A Simple Guide To Dental Caries

A Simple Guide To Dental Caries
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What is Dental Caries?
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Dental caries is the decay of a tooth or teeth in the mouth.
The tooth decay is brought about by the acid erosion of tooth enamel.
What is the cause of Dental Caries?
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Dental caries is caused by the action of the bacteria that lives in plague, a sticky coating of saliva and food debris that forms on the surface of the teeth.
Plague can occur in the mouth:
1.in the pits or grooves in the back teeth
2.in between teeth
3.around dental fillings or bridgework
4.near the gum line
These plaque bacteria convert sugar and carbohydrates in the food particles into energy and in breaking them down produce acids.
These acids dissolves the calcium and phosphate minerals on the surface of the tooth eroding the enamel or creating cavities called dental caries.
If the process is unchecked the enamel and the dentin underneath is destroyed resulting in infection of the pulp and permanent damage to the nerves and the blood vessel it contains.
Early dental caries may be reversed if damage by the acid is stopped and the tooth is allowed to repair the damage naturally.
What are the Symptoms of Dental caries?
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The early stages of decay do not cause any symptoms and only regular professional examinations can help detect the decay in early stages.
Once the dental caries is established,
1.sensitivity of the tooth to hot/ cold foods and drinks.
2.Pain occurs when the dentin is damaged.
3.Visble pits or holes appear on the enamel
Diagnosis
Dental caries is diagnosed by:
1.Dental examination .
2.X-rays if the dentist suspects hidden caries.
Treatment
1.scrape the teeth to remove plague
A flouride gel may be applied to protect the teeth from plague
2.If a cavity is present, the dental surgeon may fill the tooth with fillings made of dental amalgam in molars and premolars and composite resins for the front teeth.
3.in the case of a large cavity, the dentist will drill the decayed portion of the tooth, fill the cavity and cover the tooth with an artificial crown.
4.root canal treatment involves removal of the tooth’s pulp and replacing it with an inert material.
5.The entire tooth is taken out if the decay is very advanced
Preventing Decay
Tips for preventing caries include:
1.diet low in sugar
2.good oral hygiene:
a.Brushing teeth twice a day with fluoride toothpaste.
b.Cleaning between teeth daily with floss.
3.regular dental visits and assessment.
4.a protective plastic coating that can be applied to the chewing surfaces of the back teeth where decay often starts.

A Family Doctor's Tale - COCCYX INJURIES

DOC I HAVE A COCCYX INJURY

Coccygeal Injuries consist of Dislocation and fractures.

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

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

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

The cause of Coccygeal Dislocation and fractures is due to:

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

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

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

The symptoms and signs of Coccygeal Injuries are:

Onset is usually gradual unless due to acute injury

Symptoms:

1.Pain on sitting on the coccyx

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

4. the symptoms are more common in women.

Signs:

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

2.deformity of the cocygeal bone

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

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

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

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

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

4.Muscle relaxant to relax muscles

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

6.constipation should be avoided

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

Surgery :

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

The prognosis of Coccygeal Dislocation is:

Prognosis is usually good although recurrence may occur.

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

2. sitting in a slumping position.

OLECRANON BURSITIS

DOC I HAVE OLECRANON BURSITIS

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

The cause of Olecranon Bursitis is:

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

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

Infection of the bursa may then occur with pus formation.

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

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

This swelling is usually not painful.

The symptoms and signs of Olecranon Bursitis are:

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

2.Hardened Rubbery Swelling at the olecranon.

3.Stiffness of the elbow - inability to stretch

Signs:

1.swelling localized at the olecranon of the elbow

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

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

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

4. X-rays are usually normal.

The complications of Olecranon Bursitis are:

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

The Treatment of Olecranon Bursitis is:

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

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

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

4.Antibiotics are given to stop infections and inflammation

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

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

The prognosis of Olecranon Bursitis is:

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

The prevention of Olecranon Bursitis is :

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

A Family Doctor's Tale - TENNIS ELBOW

DOC I HAVE TENNIS ELBOW

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

The lateral epicondyle of the elbow is more commonly affected.


The cause of Tennis Elbow is unknown.

