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Showing posts with label rest. Show all posts
Showing posts with label rest. Show all posts

Sunday, September 21, 2008

A Simple Guide to Tenosynovitis

A Simple Guide to Tenosynovitis
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What is Tenosynovitis?
-----------------------------------------

Tenosynovitis is the inflammation and swelling of the tendon sheaths (called the synovium) and the enclosed tendons.

It can occur together with tendinitis(inflammation of the tendons).

It can also cause stenosing tenosynovitis (tightening inflammation of the tendon sheaths).


What are the cause of Tenosynovitis?
-----------------------------------------------

The cause of Tenosynovitis is unknown.

Some possible causes are:
1.Injury or trauma to the tendon

2.Repetitive usage of fingers and wrist joints

3.Arthritis of the joints may predispose to tenosynovitis

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

5.Tenosynovitis occurs in families, and

6.It is generally seen more often in males than in females


What are the symptoms and signs of Tenosynovitis?
-------------------------------------------------------------------

Symptoms:
--------------

1.Pain on movement of the tendon

2.Swelling of part of the tendon affected

3.Stenosis of the tendon sheath may be present

4.Stiffness of the tendon - inability to stretch

5.Pain is felt most beneath the bone of involved joints

Signs:

1.swelling over the involved tendon

2.Passive stretching of the tendon is painful.

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

4.The tendons sheaths are usually swollen and thickened

5.The tendons may become stuck in the narrowed tendon sheaths (Trigger Finger)

6.There may be crepitations felt over the tendon as it moves across the sheaths


What is the complications of Tenosynovitis?
-------------------------------------------------

Fibrosis and rupture of the inflamed tendon may occur leading to loss of function.


What is the Treatment of Tenosynovitis?
----------------------------------------------------------------

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 sheath or tendon nodule may help to reduce inflammation

7.Surgery :
------------------

Surgical opening of the synovial sheath may be necessary for tendon release.


What is the prognosis of Tenosynovitis?
----------------------------------------------------------

Prognosis is usually good although recurrence may occur after cortisone injection.

Surgery usually give excellent results.



































Saturday, July 26, 2008

A Simple Guide to Plantar Fascilitis

A Simple Guide to Plantar Fascilitis
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What is Plantar Fascilitis?
-----------------------------------------

Plantar Fascilitis (also known as Painful Heel Syndrome) is a inflammation of the plantar fascia (which stretch from the calcaneum to the toes) characterised by the pain in the heel especially in the morning and weight bearing exrcises.

It is more common in women.


What are the cause of Plantar Fascilitis?
-----------------------------------------------

The cause of plantar Fascilitis is the non-specific inflammation of the plantar fascia as a result of repetitive injury to the fascia.

In some cases the plantar fasilitis occurs as a result of a calcaneal spur impinging on the fascia.

Both heels can be affected.


What are the symptoms and signs of Plantar Fascilitis?
---------------------------------------------------------------------------------

Symptoms:

1.Pain in the heel of one or both feet

2.Pain usually is worse in the morning on getting and stepping on the floor.

3.Certain weight bearing exercises like jogging or brisk walking makes the pain worse

4.Pain is described as constant and aching

5. Pain is felt most beneath the calcaneal bone but may be present in the area of the medial arch.

Signs:

1.local tenderness in the calcaneal bone area of the heel.

2. Pain is aggravated by direct pressure.

3. It can become more painful by movement which put thethe fascia under strain such as dorsiflexion of the toes or ankles.

4.Xrays of the heel usually show no abnormally. Sometimes there is calcaneal spur which may be due to traction of the muscle or fascia on the calcaneum bone.

A stress fracture may need to be ruled out in chronic cases.


What is the Treatment of Plantar Fascilitis?
----------------------------------------------------------------

Conservative treatment:
-----------------------

Initial phase:

1.rest of the heel-avoid jogging or strenous exercises

2.Cold or ice may help reduce inflammation

3.Heel cups, cushions, tapes, pads may help to reduce the pain

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 tender area of the plantar fascia may help to relieve pain.

7.Usage of a short leg walking cast for a few weeks help to avoid exertion on the inflamed fascia.

8.A cushion lined night splint which hold the foot in slight dorsiflexion is helpful.

Mobilisation phase:

Physiotherapy such as traction of the fascia and heel cord, shortwave diathermy may help once there is no pain

Surgery is usually not indicated in plantar fascilitis.

Rarely surgery is used to remove the calcaneal spur and to release the plantar fascia at its attachment to the calcaneum bone.


What is the prognosis of Plantar Fascilitis?
----------------------------------------------------------

Prognosis is usually good although healing is slow and takes up to 1-2 years.


What is the prevention of Plantar Fascilitis?
-------------------------------------------------

Avoid certain weight bearing exercises like jogging or brisk walking

Use heel cups, cushions, tapes, pads in foot wear

Lose Weight

Tuesday, July 22, 2008

A Simple Guide to Frozen Shoulder

A Simple Guide to Frozen Shoulder
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What is Frozen Shoulder?
-----------------------------------------

Frozen Shoulder (also known as adhesive capsulitis) is a disorder of the shoulder characterised by the slow onset of pain and restriction of movement.

It tends to be chronic and full recovery may take several months.

It is more common in women and diabetes.

Incidence is about 2 in a 1000.


What are the causes of Frozen Shoulder?
-----------------------------------------------

The exact cause is unknown but several conditions has been blamed:

1.bicipital tenosynovitis- inflammation of the biceps muscles and tendon limmiting its movements

2.rotator cuff tendonitis - inflammation of the rotator cuff muscles which surrounds the shoulder with resultant adhesions and stiffness causing limitation of movement

3.reflex sympathetic dystrophy- a disturbance in the sympatheic nervous system cause pain ine the shoulder joint and hypersensitivity of the muscles surrounding the joint. There is swelling of the arm followed by atrophy of the muscles

4.trauma - injury to the joint may cause tightening of the injured muscles around the shoulder joint.

5.Surgery of the shoulder, breast and lung may also cause frozen shoulder because of the pain resulting from the movement of the shoulder and hence stiffness of the muscles.


What is the natural progression of frozen shoulder in most cases?
-----------------------------------------------------------------------

Frozen shoulder is a disabiliting disease which can last from 5 months to 4 years.

There is chronic inflammation of the muscles surrounding the joint with adhesios formed between joint and muscles causing restriction of movement of the joint.

There is also reduced fluid in the joint further restricting movement.

