News for the ‘General health’ Category

AREAS OF CONFLICT: DISCHARGE FROM HOSPITAL

This particular area can be fraught with problems and has come to the government’s attention. There are now very strict guidelines given to hospitals concerning the discharge process and these guidelines must be followed. The ideal should be as follows.
The medical problem is over, the person treated and looking forward to returning home. Any carers involved are happy and have met with the hospital staff concerning the discharge. Mobility problems have been identified and a home visit has been carried out by the hospital therapy staff. Prior to discharge the multi-disciplinary team meet and all contribute their views. A care plan is agreed with the patient and family and is written up by the social worker. If this requires a lot of new services, the community care manager either automatically agrees it or calls a case conference. A discharge date is set and each member carries out any special tasks (social worker will order services after talking with patient and carer, the ward staff order the ambulance, the junior doctor will write a discharge note and organize any medication to go with the patient). Patient and carer are kept informed of all actions as is the GP and the discharge goes ahead uneventfully. The key is communication.
Unfortunately many discharges do not resemble the above at all. Many excuses are given but inevitably the failure is in communication. There are no easy answers but wards and professionals alike should not get away with bad practice. If the discharge procedure goes wrong then the people concerned should know about it. Vigorous complaints are one way to change and hopefully improve the service. No one likes to complain but without such guided criticism mistakes will continue to occur. Complaining itself is no easy process but again this has been recognized by government and each hospital has a complaints procedure which should go into action immediately, offering a reply within 14 days. To ensure that the problem gets looked into the complaint must be in writing and preferably addressed to the service manager and/or the hospital’s public relations officer (customer service). In very serious cases a copy of the letter should also go to the hospital’s chief executive. This is not to say that many difficulties cannot be resolved by speaking to the various people concerned but a change of practice needs a letter.
A special difficulty occurs when a carer feels that a person cannot return home. This happens extremely frequently, and I have seen a vast increase in this particular problem since the NHS and community have been so starved of resources. What seems to happen is that the admission to hospital because of an acute illness provides the break needed in which a total evaluation can occur of the difficulties at home as suffered by the patient and carer. There is always a long history of increasing failure to cope at home, with either no other help sought or that help having failed in some way. It is at its most desperate when dealing with the elderly mentally confused, where the resources are indeed limited. Bear in mind that carers have to be pretty desperate to say ‘No’ to the massed authority of the hospital hierarchy.
If a carer feels concerned about the impending discharge of a relative, then they must speak out as soon as possible. In many cases discussion with the various team members involved will allow for a compromise, in that more help is provided if possible. If this does not allay fears sufficiently, the carer and other people involved should meet up with the consultant concerned; it may be appropriate to invite others to this meeting, such as the social worker dealing with the case, etc. In cases of real conflict then a case conference should be held, involving the multidisciplinary team as well as the carers, community agencies involved and the person concerned. Carers should ask for such a meeting if they are really unhappy about an impending discharge; it allows for everyone to say their piece and for the carer especially to point out the realities of life to the other conference members. The point of the conference is to arrive at a solution acceptable to everyone.
Where the patient is able to communicate well, their wishes are paramount, and if they want to return home then as much as possible will be done to ensure this. Often this involves the taking of considerable risks, and carers are sometimes counseled to accept-this. Where the patient is mentally frail, however, and not able to vocalize their wishes clearly, the task is harder. The choice is usually between the patient going home against the carer’s wishes and entering some form of institution. These decisions are never easy and there are pressures on both sides. On the consultant’s mind is his/her commitment to other people who need the beds and services of the hospital, as well as the multidisciplinary team’s appraisal of whether or not a return home is feasible. The carers on the other hand have often been through it all before. Their concern for a relative may be so great, however, as to cloud their judgment and not allow them to see alternatives. There are no easy answers. The two sides must trust each other and in most cases a reasonably amicable solution is found. The equation at the moment is far too heavily weighted in favour of the hospital; the needs of consumer and carer have to be more forcibly stated and, more importantly, acted upon.
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Edited: September 22nd, 2010

