DOC I HAVE A LUMBAR SPINAL STENOSIS
Lumbar Spinal Stenosis is a condition due to the narrowing of the spinal canal either in the central part or peripheral(lateral) to the the side in the nerve root canal.
This results in pain in one leg without back pain
Every one can get Lumbar Spinal Stenosis.
The age of onset is usually in the late 40's.
It is also more common in men than women .
The causes of lumbar spinal stenosis are:
1.congenital - in born narrowing of the spinal canal
2.Acquired
a.carrying heavy objects improperly with the back instead of the knees
b.trauma or injury to the spine or pelvic bone
c.staying in crouched or seated positions for too long
Symptoms:
1.The onset is usually gradual with bouts of back pain and stiffness over weeks or months.
2.Early morning stiffness and pain occurs,then wears off during the day.
3.It gradually affects the lower limbs with pain and stiffness.
4.Typically there is low back pain radiating to the buttocks and leg which is aggravated by activity especially walking
Signs:
1.Physical signs are not present in early cases
2. there may be a Simian stance (like a monkey) with flexion at the hips and knees
3.Spinal movements are restricted
4.motor, sensory and reflex abnormalities present in one or both lower limbs
4.sphincter impairments may be present rarely
Diagnosis:
1.medical history of duration of symptoms and the extent of pain in the back and legs
2.neurological examinations of deficits in the spinal nerve
3.Confirmation is usually by a x-ray of the spine and pelvis.
-disk height, narrowing of intervertebral space, bone spurs or osteophytes
4.MRI or CAT scans will show clearly the spinal narrowing or narrowing of the nerve root canals
Treatment:
Conservative Management:
1.physiotherapy with traction and short wave diathermy
strengthening of spinal muscles
2.spinal support with corset or light weight brace
3.Proper usage of back muscles
4. medications such as NSAIDs
5.epidural steroid injections
Surgery:
surgery may be needed if:
1. the patients do not improve with above treatments
2.the symptoms become progressively worse
3.weakness of legs
4.loss of bowel or bladder function
There is lumbar decompression surgery
1.Laminectomy or removal of disk
2.foraminotomy to widen the hole where the nerve root comes out.
3.Spinal fusion to strenthen the spine and prevent abnormal loose movement of the spine
Prognosis:
Usually very good after surgery
Prevention:
Symptoms comes and go.
There should proper posture during sitting, standing and carrying heavy things
With exercise and strengthening of the spinal muscles, pain is reduced and flexibility of the spine is improved especially with regular exercise and proper posture.
Lumbar Spinal Stenosis is never life threatening and can be controlled but not cured.
Friday, March 4, 2011
Wednesday, March 2, 2011
A Family Doctor's Tale - TENNIS ELBOW
DOC I HAVE TENNIS ELBOW
Tennis Elbow or Lateral Epicondylitis is a common conditions in adults which is due to small tear in the tendons on the lateral or outside part of the elbow.
These tendons attach the forearm muscles to the lateral epicondle of the elbow.
Repeated tears tears leads to damage in the tendon a condition called angiofibroblastic hyperplasia.
The microtears and subsequent development of the damaged tissue is due to forceful or repeated use of the forearm muscles.
Recently it has also been called golf elbow.
In fact any repetitive forceful usage of the forearm muscle during work or sports can give to this condition.
Risk factors:
1.Age above 40
2.Activity - regular tennis of more than 2 hours playing per session or a similar activity such as golf
3.Technique - poor stroke technique in tennis or golf (hitting the ball with flexed muscle) and improper grip size
4.Other factors - over exertion of muscles
Symptoms:
1.pain and tenderness over the lateral part of the elbow joint
2.Pain is worse on resisted wrist and finger extension with elbow in full extension.
Diagnosis :
1.Diagnosis is based mainly of history and site of tenderness of the elbow
2.X-rays of elbow are done to evaluate the bone surrounding the muscles and exclude other causes of pain.
It may also reveal calcification of development of bone spurs of the lateral epicondylar region in chronic cases.
Treatment:
Conservative management with rest and observation for 6 months:
1.activity modification
2.correction of playing techniques in sports
3.improved ergonomic in work related usage of elbow
4.stretching exercises
5. counterforce bracing
6.pain killers and anti-inflammation drugs
7.Topical injection of steroid into the tendon
Surgery:
3 surgical options are:
1.open release of affected tendons with excision of damaged tissues
2.arthroscopic release
3.new techniques which improved blood supply to the affected area.