Stage one("freezing" or painful stage):
There is a slow onset of pain which becomes worse and stiffening of the joint occurs.

This lasts 5 weeks to 9 months.

Stage two("frozen" or adhesive stage):
There is a slow but steady improvement in pain, but the stiffness persists.

This lasts 4 -9 months.

Stage three("thawing" or recovery):
There is a gradual return to normalcy in the shoulder motion.

This lasts 5 -26 months.


What are the symptoms and signs of Frozen Shoulder?
-------------------------------------------------------------------

Symptoms:

1.Pain in the shoulder radiating down the deltoid muscle and anterior aspect of the arm

2.Pain usually is worse at night especially lying on the affected shoulder

3.Certain movements makes the pain worse

4.Pain is described as constant, dull and aching

5.complaints of stiffness of the shoulder

6.inability to wear a shirt or blouse because of restricted movements

Signs:

1.apprehensive patient who holds the arm protectively

2.Generalised tenderness of rotator cuff and biceps muscles

3.Limited shoulder movement

4.Range of muscle movement is reduced in all directions

5.Arthrogram or MRI of shoulder can be done to confirm the diagnosis and exclude a posterior shoulder dislocation..


What is the Treatment of Frozen Shoulder?
----------------------------------------------------------------

Conservative treatment:
-----------------------
Initial phase:
1.rest of the shoulder

2.moist heat

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

4.Muscle relaxant to relax muscles

5.injection of local anesthetic and long acting steroid into the rotator cuff muscle may help to relieve pain.

Mobilisation phase:
1.Physiotherapy such as traction, shortwave diathermy

2.gradual mobilisation and exercises to loosen the tight muscles surrounding the shoulder

Maintenance phase:
1.Continual exercises of the shoulder muscles

2.Avoidance of strain on the muscles of the shoulder

Manipulation of the frozen shoulder may be done under anaethesia to break the adhesions and restore some movement.

Surgery is usually not indicated in frozen shoulder.
Rarely surgery is used to cut the adhesions.


What is the prognosis of Frozen Shoulder?
----------------------------------------------------------

Prognosis depends on the underlying cause.

In most cases frozen shoulder may resolve itself with time

Thursday, July 17, 2008

A Simple Guide to Prolapsed Intervertebral Disc

A Simple Guide to Prolapsed Intervertebral Disc
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What is Prolapsed Intervertebral Disc?
-------------------------------------------------------


Prolapsed Intervertebral Disc is the prolapse of the intervertebral disc(which is the disc between 2 vertebrae) as a result of protrusion of the nucleus pulposus out of its weakened ligamentous ring(annulus fibrosus).

It may protrude in a posterior or postero-lateral direction causing pressure to the nerve roots especially at S1, L5 and L4 vertebrae.


What are the causes of Prolapsed Intervertebral Disc?
---------------------------------------------------------------

1.Degeneration of the posterior longitudal ligaments and annulus fibrosus occurs with age resulting in the disc being pushed out between the weakened ligaments.

2.Trauma -direct injury to disc, heavy lifting, sneezing can cuse the disc to pop out of the weakened ligaments and prolapse partially or completely.

3.Spinal tumour rarely pushes the disc out of its intervertebral space


What are the symptoms and signs of Prolapsed Intervertebral Disc?
-----------------------------------------------------------------------------

Symptoms:
1.Low Backache with pain in the lumbar region

2.Sciatica or pain shooting down 1 leg

3.Pain usually follows
severe bending
lifting heavy objects
injury
sneezing or coughing

4.Pain may so bad that the person cannot stand erect.

5.pain is worse when sitting

6.weakness, numbness, difficulty in moving the leg

Signs:
1.Muscle spasm especially spinal extensor muscles

2.Movement of the back and affected led painful and restricted

3.Patient tend to stand stiffly or with slight sciatic scoliosis on the affected side

4.Straight leg raising test is usually restricted on the affected side.

5.Neurological signs such as paraesthesia commonly present on the affected side.

6.Sensory and motor deficit may be present in the affected side

7.Loss of reflex and weakness may help to localise the site of prolapse:
L4 root:
Pain in the medial buttock, lateral thigh, medial tibia and big toe
weakness of big toe and foot dorsiflexion
patella jerk is diminished

L5 root:
Pain in hip, groin,posterolateral thigh, lateral calf and dorsal surface of foot
weakness of the big toe and foot dorsiflexion
no change in patella or ankle reflexes

S1 root:
pain in posterior part of thigh, lower calf border and sole of foot
weakness of knee flexors and plantar flexors
ankle jerk is diminished


How to investigate the cause of Prolapsed Intervertebral Disc?
----------------------------------------------------------------------------

1.Full medical history especially of injuries, type of work, onset of pain,radiation to legs,

2. Full medical examination especially of movement of the back ,any deformity of the spine, straight leg raising test

3. X-ray of the Spine: to exclude osteoarthritis, injury, narrowing of disc space, bone tumor,

4.MRI of spine for slipped disc

5.bone scan for osteoporosis

A definite diagnosis can then be made and the cause of the pain treated.


What is the Treatment of Prolapsed Intervertebral Disc?
----------------------------------------------------------------------------------

Conservative treatment:
-----------------------
Initial phase:
1.Bed rest with a hard board below the mattress- straighten the back
2.Physiotherapy such as traction, shortwave diathermy

Mobilisation phase:
1.Wearing a corset to strengthen the back and help the traction of the spinal bones
2.gradual mobilisation and exercises to strengthen the spinal extensor muscles

Maintenance phase:
1.Exercises to strengthen the back muscles.
2.Wear a corset
3.Avoidance of postural strain on the back

Drug Therapy:
-----------------------
1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
3.Extradural injection of local anesthetic and long acting steroid may help to relieve the pain

Surgery:
--------------
Surgery is required if there are:
1.persistent pain and neurological symptoms remain after conservative treatment
2.progressive neurological symptoms
3.Disc has protruded more than 75% out of its intervertebral space as seen on MRI

Surgery consists of:
1.laminectomy - removal of the disc and prolapsed material.
2.microdiscectomy- insertion of a titanium disc to replace the removed prolapsed disc

Finally treatment of the underlying cause(eg.space occupying spinal tumors) is important.


What is the prognosis of Prolapsed Intervertebral Disc?
-------------------------------------------------------------------------

Prognosis depends on the underlying cause.