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

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

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

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

The symptoms and signs of Tennis Elbow are:

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

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

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

4.Pain often radiates into the forearm

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

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

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

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

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

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

The Treatment of Tennis Elbow is:

Conservative treatment:
1.rest of the tendon

2.Cold or ice may help reduce inflammation

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

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

5.Muscle relaxant to relax muscles

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

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

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

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

Surgery usually give excellent results.

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

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

A Family Doctor's Tale - DISLOCATION OF ELBOW

DOC I HAVE DISLOCATION OF THE ELBOW

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

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

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

The cause of Dislocation of Elbow is:

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

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

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

1.Pain and deformity of the  affected elbow

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

Signs:

1.swelling and difficulty in movement of the elbow

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

The complications of Dislocation of Elbow is:

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

The Treatment of Dislocation of Elbow is:

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

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

3.Extend the elbow to unlock the olecranon

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

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

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

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

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

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

Surgery :
surgery is never necessary

The prognosis of Dislocation of Elbow is:

Prognosis is usually good  with proper treatment.

The prevention of Dislocation of Elbow is:

1. Avoid any traumatic injury to elbow.

2.Avoid pulled elbow in children

A Family Doctor's Tale -DISLOCATION OF SHOULDER

DOC I HAVE DISLOCATION OF THE SHOULDER

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


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


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

The cause of anterior Dislocation of Shoulder is:

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

The symptoms and signs of Dislocation of Shoulder are:

Symptoms:
1.Pain and deformity of the Shoulder

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

Signs:

1.Little and painful movement of the Shoulder

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

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

The complications of Dislocation of Shoulder are:

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

The Treatment of Dislocation of Shoulder is:

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

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

3.Extend the Shoulder under traction to loosen the muscles

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

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

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

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

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

8.There should be a gradual return to normal movement

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

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

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

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

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

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

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

The prognosis of Dislocation of Shoulder is:

Prognosis is usually good .

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

The prevention of Dislocation of Shoulder is:

 Avoid any traumatic injury to Shoulder.

 

A Simple Guide to Bedwetting (enuresis)

A Simple Guide to Bedwetting (enuresis)
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What is Bedwetting?
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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.
What are the causes of bedwetting?
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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 recognise 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.Somtimes a child develops bedwetting in responce to jealousy or reduced attention from parents or caretaker after a new child is born into the family
Complications:
Amount of urinary incontinenc 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 behavioural conditioning.
6.Medicine such as antidressant can help to control bedwetting in children but only as as a short-term measure.
Prognosis:
Fairly good with counseling and motivation

A Family Doctor's Tale - KNEE LIGAMENTS INJURY

DOC I HAVE A KNEE LIGAMENT INJURY


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

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

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

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

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

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

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

4.Obesity cause more strain on the Knee Ligaments

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

2.Swelling of the knee within 1 to 12 hours

3.Difficulty in bending or straightening the knee

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

5.difficulty in walking because of the pain

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

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

2.MRI will show if there is Knee Ligaments damage

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

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

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

3.Muscle relaxant to relax muscles

4.crutches can reduce the weight off the affected limb

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

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

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

Prognosis depends on the severity of the ligament injury

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

Some cases however may require surgical treatment

Prognosis is good after surgical treatment.

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

A Family Doctor's Tale - MENISCUS TEARS

DOC I HAVE A MENISCUS TEAR


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

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

The meniscus helps to maintain the knee stability .

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

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

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

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

4.Obesity cause more weight bearing effect on the meniscus

Symptoms of Meniscus tears:
1.Pain in the knee

2.swelling of the knee

3.inability to bend or straighten the knee

4.locking of the knee

5.difficulty in walking because of the pain

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

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


The Treatment of meniscus tears is:

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

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

3.Muscle relaxant to relax muscles

4.crutches can reduce the weight off the affected limb

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

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

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

Physiotherapy starts the day after surgery.

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

In most cases Meniscus tears may require surgical treatment

Prognosis is good after surgical treatment.