MALARIA

A thousand Australians every year bring malaria back from their overseas holidays. As yet these numbers are not sufficient to trigger off an epidemic at home. Even so, the high incidence of infection abroad raises the issue of adequate prophylaxis. Many malaria attacks affect people all ready taking the recommended anti malarial antibiotics. It is therefore fair to say that Chloroquine and Maloprim no longer provide adequate protection from drug resistant malarial parasites all around the world.
Which is the correct malarial prophylactic regime is a complex and controversial issue. The National Health And Medical Research Council issue guidelines and medical practitioners are advised to observe them. The correct choice relates to the places visited and the length of stay. Chloroquine and Maloprim are still the preferred combination. Many practitioners favour the prescription of Mefloquine; although it is fair to say that some strains of Falciparum Malaria are resistant to everything.
Home Remedies
Don’t rely on the success of chemical prophylaxis. Hundreds of people catch malaria in spite of drug treatment. Remember that it is not possible to catch malaria if you don’t get bitten by mosquitoes. This means slacks, long sleeved shirts, a hat and insect repellent throughout a day in the tropics. At night mosquito nets, insect repellent and the burning of mosquito coils are recommended. The symptoms of malaria include high fever headache and malaise – often presenting in a periodic fashion. If these symptoms occur abroad or within months of returning home: seek medical attention immediately.
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Edited: September 22nd, 2010

CHILD’S DISORDERS: HERPES SIMPLEX MOUTH INFECTION (STOMATITIS)

Cause

As well as causing cold sores on the lipss, the herpes type I virus can infect the inside of the mouth.

Clinical features

Your child may complain of a sore mouth, and the lips, gums and throat may also be involved. Younger children may simply refuse food or drink, and drool a lot. The lining of the mouth may be swollen and red, with multiple tiny blisters or ulcers visible. Your child may be irritable and cry a lot.

When to see your doctor

• if your child is generally unwell or has a fever;

• if your child refuses food and liquids, and has passed urine less often than usual.

Treatment

There is no cure for herpes infections and the mainstay of treatment is the alleviation of symptoms. Paracetamol may help to ease the pain, but should only be given according to directions. Encourage your child to drink as much as possible, and if he is refusing food, give him high calorie drinks (such as milkshakes, lemonade or glucose drinks). A good way of providing additional fluid is to give your child flavoured ice blocks, ice cream or jelly. If your child is used to a bottle, it may be easier to feed him with a cup and spoon until the infection passes. Herpes mouth infections usually clear up within 7-10 days. If you have any concerns, you should see your doctor.

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Edited: May 21st, 2009

NEWBORN’S APPEARRENCE: HIPS, GROIN AND BOW LEGS

Hips

The hips of a newborn baby are checked very carefully by the doctor to make sure that they are not dislocated.

Groin

Newborn baby girls sometimes have swollen labia, often accompanied by a vaginal discharge which is usually white, but may be reddish. This is due to hormones from the mother which have crossed into the baby’s bloodstream during pregnancy, and which fall to normal levels soon after birth.

Newborn baby boys can have an undescended testicle, a hydrocoele (fluid around the testicle) or a tight foreskin. Erections are also common.

Genitalia often appear to be proportionally large in the newborn period. This is also due to hormonal influence from the mother, and will diminish during the first few weeks.

Bow legs

This appearance is normal in newborn babies and soon corrects itself.