Preventative measures are important in preventing recurrences of the prolapse of the intervertebral disc.

What is the Prevention of Prolapsed Intervertebral Disc?
----------------------------------------------------------------

Avoidance of postural strain on the back

Wear a corset

Exercises to strengthen the back muscles.

Sunday, March 2, 2008

A Simple Guide to Chikungunya Fever

A Simple Guide to Chikungunya Fever
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What is Chikungunya Fever?
-------------------------------


Chikungunya fever is an acute illness caused by the chikungunya virus transmitted to humans by the bite of an infected Aedes mosquito.

How is the Chikungunya Fever transmitted?
-----------------------------------------


Chikungunya virus is transmitted to humans by the bite of infected Aedes mosquito.

Monkeys and other wild animals may be possible source of the virus.

Infected mosquitoes will spread the virus to other humans when they bite their skin.

The condition was first detected in Eastern Africa in the 1950 and recently has also outbreaks in India, Africa, Indonesia and Malaysia.


What are the Symptoms of chikungunya fever?
-----------------------------------------------


The incubation period in mosquito is 3-5 days and 1-12 days in humans.

Symptoms usually last 3-10 days.

Symptoms may be the same as denque fever:

1.fever of sudden onset

2.severe and prolonged joint pains with or without swelling

3.muscle pain

4.headache

5.chills

6.rash -no petechiae, more of a maculopaular rash

7.fatigue

8.nausea

9.vomiting.


The most severe symptom is the severe and prolonged joint pains which can even last up to 1 month.

Unlike dengue fever,there has been no documented cases of hemorrhagic (bleeding) or shock syndrome reported in chikungunya infection.

The chikungunya virus also does not affect the nervous system.

How do you diagnose chikungunya fever?
---------------------------------------


Diagnosis is made on the basis of :

1.high fever

2.severe and prolonged joint pain

3.blood tests for chikungunya fever


What is the treatment for chikungunya fever?
-------------------------------------------------


There is at present no specific medication or vaccine to treat chikungunya fever.

TREATMENT IS THEREFORE SYMPTOMATIC:

1.rest,

2.plenty of fluids and

3.pain medication such as paracetamol may relieve symptoms of joint pain, body aches and fever.
Aspirin and NSAIDs should be avoided if possible.


What is the prognosis of chikungunya fever?
--------------------------------------------


The illness is usually self-limiting.

Most symptoms lasts for 3-10 days and the joint pain may last for weeks to months.

Rarely does it cause death(through high fever and dehydration
).

How can you prevent being infected with the chikungunya virus?
---------------------------------------------------------------------


The best way to prevent chikungunya infection is to avoid bites from the Aedes Mosquito.

Preventive measures are the same as dengue fever such as getting rid of mosquito breeding places.

Wednesday, November 7, 2007

A Simple Guide to Hepatitis A

A Simple Guide to Hepatitis A
-----------------------------------

What is Hepatitis A?
-------------------------

Hepatitis A is a acute inflammatory infection of the liver which is caused by the hepatitis A virus(HAV).

How is Hepatitis A virus spread?
--------------------------------------

The virus is excreted in faeces and transmitted through contaminated food and water. Eating shellfish, cockle shells, prawns or crabs taken from sewage-contaminated water is a common means of contracting hepatitis A.
It can also be acquired by close contact with individuals infected with the virus.
HAV causes the liver to become enlarged, inflamed and tender resulting in all the symptoms of hepatitis.
There is no chronic (long-term) infection.

What are the Symptoms of Hepatitis A?
----------------------------------------------

A person is infectious for 2-3 weeks before he or she experiences symptoms:
1.fever and joint pains

2.jaundice

3.fatigue

4.loss of appetite

5.nausea and vomiting

6.abdominal pain

7.pale coloured stools and dark urine

8.itchy skin due to irritation by the bilirubin.

During the first week of the illness he feels very sick and weak.
As the condition improves, the patient generally feels better after the first week but may requires to rest at home for 6 weeks to avoid damage to the liver.

How is the diagnosis of Hepatitis A made?
-------------------------------------------------

A blood test is the best way to diagnose hepatitis A.
His hepatitis antigens are raised at the early stage but as his condition improves the antibodies become positive.

His liver function tests are also done to assess the damage to the liver.
Usually the serum bilirubin is high, liver enzymes or tramsaminase, alkaline phosphatase are raised in the acute stage of illness.
As the condition improves, these tests gradually returned to normal.

What is the Treatment of Hepatitis A?
---------------------------------------------

There are no medicines for treatment of Hepatitis A except for symptomatic treatment of symptoms.
1.Rest in bed

2.multivitamins especially vitamin B to improve the function of the liver

3.Lots of fluids

4.carbohydrate diet

5.Anti-itch creams and lotions to stop itch

Recovery is usual with very rare cases going on to cirrhosis of the liver.

What is the Prevention of Hepatitis A?
---------------------------------------------

Hepatitis A vaccination is the best protection.
It is usually given in 2 doses within 1 year.

Immune globulin can be given for short-term protection.
It is given before and within 2 weeks after coming in contact with hepatitis A virus.

The vaccine is recommended for travellers travelling to developing countries and people with chronic liver disease.

Always practice good food hygiene
.
Avoid food like seafood which may be contaminated by unhygienic water.

Always wash your hands with soap and water after using the toilet, before preparing and eating food.

Recovery is usual within 6 weeks.

What is the difference between Hepatitis A and Hepatitis B?
----------------------------------------------------------------------

Hepatitis A is spread through eating food contaminated with the HAV virus.
Examples include partially cooked shellfish (oysters, clams) or in situations where there is poor hygiene (food/drink/utensils contaminated with an infected person's faeces).
Most people suffer an acute episode and upon recovery have immunity to Hepatitis A.

Hepatitis B is spread by contact with blood or body/fluids of an infected person (including a carrier) or from a carrier mother to her newborn during childbirth.
Hepatitis B infection can lead to hepatitis carrier stage or chronic hepatitis which can results in liver cirrhosis or cancer.

Saturday, November 3, 2007

A Simple Guide to Headache

A Simple Guide to Headache

---------------------------------

What is Headache?

----------------------

Headache is a very common complaint, not an illness.

It literally means pain in the head.

What are the Common Types of Headaches?

--------------------------------------------------

Tension headache:

-----------------

as defined by the International Headache Society is characterised by:

1.bilateral location

2.pressing/tightening (non-pulsating) quality

3. mild to moderate in intensity

4. not aggravated by routine physical activity like walking or climbing stairs.