Prevention of Meniscus tears is:

Avoid obesity and weight bearing on the knee

Avoid strenuous physical activity of the knee

Avoid sudden turning and twisting of the knee

A Family Doctor's Tale - MALE MENOPAUSE

DOC  I HAVE MALE MENOPAUSE

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

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

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

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

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

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

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

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

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

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

A Family Doctor's Tale - SLEEPING SICKNESS

DOC I HAVE SLEEPING SICKNESS

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

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

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

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

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

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

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

Symptoms:
Incubation period is usually 10 days.

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

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

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

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

Diagnosis:
1.characteristic fever, jaundice and drowsiness

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

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

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

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

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

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

3.Coma and death

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

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

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

Other medicines include:

1.Eflornithine (for gambiense only)

2.Pentamidine

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

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

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

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

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

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

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

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

A Family Doctor's Tale - YELLOW FEVER

DOC I HAVE YELLOW FEVER

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

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

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


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

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

A.Mild form:

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

B.Severe form

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

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

C.Recurrent Stage:

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

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

2.inflammation of nerves and meninges

3.contraction of muscles of face, scalp and neck

4.neuralgia

5.MRI of the brain

6.blood tests for antibodies

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

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

3.Dilatation and distension of the cranial arteries

4.Inflammation of the cranial nerves, meninges, neuralgia

Treatment of Yellow Fever:
There is no specific anti-viral drug to treat the disease or a vaccine to prevent a person from being infected with the YELLOW FEVER virus.
Treatment is mainly supportive.
1. Rest
2. drinking lots of water to prevent dehydration will help.
3. Paracetamol for fever, severe headaches and body aches( Avoid aspirin and NSAIDs due to the risk of bleeding) to reduce the discomfort.
4. Intravenous fluids for hyto 10 days, but complete recovery can take as long as a month.potension and dehydration.
5. Antidepressant medicines are helpful

The illness can last up to one month before recovery

Prevention of Yellow Fever:

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

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

To prevent YELLOW FEVER fever, it is important to prevent the breeding of its carrier, the Aedes mosquitoes, identified by their black and white stripes on the body .
A puddle of water about the size and depth of 20-cent coin is sufficient for an Aedes mosquito to breed in.

The Aedes mosquitoes are commonly found breeding in clear stagnant water in flower vases, flower pot plates, roof gutters, earthen jars for water storage or decorative purposes, watering cans, and bamboo pole holders.

The Aedes mosquito can also breed in unusual places such as water trapped in the hardened soil in potted plates, and the rim of unwanted pails

 

A Family Doctor's Tale - HEMOPHILIA

DOC I HAVE HEMOPHILIA

Hemophilia is an inherited disorder of bleeding associated with deficiency of Factor VIII (a clotting factor) in the blood.

The cause of Hemophilia is:
It is an inherited X-linked recessive disorder.

Women are carriers .
50 per cent of the sons of carriers will get the disease and 50 per cent of the daughters will be carriers.

This condition is present in the Royal family of England.

It is also associated with Christmas disease which is a deficiency of Factor IX and von Willebrand disease (deficiciency of Factor VIII and platelet abnormalities leading to prologed skin bleeding)

It is a lifelong disease and there is no cure for it.

In Hemophilia patients, the deficiency of a clotting factor can lead to severe bleeding during injury or spontaneous bleeding into the joints.

The Symptoms of Hemophilia are:
1.excessive bleeding during mild trauma(example: tooth extraction)

Sometimes internal bleeding may occur without the knowledge of the patient because the injury is so mild.

2.soft tissue hematomas (big blood clots) which can cause nerve compression

3.Hemarthroses (bleeding in the joints) and joint contactures

4.hematuria (bleeding in the urine) or epistaxis (nose bleeds)


Diagnosis of Hemophilia is often based on
1. family history of Hemophilia

2. history of bleeding following minor trauma

3. Blood clotting Factor VIII low on testing

4.Skin bleeding time and blood clotting time abnormal

The complications of Hemophilia are:
1. Anemia

2. damage to bleeding joints

3. shock and death

The treatment of Hemophilia is by:

1.Blood transfusion or replacement of blood clotting factors VII cryoprecipitates

2.Aspiration of blood from bleeding joints

3.Avoid joint immobility to prevent contractures

4.Avoidance of injury

5.Careful preparation for dentistry or surgery

6.Proper genetic counseling

The prognosis of Hemophilia is:
Prognosis is good for hemophilia patients with modern therapy.

