cardiac stenting and had a full recovery. I can only hope this was a wake-up call.
There have been thousands of cocaine related deaths but the one I always remember is Maryland basketball star Len Bias.
Talk to your children about drugs. A helpful guide is on the Family Doctor website. Click here.
Contact your primary physician for more information.
Also, useful websites include:
National Institute on Drug Abuse
Substance Abuse Treatment Facility Locator
If you have never tried cocaine, please don't...it only takes one time to potentially ruin your life.
Cocaine is the most abused illegal stimulant in the United States. About 15% of adults have tried cocaine. About 34 million people age 12 or older have experimented with this highly addictive drug and about 1.5 million are regular users. Recently, the percentage of college students using this substance has increased.
Cocaine is a powerful stimulant of the central nervous system. It comes from the leaves of the Erythroxylum coca bush located in South America. Cocaine can be injected, snorted, swallowed, smoked, or rubbed onto gums. Its effect is immediate and wears off in about thirty to sixty minutes.
The signs and symptoms of cocaine use include:
1. Euphoria
2. Increasing sense of alertness
3. Elevated mood
4. Paranoia
5. Restlessness
6. Anxiety
7. Dilated pupils
8. Excited speech
9. Decreased appetite
10. Sense of power
11. Hallucinations
There are many more symptoms....here are some of the detrimental health effects
1. Increase risk for heart attacks
2. Abnormal and life threatening heart rhythms
3. Stroke
4. Emphysema
5. Stomach ulcers
6. Kidney failure
7. Impair sexual function
8. Psychosis
The risk of heart attack in the first hour after using cocaine is 24 times normal!!!
Nearly one-fourth of heart attacks in people ages 18 to 45 are cocaine related.
The patient underwent cardiac stenting and had a full recovery. I can only hope this was a wake-up call.
There have been thousands of cocaine related deaths but the one I always remember is Maryland basketball star Len Bias.
Talk to your children about drugs. A helpful guide is on the Family Doctor website. Click here.
Contact your primary physician for more information.
Also, useful websites include:
National Institute on Drug Abuse
Substance Abuse Treatment Facility Locator
If you have never tried cocaine, please don't...it only takes one time to potentially ruin your life.
Sunday, December 6, 2009
Postpartum Depression
I recently saw a 22 year old patient with complaints of fatigue, muscle aches, and feeling down for several weeks. She recently had her second child with no obstetrical complications. She feels depressed and is also worried about not bonding with her baby. Her medical history is unremarkable with no history of psychiatric disorders. She has a very supportive family. The patient was diagnosed with postpartum depression and was started on treatment with success.
Postpartum depression is a common type of depression affecting about 15% of women after the birth of their child. PPD usually begins several weeks after delivery but can occur anytime in the first year. PPD can last for several weeks to months.
There is a milder form of depression called the baby blues that begins a couple days after delivery and lasts for about 2 weeks. About 50% of women experience this condition. The signs and symptoms include trouble sleeping, irritability, heightened emotions, but it does not interfere with the mother's ability to care for her child. PPD does affect the woman's ability to function.
Risk factors include history of depression, psychosocial stress, lack of family support, young age, substance abuse, and problems with a previous pregnancy.
It is not clear what causes PPD but hormonal or chemical changes may play a factor.
Signs and symptoms of PPD (lasting more than two weeks) include:
1. Agitation
2. Feeling sad, hopeless, and overwhelmed
3. Crying a lot
4. Fatigue
5. Loss of appetite
6. Insomnia
7. Trouble focusing, remembering, or making decisions
8. Feeling worthless
9. Loss of interest or pleasure in activities
10. Headaches
11. Chest pain
12. Body aches
13. Lack of motivation
14. Withdrawal from friends and family
15. Decreased sex drive
16. Negative thoughts about the baby
Treatment includes
1. Family support
2. Asking for help
3. Rest and taking naps
4. Exercise, take walks
5. Talk to other mothers
6. Breast feeding
7. Eating healthy and continuing a prenatal vitamin (add fish oil to your diet)
8. Counselling with a professional
9. Medications such as antidepressants
Postpartum psychosis is a rare, severe form of postpartum depression that requires immediate medical attention. Mothers may experience hallucinations, display bizarre behavior, thoughts of hurting or killing herself or the infant. Postpartum psychosis requires psychiatric hospitalization and treatment.
Bringing a newborn into the world is a beautiful but life changing experience. If you have any concerns of the "baby blues" or postpartum depression, contact your physician immediately. Early intervention will improve the quality of the baby's life and your life.
Here is a postpartum checklist adapted from the New England Journal of Medicine
Click here
Talk to your healthcare professional for more information. Thank you.
Postpartum depression is a common type of depression affecting about 15% of women after the birth of their child. PPD usually begins several weeks after delivery but can occur anytime in the first year. PPD can last for several weeks to months.
There is a milder form of depression called the baby blues that begins a couple days after delivery and lasts for about 2 weeks. About 50% of women experience this condition. The signs and symptoms include trouble sleeping, irritability, heightened emotions, but it does not interfere with the mother's ability to care for her child. PPD does affect the woman's ability to function.
Risk factors include history of depression, psychosocial stress, lack of family support, young age, substance abuse, and problems with a previous pregnancy.
It is not clear what causes PPD but hormonal or chemical changes may play a factor.