It is the most common headache and may be associated with contractions of head and neck muscles due to physical or mental stress. The headache is made worse by changes in the environment, drugs, or factors unique to the individual.

It can also be classified into 2 side types:

episodic (<>

chronic (> 14 days a month on average and <>

Treatment can be divided into:

pharmaceutical

non pharmaceutical

Pharmaceutial:

can be divided into acute and prophylactic.

In acute treament simple painkillers is usually effective.

In prophylactive treatment,antidepressants like amitriptyline usually help in the prevention of tension headache.

Medicines should always be given at low doses and titrated up to therapeutic doses to minimise side effects.

Non-pharmaceutical:
1. rest

2. removal of aggravating factors.

3. relaxation exercises

Migraine:

-----------

is defined as a heavy throbbing pain usually over one side of the scalp, forehead and about the eye, caused by abnormally dilated blood vessels.

Migraine may be accompanied by nausea, vomiting or sensitivity to loud noises or bright lights.

It is also triggered by certain factors unique to the individual such as:

1.menstruation,

2.alcohol,

3.anxiety,

4.loud noises,

5.bright lights

A validated 3 items questionaire covering

1. disability

2. nausea

3. sensitivity to lights

should given to every patient to screen the severity of the migraine.

Treatment again is divided into:

phamaceutical

non-pharmaceutical.

Pharmacetical:

can be divided into acute and prophylactic.

In acute treament simple painkillers like paracetamol is usually effective in mild cases.

Non-steroidal anti-inflamatory drugs should be tried if paracetamol fails.

If NSAIDs are ineffective then migraine-specific drugs like triptans or ergotamine which act to constrict blood vessel should be tried.

In some cases anti-emetic drugs like stemetil to prevent vomiting is given together with the migraine medication.

In prophylactic treatment, the goals are to:

1. reduce frequency,severity and duration

2.improve function and reduce disability

3.improve responsiveness to treatment of acute attacks

Medicines used include:

betablockers

Calcium channel blockers

Serotonin receptor antagonists

Antidressants

Anticonvulsants

Angiotensin blockers

NSAIDs

Non-pharmaceuticals:

1.resting in a cool, dark and quiet room.

2.relaxation exercises

3.Solving the triggering factors also help.

4.Oestogen containing oral cotraceptives should avoided in menstrual migraine.

During pregnancy or lactation treatment should be non-pharmaceutical when possible. If necessary paracetamol is the safest drug for women during pregnancy or lactation.

Cluster headaches

----------------------

is defined as pain which occurs in runs with tearing pain over the forehead or behind the eye(s) with flushing of the face.

There are aura of stars,flashing lights etc associated with this headache.

The cause is beleived to be due to histamine release from ingestion of certain foods like cheese, seafood,alcohol etc.

It is more common in males.

Treatment is by

1.strong painkillers

2.avoidance of food triggers

3.rest.

What are Secondary headaches?

---------------------------------------


Secondary headaches refer to headaches associated with a known medical illness.

It is diagnosed by its close relation to a disorder that is known to cause headache.

The headache improves or disappear after successful treatment or spontaneous resolution of the causative illness.
1.Sinus headaches:

----------------------

are due to acute sinus inflammation attacks.

Pain is over the frontal forehead and the upper cheeks.

It may be associated with fever and heavy mucus production.

Treatment is by

1.antibiotics for the sinus infection,

2.antihistamines to reduce mucus production

3.painkillers

4.rest.

2.Referred headaches:

---------------------------

these are caused by by referred pain from disorders of structures around the head. Common ones are

1. earaches,

2. toothache causing pain over an entire part of the face and

3. temporomandibular joint dysfunction from mechanical pain from the jaw joint.

4. temporal arteritis, a rare inflammatory blood vessel condition causing persistent headache at the temporal artery. There is possible complication of blindness secondary to anterior ischemic optic neuropathy. The headache usually resolves or improves with 3 days of high dose steroid treatment.

3.Meningitis / Encephalitis headaches:

---------------------------------------------

caused by infection of the brain tissue (encephalitis) or the membranes surrounding the brain (meningitis).

Headache is the most common symptom. The pain is diffuse and progressive with fever, a painful stiff neck and other symptoms such as drowsiness, seizures and neurological problems including weakness and numbness.

This type of headache needs immediate hospital treatment.

4.Cerebrovascular Accidents (haemorrhagic stroke):

-------------------------------------------------------------

a stroke happens when a blood vessel in the brain is blocked or bursts.

Bleeding in the brain causes a sudden severe headache.

There is also associated loss of consciousness and other neurological signs such as weakness, numbness and seizures.

This type of headache needs immediate hospital treatment.

5.Brain Tumour:

------------------

is rare and causes a gradual headache lasting for weeks.

It is localised and associated with nausea, vomiting, loss of appetite and loss of weight.

It is worse in the morning and aggravated by coughing or leaning forward.

By the time neurological symptoms appear such as seizures, numbness, weakness or blindness, the brain tumour has already grown to an advanced stage.

Treatment includes surgery, chemotherapy or radiotherapy.

6. Other causes of secondary headaches are:

a.post traumatic headache following a head injury

b.whiplash injury

c.cerebral venous thrombosis

d. idiopathic intracranial hypertension

e. hydrocephalus

f. sleep apnea

g.cardiac cephalgia

h.acute glaucoma

Simple Treatment of Headache

-------------------------------------

Consume a painkiller.

Lie down in a dark, quiet room.

Use muscle relaxation techniques or a gentle massage.

For tension headaches, try a warm bath.

For migraines, put an ice bag or cold towel on your temple.

If the headache do not improve, go for a complete investigation of the headache.

What are the investigations done in Headache?

-------------------------------------------------------

You should be investigated for your headache if the headache has:

1. associated fever and and change in mental state.

2. numbness of part of the body or with paralysis.

3. associated fits.

4. sudden onset of severe headache

5. lasted for more than a day even after taking painkillers.

6. increased headache frequency.

7. appeared different from your usual type

8. been precipitated by coughing,sneezing,bending

9. associated with stiff neck and vomiting

10.appeared for the first time in middle age

Common tests:

Blood tests - for infections,raised ESR, bleeding disease

MRI of brain- to exclude brain tumours, bleeding in the brain

Lumbar puncture - used only if there is suspected infection of brain or meninges

Thursday, October 4, 2007

A Simple Guide to Backache


A Simple Guide to Backache
----------------

What is Backache?
-----------------

Backache is a symptom, not an illness.
It is one of the most common complaints.