Most patients are able to live normal lives.

Rarely life threatening bleeding may occur.

The Prevention of Hemophilia is through:
Genetic counseling and testing for Hemophilia

A Family Doctor's Tale - PORPHYRIA

DOC I HAVE PORPHYRIA

Porphyria is an autosomal dominant inherited disorder of hemoglobin biosynthesis.


Porphyrins are produced in the process of hemoglobin synthesis.

Because of the deficiency of enzymes in the porphyria patients, the porphyrins are not converted into hemogloblins.

As a a result excessive porphyrins accumulates and less hemoglobin is formed.

The  red blood cells formation is affected resulting in neurological dysfunction or photosensitive rashes.


The causes of Porphyria is:
It is an inherited deficiency of one or more enzymes helping to synthesize hemoglobin.

Acute intermittent porphyria can be precipitated by
1.many drugs:
a.barbiturates
b.sulphonamides
c.methyl dopa
d.oral contaceptives

2.infection

3.alcohol

4.starvation

5.hypoglycemia

Chronic cutaneous porphyria may also be precipitated by
1.the same agents as above

2.hepatotoxins

It is a lifelong disease and there is no cure for it.

The symptoms of Porphyria are:
Symptoms:


Acute intermittent porpyria
1.recurrent attacks of neurologic dysfunction affecting the autonomic nervous system:
a.fever
b.tachycardia
c.nausea
d.vomiting
e.abdominal pain -main recurring symptom
f.sweating
g.hypertension
h.leucocytosis

2.peripheral nervous system
a.mononeuritis multiplex with nerve pain
b.polyneuropathies
c.cranial neuropathies

3.central nervous system
a.psychiatric disturbance
b.seizures

Chronic cutaneous tarda:
1.bullous eruption on exposure to sunlight
2.evidence of hepatic disease

The diagnosis of Porphyria is made by:
Diagnosis of Porphyria is often based on
1. family history of Porphyria

2. porphyrins in the urine with urine turning dark red or brown on exposure to light

3. 24 hour excretion of urinary porphoblininogen and delta-aminolevulinic acid increased in acute porphyria

4. 24 hour excretion of urnary porphobilinogen and other porpyrins increased in other porphyrias

5.50 per cent reduction of uroporphyrinogen I synthesase in red blood cells diagnostic of acute intermittent porphyria

6.MRI or ultrasound of the abdomen may be necessary due to persistant recurrent abdominal pain

The complications of Porphyria are:

1. Anemia

2. damage to liver and gallstone formation


3. seizures and brain damage

4.Paralysis

5.Scarring of the skin

The treatment of Porphyria is by:
1.Blood transfusion of hematin in severe cases

2.high carbohydrate diet helps limit the production of porphyrins


3.Avoid causative agents especially medications

4.propanolol for tachycardia

5.anagesics for pain

Other treatment includes:

1.chloroquine

2.Vitamin A supplements

3.Removal of blood to reduce the porphyrins

4.Avoid alcohol

The prognosis of Porphyria is :
Prognosis is fair for Porphyria patients with modern treatment however the illness is a lifelong condition.

There is recurrence of attacks and high rates of hospitalization

The Prevention of Porphyria is by:
Genetic counseling and testing for Porphyria

A Family Doctor's Tale - NASAL POLYPS

DOC I HAVE A NOSE POLYP

Nose Polyp is a benign tumor with soft round body rising on a stalk from the nose inner lining or nasal mucosa.

It is usually the result of chronic inflammation within the nasal cavity.

Nose Polyp can occur at any age.

The causes of nasal polyps is unknown but predisposing conditions are:
1.chronic inflammation of the nasal cavity or sinuses

2.allergies as some people with nasal polyp test positive for environmental allergen

3.Asthma

4.smoking

5.Aspirin sensitivity

Symptoms :
1.Nose Polyp is a well encapsulated round swelling rising from the nasal mucosa on a stalk called the peduncle.