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Edited: May 19th, 2009

SEXUALITY, ILLNESS, AND HEALTH: NOT FEELING TOO GOOD BUT HAVING NO DETECTABLE HEALTH PROBLEMS

Medical measurement techniques are all vague estimates of body processes that can never be directly assessed. We can only compare somebody response, count of cells, or appearance of body products with some arbitrary numerical standard. When your “count” falls within pre-established limits, then cosmopolitan medicine says there are “no remarkable findings.” (Actually, the human system is far beyond remarkable, a true, infinitely complex miracle.) Even when medicine says you are fine, you may not “feel good.” Too many times, physicians either ignore the sexual dimensions of our health problems or are too uncomfortable to deal with them. Physician Harold Lief reports that the instance of patient report of sexual difficulties is predicted by the willingness on the part of the physician to talk about this important area of life. Another doctor, Richard Green, writes that to ignore sexual health in attempting to treat any health problem is incomplete, even unethical health care. ‘ ‘Not feeling too good” affects and can be affected by our sexuality.

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Edited: May 18th, 2009

THE JOY OF PERFECT HEALTH: HELPING OTHERS

The motto of this book is a wonderful phrase from one of the public lectures of Master Ching Hai: “We doubt everything and everybody except our own ignorance “.

Have it in mind, when trying to give advice to other people. They may not want it. Always ask if they need help.

Help only people who ask you for it or explicitly agree that you help them.

Even then, watch carefully // they listen to what you say. If they do not listen, it means that they are not yet ready to listen. Or perhaps you are not yet ready to give them advice.

Instead of trying to explain everything in a few sentences, give them this book, and suggest that you could perhaps answer some of their questions after they have read it. You will save a lot of time as well as avoid exhausting discussions and arguments.

If, after reading this book, people still miss the point, there is nothing you can do to help them. They should help themselves first. Their “bowl” is full. Any new information is just causing an overflow.

Note, that it may take years or even decades for some people to understand advice. Some people have to experience themselves consequences of all their mistakes before they understand. It is their best lesson.

Please notice, that in view of what we learned reading this book, “curing” other people does not really help them.

If they do not understand that all their diseases are caused by their own actions and ignorance, they will develop other diseases later on anyway.

It is clear, that it is much better to explain to them how they can heal themselves and never get sick again. The only difficulty in this approach is that they may not want to understand our advice.

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Edited: May 18th, 2009

IRITIS – INTRODUCTION

The iris is the colored portion of the eye. It acts like the shutter of a camera and its fine muscles open and close the pupil, the small hole in the centre of the iris, to admit more or less light, depending on how bright it is.

Inflammation of the iris or iritis, is not uncommon. It is not an infection. Conjunctivitis, or infection due either to viruses or to bacteria, usually affects both eyes and there is usually the production of pus, rather than just tears.

In iritis, there is pain in the eye, and sometimes around the orbit, even into the nose. There is photophobia, or dislike of light, an excess production of tears, and sometimes blurring of vision.

When the eye is examined, it has a diffuse pink flush around the cornea, the outer edges of the white of the eye are often unaffected.

In conjunctivitis, the eye is more red than pink, with prominent blood vessels and involving the whole of the white of the eye. The colored iris looks a greenish, muddy color and the normal markings on it are blurred. The pupil is often small and reacts sluggishly to light.

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Edited: May 15th, 2009

ASTHMA – DISCRIPTION

Asthma is a common disorder which causes shortness of breath and a wheeze.

It affects the bronchial tubes carrying the air in and out of the lungs.

Three things happen to these tubes — the muscles in the wall constrict or tighten, the lining is swollen, and there is an increase in the amount of sputum, all interfering with the air flow to the lungs.

The wheeze, the most noticeable feature, may be absent and some mild cases may show only shortness of breath or a chronic cough.

The wheeze is most marked in expiration, that is, when the person breathes out. Although there is always some difficulty in inspiration or breathing in, there may be no noisy wheezing.

Asthma is usually associated with allergy and, like the other atopic or allergic disorders of hay fever and eczema, tends to run in families.

Most asthma starts in childhood and, fortunately, many children outgrow it but it can start at any age and, sometimes, persists throughout life.