The complaint may be:
1.Constant aching, pain or stiffness that occurs anywhere along your spine, from the base of the neck to the hips.

2.Sharp pain in the neck, upper back, or lower back, especially after lifting heavy objects or other strenuous activity.

3.Chronic ache in the middle or lower back, especially after sitting or standing for long period of time.

Who suffer from Backache?
--------------------------------

About 80 per cent of people will experience back pain at some point in their lives.
More men suffer from it than women.
Backache is most common among people in their middle age.
Backache also occurs among young people aged between 16 - 24
Backache can also be hereditary (example: ankylosing spondylosis)

What causes Backache?
----------------------------

Acute Backache
Acute backache may occur due to
1.back strain from the lifting of a heavy object,

2.from a fall,

3.violent jerk as a car suddenly stops.

4.fracture of the spine or the dislocation of a vertebral disc

Chronic Backache
Chronic backache may be caused by

1.Osteoarthritis with degeneration of the spinal column when one vertebra slips forward on the one immediately below it

2. slipped disc. The discs act as cushions between two vertebral bones but due to degeneration in old age, or in cases when the spine has been injured before, a slipped disc may occur.

3.Bad posture can also lead to chronic backache such as sitting for long hours in an incorrect position. The right position is to stand up or sit up straight instead of slouching in a couch when watching TV. If the bad posture is prolonged, backache may occur.

4.sprains in the muscles of the back and

5.gynaecological problems (such as ovarian tumours,fibroids) and pregnancy.
6. Chronic infections of spine such as Tuberculosis

7. Cancer of the organs of pelvic region such as bladder or prostate

8. Cancer of the spine from primary bone marrow or secondary spread.

How can Backache be prevented?
--------------------------------------

1.Maintain the correct posture at all times. When standing or sitting, ensure that your back is kept straight instead of a slouched position.

2.support your back and use a cushion when necessary.

3.Correct furniture can also help to prevent the occurrence of backache.
Use chairs of a proper height in relation to the table or desk.

4.Sleep on a firm mattress

5. Do not wear high heels

6. Keep your back straight when carrying heavy item.Keep the item close to the body.

7.Do not bend the back to carry heavy objects. Bend the knees and keep the back straight

8.Exercise is another good way to prevent backache by strengthening the back muscles. However, if you have had back injuries before such as a slipped disc, do be cautious when you exercise.

What to do when Backache occurs?
-----------------------------------------

1. maintain good posture and rest the back.

2.Ice packs can provide relief for backaches. Ice packs will help to reduce the swelling and inflammation.

3.Heat treatment will help improve circulation and reduce stiffness.

4.Painkiller like paracetamol may relieve pain

If pain persists, do consult a doctor.

When should you see a doctor for Backache?
---------------------------------------------------

You should see a doctor under the following conditions:
1. backache is severe and acute.

2.backache starts suddenly and is severe enough to prevent you from work.

3.backache is accompanied with associated pain in legs or weakness and tingling in the legs or back.

4. painkillers and other therapies do not help to relieve pain and your backache is getting worse.

5.pain increases when you cough or bend forward at the waist. This could be a sign of a herniated disk. Try to lie flat with a pillow under your knees.

6.pain follows an injury and is accompanied by sudden loss of bladder or bowel control. If you have difficulty moving any limb, or if you feel numbness, pain, or tingling in a limb, you may have injured your spinal cord.

7.backache is accompanied by nausea, vomiting, fever, muscle weakness, pain down an arm or leg, or bowel or bladder disturbances

8.pain is still present after two to three days of rest.

9.pain lasts longer than 72 hours.

10.pain radiates into the legs,

11.other symptoms such as unexplained weight loss occur,

12.pain is in one side of the small of your back accompanied by a sick feeling and fever. You may have a kidney infection.

13.the pain in your back extends downward along the back of the leg. You may be suffering from sciatica.

14.dull pain in one area of your spine when trying to lie down or getting out of bed, especially if you are over 50 years of age. You may be suffering from osteoarthritis.

15.pain is felt in both thighs when walking. This can be a symptom of spinal stenosis (the narrowing of the lower spinal canal).

16.persistent backache may also be an indication of an undetected cancer of the colon,ovary,bladder or prostate.

How to investigate the cause of Backache?
--------------------------------------------------

1.Full medical history especially of injuries, type of work, onset of pain,radiation to the arms or legs, changes in bowel or bladder habit, loss of weight

2. Full medical examination especially of movement of the back ,any deformity of the spine, abdominal swelling, straight leg raising test

3. X-ray of the Spine: to exclude fracture, osteoarthritis, dislocation,deformity, bone tumour,

4. X-ray of abdomen to exclude any tumours in the abdomen pressing against the spine

5.MRI of spine for slipped disc,tumours,fracture

6.Bone density test to exclude osteoporosis

7.Blood tests for calcium, protein,kidney function,cancer markers, RA factor

8. Urine and stool tests for blood,

A definite diagnosis can then be made and the cause of the pain treated.

What is the Treatment of Backache?
-------------------------------------------

Symptomatic:

Painkillers and muscle relaxants

Ice packs or heat treatment

Physiotherapy to strengthen muscles

Good posture and firm mattress

Avoid aggravating factors like high heels, overstretching muscles,excessive strenous activities

Curative:

The cause must be found and treated. Examples are fractures due to injury.

Causes like cancer and aged related illness(osteoarthritis) may not be cured but may improved with treatment.

Wednesday, September 12, 2007

A Simple Guide to Dizziness


A Simple Guide to Dizziness
----------------------------------

What is Dizziness?
----------------------

Dizziness has been used to describe different sensations.
Some may liken it to giddiness, light-headedness, unsteadiness or simply feeling faint.
The symptom of "dizziness" needs to be separated from vertigo, which is a feeling that the room is moving or spinning, or that the person is moving when they are not (or even a floating sensation).
Balance difficulty is also a separate topic where a person feels they are about to fall, has difficulty staying balanced, or may actually fall.

What are the Causes of Dizziness?

---------------------------------------

There are many causes of dizziness:
1.insufficient blood flow to the brain
2.Lack of sleep

3.Low blood sugar

4.Low or very high blood pressure

5.Anaemia

6.Fever

7.Stress & Anxiety

6.Cochlea imbalance(Motion Sickness)

7.Cold or Influenza

8.heart disease9. Medicines

10.Brain condition such as Parkinson,brain tumours

Most dizzy spells are minor and go away after a while.