2.mutiple swellings may also be present.

3.They are usually painless

4.They may block the nasal passage giving rise to the sensation of nasal obstruction.

5.There is decreased sense of smell or even complete loss of smell

6.excessive nasal secretions may also be present

Diagnosis:
1.nasoendoscopy may be done to confirm the presence of nasal polyps

2.Allergy skin tests to detect if there are any allergy contributing factors

3.CT Scan of the sinuses may be done to see the extent of the nasal polyps as well as to localize their position and other possible obstructions in the nasal cavity

There can be complications such as:
1. bleeding

2. infection of sinuses

Treatment:
Medical:
1.antibiotics to treat infections

2.antihistamine to treat allergy

Surgery:
The only surgical treatment is removal of the Nose Polyp if the medications do not work or if there is suspicion of cancer.

This can be done by nasal endoscopy sugery under general anesthesia
1.Excision of the nasal polyp with a knife or scissors through the endoscpoe

2.Clearing of any obstruction which can prevent the flow of discharge from the sinuses.

3.use of nasal steroid after surgery to prevent reccurrence of polyps

4.nasal washes to prevention the accumulation of dried mucus or crusts in the nasal cavity.

The prognosis is usually excellent.

Recurrence at the same spot is rare but do occur due to regrowth of the blood vessel supplying the Polyp.

Prevention:
Avoid any irritants or allergies as much as possible

Avoid smoking

Manage asthma or allergies with medication.

A Family Doctor's Tale - VOCAL CORD POLYP

DOC I HAVE VOCAL CORD POLYP, NODULE AND CYST

Vocal polyp is a benign tumor with soft round body rising on a stalk from one of the vocal cords.

Vocal nodules are thickened area occurring on both vocal cords
and are also known as singer's nodules or callusese of the vocal cords.

Vocal cysts are swellings (containing fluid in a sac) found on the vocal cords.  

Vocal polyp,nodules and cysts can occur at any age.

The causes of vocal polyp and nodules are:

1.Vocal polyps and nodules are usually the result of chronic inflammation or repetitive trauma to the vocal cords such as frequent shouting or voice overuse.

2.reflux of acid from stomach to larynx

3.smoking irritates the vocal cors

4.cysts occur due to blockage of a mucous gland in the mucosa of  the vocal cords.

Symptoms of Vocal Cord Polyp, Nodule and Cyst:
1.Hoarse voice

2.breathless voice

3.low pitch husky voice

4.vocal faigue

5.inability to sing high pitched notes

6.increased effort to speak or sing

7.frequent throat clearing

Diagnosis of Vocal Cord Polyp, Nodule and Cyst:
1.history of voice problem

2.nasoendoscopy through the nose down to vocal cord under local anesthesia to check on the vocal cords and confirm the presence of nodules, polyp or cysts

3.test for laryngopharyngeal reflux

4.Sensitive nose and sinusitis may be excluded with CT Scan of skull from nose to vocal box.

There can be complications of Vocal Cord Polyp, Nodule and Cyst such as:
1. bleeding (rare)

2. chronic hoarseness of voice

Treatment of Vocal Cord Polyp, Nodule and Cyst:
Medical:
1.antibiotics to treat infections

2.antihistamine to treat allergy

3.antacid to reduce acid reflux

4.voice rest

Most benign vocal cord growths will resolve with conservative medical treatment especially voice rest.

Surgery:
The only surgical treatment is phono-microsurgical removal of the Vocal polyp,nodules and cysts if the medications do not work or if there is suspicion of cancer.

Phono-microsurgery is surgery to the vocal cord using micro-surgical techniques and instruments and sometimes lasers.

This surgery can also be done to improve the voice or remove a growth for microscopic analysis.

If a lesion is found to be cancerous, further treatment may be required.

The prognosis of a Vocal Cord Polyp, Nodule and Cyst is usually excellent.

Recurrence at the same spot is rare but do occur due to regrowth of the blood vessel supplying the Polyp or nodule.