Signs and symptoms of PPD (lasting more than two weeks) include:
1. Agitation
2. Feeling sad, hopeless, and overwhelmed
3. Crying a lot
4. Fatigue
5. Loss of appetite
6. Insomnia
7. Trouble focusing, remembering, or making decisions
8. Feeling worthless
9. Loss of interest or pleasure in activities
10. Headaches
11. Chest pain
12. Body aches
13. Lack of motivation
14. Withdrawal from friends and family
15. Decreased sex drive
16. Negative thoughts about the baby
Treatment includes
1. Family support
2. Asking for help
3. Rest and taking naps
4. Exercise, take walks
5. Talk to other mothers
6. Breast feeding
7. Eating healthy and continuing a prenatal vitamin (add fish oil to your diet)
8. Counselling with a professional
9. Medications such as antidepressants
Postpartum psychosis is a rare, severe form of postpartum depression that requires immediate medical attention. Mothers may experience hallucinations, display bizarre behavior, thoughts of hurting or killing herself or the infant. Postpartum psychosis requires psychiatric hospitalization and treatment.
Bringing a newborn into the world is a beautiful but life changing experience. If you have any concerns of the "baby blues" or postpartum depression, contact your physician immediately. Early intervention will improve the quality of the baby's life and your life.
Here is a postpartum checklist adapted from the New England Journal of Medicine
Click here
Talk to your healthcare professional for more information. Thank you.
Sunday, November 29, 2009
Hand Foot and Mouth Disease
Recently, a five year old girl saw me with complaints of "my mouth hurts" and "my tummy hurts." Her mother noticed sores in her mouth several days ago. Her medical history was unremarkable, she was a healthy active young girl. Upon examination, she had a temperature of 100.6 and a couple of small sores in her mouth. Interestingly, she also had a rash on her hands. Reassurance was given to both the mother and the girl and she recovered nicely in several days.
Hand Foot and Mouth Disease is a viral illness that affects young children, typically under ten years of age. It is most commonly caused by coxsackieviruses (Enterovirus genus), members of the Picornaviridae family. HFMD is contagious and spread by nasal secretions, saliva, fecal material, and aerosolized droplets. Daycares have a high incidence of HFMD. It is more common during the summer and autumn months. Children are contagious one week prior to the onset of symptoms and potentially several weeks after resolution.
The signs and symptoms include (but not limited to):
1. Fever
2. Fatigue
3. Cough
4. Abdominal pain
5. Sore throat
6. Poor appetite
The rash and sores develop 12 to 36 hours later. The oral sores are painful, red, blister-like lesions located on the tongue, inner cheeks, or gums. The rash on the palms, soles of feet, or buttocks are not itchy, red, and possibly blistery. The rash and sores can last for five to seven days.
HFMD is not usually serious and self-limiting (will resolve with time). Rare complications include viral meningitis, myocarditis, and encephalitis.
Treatment includes:
1. Fluids
2. Supportive care
3. Tylenol or ibuprofen for the pain
4. Popsicles/ice cream for the oral pain
5. Warm salt water rinses without swallowing (1/2 teaspoon of salt with one cup of warm water)
6. Time...HFMD will usually resolve in 7-10 days
Prevention includes:
1. Good hygiene
2. Hand washing (twenty seconds)
3. Do not rupture blisters
4. Avoid close contact with patients diagnosed with HFMD
5. Keeping toys and surfaces clean
Call the doctor immediately if the child develops any of the following symptoms:
1. Fever higher than 100.4° Fahrenheit (38° Celsius) for infants younger than 6 months and higher than 102° Fahrenheit (38.8° Celsius) for older kids
2. Poor appetite or trouble feeding
3. Difficulty breathing
4. Convulsions
5. Unusual sleepiness
6. Severe headache, especially with vomiting, confusion, unusual sleepiness, or convulsions
7. Neck stiffness
Please note Hand Foot and Mouth Disease is not Foot (Hoof) and Mouth Disease.
Call your primary physician for more information. Hope this was informative!
Hand Foot and Mouth Disease is a viral illness that affects young children, typically under ten years of age. It is most commonly caused by coxsackieviruses (Enterovirus genus), members of the Picornaviridae family. HFMD is contagious and spread by nasal secretions, saliva, fecal material, and aerosolized droplets. Daycares have a high incidence of HFMD. It is more common during the summer and autumn months. Children are contagious one week prior to the onset of symptoms and potentially several weeks after resolution.
The signs and symptoms include (but not limited to):
1. Fever
2. Fatigue
3. Cough
4. Abdominal pain
5. Sore throat
6. Poor appetite
The rash and sores develop 12 to 36 hours later. The oral sores are painful, red, blister-like lesions located on the tongue, inner cheeks, or gums. The rash on the palms, soles of feet, or buttocks are not itchy, red, and possibly blistery. The rash and sores can last for five to seven days.
HFMD is not usually serious and self-limiting (will resolve with time). Rare complications include viral meningitis, myocarditis, and encephalitis.
Treatment includes:
1. Fluids
2. Supportive care
3. Tylenol or ibuprofen for the pain
4. Popsicles/ice cream for the oral pain
5. Warm salt water rinses without swallowing (1/2 teaspoon of salt with one cup of warm water)
6. Time...HFMD will usually resolve in 7-10 days
Prevention includes:
1. Good hygiene
2. Hand washing (twenty seconds)
3. Do not rupture blisters
4. Avoid close contact with patients diagnosed with HFMD
5. Keeping toys and surfaces clean
Call the doctor immediately if the child develops any of the following symptoms:
1. Fever higher than 100.4° Fahrenheit (38° Celsius) for infants younger than 6 months and higher than 102° Fahrenheit (38.8° Celsius) for older kids
2. Poor appetite or trouble feeding
3. Difficulty breathing
4. Convulsions
5. Unusual sleepiness
6. Severe headache, especially with vomiting, confusion, unusual sleepiness, or convulsions
7. Neck stiffness
Please note Hand Foot and Mouth Disease is not Foot (Hoof) and Mouth Disease.
Call your primary physician for more information. Hope this was informative!
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