However, dizziness can also point to more serious disorders. These include:

1.Vertigo
There is a spinning sensation or feeling that your surrounding is moving around you.
It is often accompanied by nausea and vomiting.
Nystagmus, a jerky movement in the eye, is a common sign.
Vertigo often indicates an inner ear problem.
Viruses, such as those causing the common cold or flu, can also attack the inner ear and its nerve connections to the brain, resulting in severe vertigo.
In a more serious case, a bacterial infection such as mastoiditis can make a person lose his hearing and sense of balance.
Poor blood flow to the inner ear can also lead to vertigo. This is often due to the hardening of the arteries (arteriosclerosis) which is commonly seen in patients with diabetes, high blood pressure or high blood cholesterol.

2.Light-headedness
A typical form of light-headedness occurs when you stand up too fast for the blood to reach your brain. This form of light-headedness is often transient and harmless. More persistent forms of light-headedness can be caused by:
Loss of body fluids, for instance, loss of water in excessive sweating.
Changes to your blood pressure caused by medicines such as anti-hyptensives, diuretics and anti-depressants.
Medical conditions such as diabetes, Parkinson's disease and Anaemia.

3.Motion sickness or sea-sickness
People prone to this condition can experience nausea and even vomiting when travelling in cars, airplanes, boats, or ships.
Motion sickness occurs when the central nervous system receives conflicting messages from four different systems of the body. They are the inner ears, the eyes, pressure receptors in our skin and sensory receptors in the muscles and joints.
It is the complex interaction of these four systems that gives us our sense of balance and equilibrium.
The inner ears, specifically the three semicircular canals in each ear, detect motion in three dimensions, that is, forward-backward, up-down, and left-right.
The central nervous system (that is, the brain and spinal cord) receives all the information from the four systems to make some sense of the body's position in relation to the environment.
Thus, if you are sitting in the back seat of a moving car, your inner ears and skin receptors will detect the motion of your travel. And if your eyes see the same motion, you will not become "car sick". But if you are reading in the car, your eyes see only the pages of your book, so your brain receives conflicting signals and you become "car sick."

How to diagnose Dizziness?
--------------------------------
History:
--------
1.duration of dizziness - to determine if acute or chronic.
2.any evidence of vertigo i.e. episodic sudden sensation of circular turning motion of your body or your surroundings - this is a sign of nervous system or ear disease.
3.sensation of lightheadedness, floating, giddiness, unsteadiness, fainting - all known as pseudovertigo and are more likely to be a sign of cardiovascular disease. 4.occasional dizziness episodes - e.g. benign positional vertigo attacks are brief, usually lasting a minute, and then subside rapidly.
5. Continous dizziness episodes may indicate Meniere's syndrome which is characterized by paroxysmal attacks lasting 30 minutes to several hours of vertigo, tinnitus, nausea and vomiting, sweating and pallor and progressive deafness.
6. effect of position (of head or body) or a change in posture on the dizziness - e.g. benign positional vertigo is a common type of vertigo that is induced by changing head position, especially tilting the head backwards, changing from lying to sitting position or turning to the affected side.

Physical examination
--------------------------
1.Observe for pallor of skin or conjunctiva. Moderate or severe anemia will cause lightheadedness and dizziness, but usually not true vertigo
2.Blood pressure taken when lying down and again after rapidly arising to standing position. Very High blood pressure may cause true vertigo or lightheadedness.
Low blood pressure or postural drop in blood pressure is more likely to cause lightheadedness not true vertigo
3.Examine the ear for abnormalities. Abnormalities on ear examination with no other abnormalities found on nervous system examination may suggest ear wax, otitis media (middle ear infection), cholesteatoma or petrositis
4.Complete nervous system examination should be performed including visual acuity, inspecting for nystagmus, cranial nerve and cerebellar signs.
If abnormalities are found may suggest multiple sclerosis, advanced brain stem tumor, acoustic neuroma or basilar artery insufficiency

What is the Treatment of Dizziness?
-------------------------------------------

Treatment of dizziness depends on whether the symptom indicates a more serious condition.
Most cases of dizziness and motion sickness are mild and self-treatable disorders.
1.Medications given usually act to balance the inner ear nerves or increase blood flow to the inner ear. Iron and vitamin supplements may be given to treat anaemia.
Other than medicines, the following may relieve some of your discomfort:
2.Avoid rapid changes in position, especially standing up quickly from lying down or turning around from one side to the other.
3.Avoid extremes of head motion (especially looking up) or rapid head motion (especially turning or twisting).
4.Remove or reduce using products that impair circulation, e.g. nicotine, caffeine, and salt.
5.Avoid stress or anxiety, or substances that can trigger dizziness. These include substances that you are allergic to.
6.Avoid hazardous activities such as driving a car, operating dangerous equipment or climbing a ladder.
7.Avoiding motion sickness
Always travel in a manner such that your eyes will see the same motion that your body and inner ears feel.
When in a car, look forward into the distance.
On a ship, watch the horizon
In a plane, choose the window seat if you can, and look out of the window.
Do not read while travelling and do not sit in a seat facing backwards.
8.Treating balance disorders
The main way is to treat the underlying disease or disorder that may be causing the imbalance in the first place. These diseases include ear infection, stroke, multiple sclerosis and other diseases of the nerve.

Tuesday, September 11, 2007

A Simple Guide to Coryza(Common Cold)


A Simple Guide to Coryza( Common Cold )
-----------------------------------


What is Coryza(Common Cold)?
---------------------------------------

Coryza or Common Cold is one of the most common infections contracted by humans.It is characterised by inflammation of the mucous membranes of the nose and throat, with sneezing, sore throat, and mild coughing.

What causes Coryza (Common Cold)?
------------------------------------

The Common Cold is caused by one of the viral infections of the upper respiratory tract. There are over 200 different viruses which can cause a common cold.

Some of the common viruses include: rhinovirus, respiratory syncytial virus (RSV), coronavirus, parainfluenza.

What are the Symptoms of Coryza(Common Cold)?
------------------------------------------------------------

Generally the common cold viruses produces mild but uncomfortable symptoms:

1.Runny nose
2.Sneezing
3.Nasal congestion
4.Tiredness
5.Headache especially around the eyes and forehead
6.Fever low grade rare

Symptoms usually last less than two weeks.