Prevention of Vocal Cord Polyp, Nodule and Cyst:
Avoid strenuous use of the vocal cords

Avoid smoking and alcohol

Avoid any irritants or allergies as much as possible

A Family Doctor's Tale - SNORING

DOC I HAVE SNORING

Snoring is the symptom of spectrum of problems including Sleep disorders such as Obstructive Sleep Apnea during which breathing is interrupted during sleep.

About 24 per cent of the local population are loud habitual snorers.

Causes of snoring:
The cause of snoring is due to the vibration or flapping of the tissues lining the upper respratory passages.

Snoring in most people are due to multiple factors each playing some part in the snoring process:
1.Inadequate muscle tone of the palate, tongue and pharynx leads to airway collapse during inspiration causing the walls of the airway to vibrate.

2.bulky tissue in the upper respiratory airway(adenoids and tonsillar hypertrophy, cysts and tumors)cause narrowing of the airway and result in snoring.

3.excessive soft palatial tissue or long uvula can also vibrate during breathing causing snoring.

4.a backward prolapsing tongue may fall backwards into the throat when sleeping on the back and contribute to snoring

5.anatomical abnormalities in the nose(deviated nasal septum, hypertrophied inferior turbinates) or congested nasal passages (allergies, sinusitis, nasal polyps) can cause poor nasal inflow and make the soft tissues of the palate and throat vibrate.

Systemic disorders:
1.Hypothyroidism -large tongue

2.Acromegaly - large tongue

3.heartburn resulting in congestion of the throat

4.Obesity - enlarged tongue or uvula

Symptoms:

1.snoring present in 20% of men and 5% of women at age 30-35 years.
At age 60 years or more, 60% of men and 40% of women snore habitually

2.unrefreshed sleep

3.daytime sleepiness

4.poor concentration

5.forgetfulness

6.morning headaches

7.dryness of mouth in the morning

8.irritabilty

9.depression

10.sexual dysfunction

Signs:

1.Enlarged nasal turbinates, polyps , and nasal blockage

2.Enlarged tonsils and adenoids

3.Long uvula

4.large protruding tongue


Diagnosis of Snoring is made:
1.Symptoms of snoring, nasal congestion and inadequate sleep

2.observation of airway obstruction during sleep

3.Sleep study using monitoring devices such as

a. electroencephalogram(EEG)

b electro-oculogram(EOG)

4.Electrocardiogram(ECG)

5.Blood oxygen studies

6.Nasal and oral airflow

7.Thoracic and abdominal movement

8.Snoring sounds

Complications:
1.higher risk of hypertension

2.cardiovascular disease

3.Congestive heart failure

4.cardia arrhythmias

5.cerebrovascular accidents

Treatment:
A.Non Surgical treatment:

1.Continuous Positive Airway Pressure(CPAP)
CPAP administered by mask through the nose is the single most effective least invasive treatment for Obstructive Sleep Apnea.
It can improve all the bad effects of OSA.

2.Oral appliances which pushes the mandible forward and prevent it from falling open during sleep

3.Nasal Congestion treatment:
Patients with nasal congestion and blockage should be treated with antihistamine and decongestant

4. Weight reduction:
Any obese patients should have at least 10% of his weight reduced over a 6 months period

B.Surgical Treatments:
1.Surgery on the upper pharyngeal airway(uvula and palate)

a.Radiofrequency reduction of the palate and uvula shrinks the tissues of these and is indicated in simple snorer or mild OSA.

b.Uvulopalatopharyngoplasty (UPPP) surgery includes uvulectomy, palatal releasing and shortening incisions.

2.Surgery of the Tongue base:
Radiofrequency reduction is done for mild cases.
Advancement of the tongue, hyoid suspension is done under general anesthesia. All these enlarge the posterior airway space.

3.Maxillomandibular Advancement:
This is the most effective surgical procedure for treatment of OSA.It causes enlargement of the pharyngeal and hypopharyngeal airway by physically expanding the skeletal framework.

Prognosis depends on the severity of the condition but is generally good.

Prevention:
1.Lose weight in obese individual with snoring

2.Healthy lifestyle with balanced diet and exercise.

3.Neck elevation to prevent obstruction of airways and heartburn

4.Sleep on the side rather than on the back.
Snoring is worse when sleeping on the back