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Edited: May 15th, 2009

SKIN PROBLEMS: CREEPING ERUPTION

Creeping eruption is the intensely itching skin disease caused by tiny parasitic worms (the larvae of insects) crawling around just under the surface of the skin. Wandering aimlessly, the larvae move about one inch daily, leaving irregular, red, slightly raised tracks in the skin rather like miniature mole tunnels.

Also known as Cutaneous Larva Migrans, this condition occurs when human skin is parasitized by the eggs of worms that normally infest other species (e.g: dog, cat, or cattle hookworms), the American Family Physician (35#6:163) reports. The same sort of situation arises when horse flies or deer flies lay eggs in human skin, but the resulting maggots that hatch and live there are much larger and cause “hot spot” lesions that resemble boils.

Larvae remain trapped under the surface of our skin only if their species are not adapted to ours. When “human” hookworms get into us, however, the larvae not only causes redness and irritation at the site of entry through the skin, but they soon move on through the bloodstream to the lungs (temporarily producing cough and bloody sputum) to settle ultimately in our intestines. There they develop into adult worms that cause us to bleed internally and become anemic. Only when parasites are in the wrong species are they unable to migrate and to complete their life cycles.

Fortunately, when any of these conditions is recognized, it can be cured with appropriate medications. The moral of this story, then, is to visit a dermatologist without delay if creams do not quickly take care of itchy red lesions of the skin.

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Edited: April 28th, 2009

HERPES SIMPLEX IN CHILDREN: SYMPTOMS, HOME CARE AND TREATMENT

Signs and symptoms

Oral herpes (type 1 infection) causes multiple ulcers of the membranes of the mouth (lips, cheeks, tongue, and palate) or the eyeballs. The ulcers are painful and are accompanied by painful, red, swollen gums and swollen lymph nodes in the neck. The child’s fever may climb to 40.6°C. The canker sores have a distinctive appearance and are easily distinguished from other mouth sores such as gumboils. Canker sores are open, red ulcers which have a scooped-out appearance, unlike gumboils which protrude above the surface of the membranes. When oral herpes appears as fever blisters, the blisters can be mistaken for impetigo. Fever blisters, however, are usually more painful. To confuse the diagnosis, fever blisters may become further infected with impetigo.

Oral herpes lasts seven to ten days, but the virus remains in the body and may cause recurrent outbreaks. This recurrent condition is contagious each time it appears.

Genital herpes (type 2 infection) causes painful ulcers and blisters on the genitals. Like oral herpes, genital herpes is contagious when the blisters are present and often recurrent.

Home care

For oral herpes, give aspirin or paracetamol to relieve pain. Have the child eat bland, soothing foods such as ice cream, gelatin desserts, puddings, and milk. Encourage an older child to rinse the mouth with a mild table salt solution. Canker sores can be treated in older children with triamcinolone in dental ointment form, or with thick solutions of local anesthetic available from the pharmacy. Antibiotic ointment applied to fever blisters may prevent painful cracking and lessen the chances of impetigo developing. For genital herpes, warm soaks help relieve inflammation and pain. There is a drug that has been used by adults to lessen the recurring attacks, but this drug has not been tested in children.

Precautions

• Herpes simplex of the eyeball is serious and requires the immediate attention of an eye doctor.

• Herpes can be severe in an infant. Adults or children with herpes should be kept away from the baby. If a baby contracts herpes, consult a doctor.

• There is no cure for recurrent herpes.

Medical treatment

The doctor will probably prescribe eye drops to treat herpes of the eyeball. An experimental drug, Cytosine arabinoside (Ara-C) is available to treat life-threatening complications of herpes, such as may occur in infants. If a child with herpes has a severely ulcerated mouth, hospitalization may be necessary for intravenous fluids to be given until the child can swallow normally again.

A Caesarean section (delivery by surgery) may be performed in the case of a pregnant woman who has genital herpes and whose baby might be exposed to the disease during a normal delivery.

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Edited: April 28th, 2009