What is the Treatment of Coryza(Common Cold)?
-----------------------------------------------------------

Usually a common cold runs its course without complications in one to two weeks.
Because there is no cure for a viral infection, treatment is aim at relieving symptoms.

1.Rest is the most important part of treatment. A rested patient will recover faster.

2.Adequate warm Fluids helps to keep the mucus membranes moist to allow infected mucus to flow better and also to replace wet mucus lost during the runny nose.

3.If there is any fever, headaches and pains, paracetamol can be given to relieve symptoms.

4.Oral (tablet or syrup) decongestants may also relieve nasal symptoms.
Antihistamines may be of some benefit in reducing mucus production.

5.Decongestant sprays can relieve block nose temporarily, but should not be used for more than three days. Longer use can lead to rebound congestion with more symptoms of congestion.

6.Antibiotics and vitamin C are not helpful in relieving symptoms of the common cold.

What are the Complications of Coryza(Common Cold)?
-----------------------------------------------------------------

Very rarely young children may develop bronchiolitis, viral pneumonia, and croup.
Some infants less than 3 months of age are particularly susceptible to developing secondary bacterial lower respiratory infections.

Two thirds of people over 60 years who live in the community and develop a rhinovirus infection can be expected to develop a lower respiratory tract illness.

Acute otitis media occurs in 2% of people with a cold.

Bacterial infection of the paranasal sinuses occurs in 0.5% of people with a cold.

People with chronic obstructive pulmonary disease who have a rhinovirus infection are more likely to have a longer duration of illness, a more severe illness, and to cough for longer afterwards than those without lung disease.

What is the Prognosis of Coryza(Common Cold)?
----------------------------------------------------------

The median duration of a common cold is a week.

Rarely the commn cold will last up to 2 weeks.

In smokers with a rhinovirus infection the cough is more likely to be troublesome and prolonged.

Friday, August 24, 2007

A Simple Guide to Parkinson's Disease




A Simple Guide to Parkinson's Disease
----------------------------------

What is Parkinson's Disease?
----------------------------------
Parkinson's Disease is a disorder of old age characterised by slow movement , rest tremors , rigidity and poor coordination.

Who gets Parkinson's Disease?
------------------------------------

Parkinson's Disease usually after the age of 50 years.
Incidence is about 0.2% of population.
It is one of the most common neurologic disorders of the elderly.
It affects both men and women equally.

What causes Parkinson's Disease?
---------------------------------------

Parkinson's Disease results when the nerve cells in the part of the brain that controls muscle movement (substantia nigra) are gradually destroyed.
Nerve cells use a brain chemical called dopamine to help send signals back and forth.
Damage in the area of the brain that controls muscle movement causes a decrease in dopamine production.
Low dopamine affects the balance between nerve-signalling substances (transmitters).
As a result, the nerve cells cannot properly send messages.
This results in the loss of muscle function.

What are the symptoms of Parkinson's Disease?

--------------------------------------------------------

Early symptoms may be nonspecific and may include numbness, painful and tender muscles, stiffness and weakness of limbs, fatigue and unexplained weight loss.

As the disease progresses, the classical features of Parkinson's Disease appear:
1. Bradykinesia(slowness of movement)
2. leadpipe rigidity
3. rest tremors
4. Postural instability


How is Parkinson's Disease diagnosed?
----------------------------------------------

Parkinson's Disease is diagnosed when there are at least 2 of the four classical features are present. To improve diagnostic accuracy, bradykinesia must be present.

1. Bradykinesia usually presents with lack of voluntary and automatic movement such as monotonous speech,
lack of facial expression,
Slow movements
Difficulty initiating any voluntary movement
Difficulty beginning to walk
Difficulty getting up from a chair
shuffling of feet movement

One way to demonstrate this is to have the patient tap his index finger on his thumb.
The movement is slow and lack momentum.

2. Rigidity of Parkinson's Disease is leadpipe in nature.
This rigidity contribute to the
mask like facial appearance,
Muscle rigidity
stiffness of posterior neck muscles,
diminished arm swing,
cogwheel rigidity of the wrists,
Difficulty bending arms or legs

3.Rest tremor is classical of Parkinson's Disease.
There is this resting or pill rolling tremors of the hand which is worsened by anxiety and fatigue and disappears when the hand is in use. Tremor is usually unilateral.

4. Postural instability usually occurs late in the illness.
It is seen in the
Unstable, stooped, or slumped-over posture
freezing gait,
retropulsion,
loss of balance and
frequent falls

Turning in bed, rising from the chair and turning when walking is difficult because of poor body and limbs coordination.

What are the other symptoms associated with Parkinson's Disease?
-----------------------------------------------------------------------------

Additional symptoms that may be associated with this disease:
Depression
Confusion
Dementia
Seborrhea (oily skin)
Loss of muscle function or feeling
Muscle atrophy
Memory loss
Drooling
Anxiety, stress, and tension

What are the Complications of Parkinson's Disease?

------------------------------------------------------------

Untreated Parkinson's Disease progresses to total disability, often accompanied by general deterioration of all brain functions, and may lead to an early death.

Treated, the disorder impairs people in varying ways.
Most people respond to some extent to medications.
The side effects of medications may be severe:
Varying degrees of disability
Difficulty swallowing or eating
Difficulty performing daily activities
Injuries from falls
A variety of gastrointestinal symptoms, mainly constipation
Daily activities such as bathing,dressing, walking and even writing may be difficult.

How is Parkinson's Disease treated?
------------------------------------------

Parkinson's Disease is not curable and the purpose of treatment is to:
1. improve functions and
2. treat symptoms

Treatment of Parkinson's Disease can be broadly classified into:
1. Non-drug therapy:

Good general nutrition and health
are important.
Exercises that improve strength, agility and flexibility are useful to minimise the disability of Parkinson's Disease.
A range of motion exercises is useful to keep the joints supple and mobile.
Patients are encouraged to exercise according to their ability.
Good exercises include walking,swimming, stretching and riding stationary bicycles.

Patients are taught sitting balance,walking techniques and the use of handrails. Activities of daily living is made more manageable with aids like:
Buttoning -replace buttons with Velcros
Eating -use utensils with large handles
Getting out of bed -install an overhead grab bar
Prevents falling -install hand bars in bedroom and bathroom. use nonslip mats.
Getting out of chair - use high seat chair
Railings or banisters placed in commonly used areas of the house may be of great benefit to the person experiencing difficulties with daily living activities.
Special eating utensils may also be helpful.

2. Drug therapy

There are 2 main types of drugs:
1. symptom modifying helps to alleviate the symptoms but do not change the natural history of the conditions.
depression
insomnia
constipation,
dysphagia,
urinary frequency

2. disease modifying drugs such as:
Levodopa may be used to increase the body's supply of dopamine, which may improve movement and balance.
Artane -is particularly good for reducing tremors
Jumex- is used in early Parkinson's Disease and helps reduce bradykinesia
Bromocriptine - enhance the effect of levadopa Deprenyl may provide some improvement to mildly affected patients.
Amantadine or anticholinergic medications may be used to reduce early or mild tremors. Carbidopa reduces the side effects of levodopa and makes levodopa work better.
Entacapone is used to prevent the breakdown of levodopa.
Pramipexole and ropinirole are used before or together with levodopa.
Rasagiline is approved for patients with early Parkinson's disease. Rasagiline helps block the breakdown of dopamine.
Neupro is a new skin patch that contains the drug rotigotine. This medicine helps dopamine receptors in the brain work better. The patch is replaced every 24 hours.

Additional medications to help reduce symptoms or control side effects of primary treatment medications include antihistamines, antidepressants, monoamine oxidase inhibitors (MAOIs), and others.
It is important that the disease should be controlled before irreversible brain damage occurs.

3. Surgery:
In some cases surgery can help to alleviate symptoms especially when all other medications and measures failed.
Surgery to implant stimulators or destroy tremor-causing tissues may reduce symptoms in some people.
Transplantation of adrenal gland tissue and stem cells to the brain has been attempted, with variable results.


Added 4th October 2008:
---------------------------------

Parkinson Disease:
----------------------
Less than 5% of Parkinson's Disease patients gets the disease through genetic reasons.

A mutation of a gene (LRRK2) called G20135 has been found to increase the risk of Parkinson's disease in some families.

People with the mutated gene gets the illness at a younger age than the normal which is 60 and above.

The cause of Parkinson's disease is still unknown.

The prevailing theory is that environmental factors such as exposure to high levels of pesticides is the cause of the disease.

Wednesday, August 15, 2007

A Simple Guide to Gastroenteritis




A Simple Guide to Gastroenteritis
-------------------------------------

What is Gastroenteritis?
---------------------------

Gastroenteritis is an inflammation of the lining of the intestines caused by a virus, bacteria or parasites resulting in leakage of fluid from the cell into the intestine(diarrhea),abdominal pain and vomiting.

What are the causes of Gastroenteritis?
--------------------------------------------

Viral Gastroenteritis:
The most common cause of Gastroenteritis is Viral.

Rota virus is the leading cause among children 3 to 15 months old and the most common cause of diarrhea in children under the age of 5 years.

Adenovirus occurs mainly in children under the age of 2 years.

Caliciviruses especially the norovirus cause infection in people of all ages.

Astrovirus also infects primarily infants, young children, and the elderly.

Bacterial Gastroenteritis:
The most common cause is the E. coli bacteria, usually mild with diarrhea, abdominal pain and occasional vomiting. It rarely cause fever.

Salmonella, Shigella ,Vibrio cholerae, are more serious bacterial infection causing diarrhea and high fever.

Parasitic Gastroenteritis:
Most common is amoebic dysentery,common in India and Africa.
Other parasitic infection are giardiasis and threadworms.

What are symptoms of Gastroenteritis?
----------------------------------------------

The main symptoms of gastroenteritis are
1. watery diarrhea
2. abdominal pain
3. vomiting
4. headache
5. fever.
6.loss of appetite and energy

Symptoms usually appear within 4 to 48 hours after exposure to the germ and last for 1 to 2 days, though symptoms can last as long as 10 days.

How is Gastroenteritis transmitted?
------------------------------------------

Gastroenteritis can be highly contagious. The germs are commonly transmitted by people with unwashed hands.
People can get the germs through close contact with infected individuals by sharing their food, drink, or eating utensils, or by eating food or drinking beverages that are contaminated with the germs.
Noroviruses in particular, are typically spread to other people by contact with stool or vomit of infected people and through contaminated water or food—especially oysters, prawns, crabs, lobsters, cockleshells from contaminated breeding waters.

How is the diagnosis of Gastroenteritis made?
-----------------------------------------------------

Doctors generally diagnose gastroenteritis based on the symptoms and a physical examination. Your doctor may ask for a stool sample to test for rotavirus or to rule out bacteria or parasites as the cause of your symptoms.

How is Gastroenteritis treated?
-------------------------------------

Most cases of viral gastroenteritis resolve without specific treatment.
Antibiotics are not effective against viral infections.

The primary goal of treatment is to reduce the symptoms which may include an antispasmodic drug to stop abdominal cramps, medicine to harden the stools such as kaolin and slow down the intestinal movement (lomotil or loperamide).

Prompt treatment may be needed to prevent dehydration which is the loss of fluids from the body. Important salts or minerals, known as electrolytes, can also be lost with the fluids. Dehydration can be caused by diarrhea, vomiting, excessive urination, excessive sweating, or by not drinking enough fluids because of nausea, difficulty swallowing, or loss of appetite.

The symptoms of dehydration are
excessive thirst
dry mouth
little or no urine or dark yellow urine
sunken eyes
severe weakness or lethargy
dizziness or lightheadedness

Mild dehydration can be treated by drinking liquids.
Severe dehydration may require intravenous fluids and hospitalization.
Untreated severe dehydration can be life threatening especially in babies, young children and the elderly.

The following steps may help relieve the symptoms of gastroenteritis.
1.Allow your gastrointestinal tract to settle by not eating for a few hours.
2.Sip small amounts of clear liquids or suck on ice chips if vomiting is still a problem.
3.Give infants and children oral rehydration solutions to replace fluids and lost electrolytes. 4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
5.Avoid dairy products, caffeine, and alcohol until recovery is complete.
6.Get plenty of rest.

How is Gastroenteritis prevented?
----------------------------------------

You can avoid infection by:
1.washing your hands thoroughly for 20 seconds after using the bathroom or changing diapers
2.washing your hands thoroughly for 20 seconds before eating
3.disinfecting contaminated surfaces such as counter tops and baby changing stations
4.Avoid eating or drinking foods or liquids that might be contaminated

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