Prognosis:
Usually very good with injections or surgery
Prevention:
1.Adequate warm up exercise before strenuous activity to forearm
2.limit duration of play or activity
3.use correct technique
Tennis Elbow or Lateral Epicondylitis is a common conditions in adults which is due to small tear in the tendons on the lateral or outside part of the elbow.
These tendons attach the forearm muscles to the lateral epicondle of the elbow.
Repeated tears tears leads to damage in the tendon a condition called angiofibroblastic hyperplasia.
The microtears and subsequent development of the damaged tissue is due to forceful or repeated use of the forearm muscles.
Recently it has also been called golf elbow.
In fact any repetitive forceful usage of the forearm muscle during work or sports can give to this condition.
Risk factors:
1.Age above 40
2.Activity - regular tennis of more than 2 hours playing per session or a similar activity such as golf
3.Technique - poor stroke technique in tennis or golf (hitting the ball with flexed muscle) and improper grip size
4.Other factors - over exertion of muscles
Symptoms:
1.pain and tenderness over the lateral part of the elbow joint
2.Pain is worse on resisted wrist and finger extension with elbow in full extension.
Diagnosis :
1.Diagnosis is based mainly of history and site of tenderness of the elbow
2.X-rays of elbow are done to evaluate the bone surrounding the muscles and exclude other causes of pain.
It may also reveal calcification of development of bone spurs of the lateral epicondylar region in chronic cases.
Treatment:
Conservative management with rest and observation for 6 months:
1.activity modification
2.correction of playing techniques in sports
3.improved ergonomic in work related usage of elbow
4.stretching exercises
5. counterforce bracing
6.pain killers and anti-inflammation drugs
7.Topical injection of steroid into the tendon
Surgery:
3 surgical options are:
1.open release of affected tendons with excision of damaged tissues
2.arthroscopic release
3.new techniques which improved blood supply to the affected area.
Prognosis:
Usually very good with injections or surgery
Prevention:
1.Adequate warm up exercise before strenuous activity to forearm
2.limit duration of play or activity
3.use correct technique
Saturday, February 26, 2011
A Simple Guide to Amoebiasis
A Simple Guide to Amoebiasis
------------------------------------------
What is Amoebiasis?
---------------------------
Amoebiasis is an acute infectious illness caused by the parasite Entoamoeba histolytica.
What is the cause of Amoebiasis?
----------------------------------
The bacteria which causes Amoebiasis is the Entmoeba histytica which is an extremely hardy parasite able to live in polluted water, contaminated food and soiled clothes.
Amebic infections occur most common in the cacum and rectosigmoid region of the colon.
Initial infections are small ulcers, usually discrete erosions whhich may extend more deeply ,coalescing to form bigger lesions resulting in extensive mucosal loss.
Penetration through the muscle lining may occur causing peritonitis.
Liver involvement may occur with the ameba traveling through the portal vein.
Liver abscesses consists of necrotic liver tissue.
Secondary bacterial infection are rare.
Most liver abscesses are solitary, rarely multiple and occur long after clinically evident bowel ulceration.
Single and multiple liver abscesses may occur shortly after a bout of amebic dysentry.
Abscesses of the brain and lung may occur.
Ulcers heal rapidly after treatment and permanent scarring is rare.
What are symptoms of Amoebiasis?
----------------------------------------------
The main symptoms of Amoebiasis are
1. Many people with E.histolytica in stools are passive carrier
2. Invasive bowel disease begins 1-6 months after infection sometimes later
3. abdominal pain especially at the sides
4. altered bowel habit
5.diarrhea with blood or mucus in stools
6.foul stools
7.adominal bloating or gas
8.tenderness on palpation at caecum or sigmoid colon regions
Severe cases may have:
1.more severe symptoms as above
2.bloody stools
3.fever
4.weight loss
5.liver enlargement and tenderness on palpation
6.dehydration and its effects such as delirium and disorientation
7. lassitude and tiredness
8. convulsions
9.tender abdominal mass with obstruction
How is the diagnosis of Amoebiasis made?
-----------------------------------------------------
Doctors generally diagnose Amoebiasis based on:
1. stool cultures.
2.blood tests
3.colonoscopy
4.liver scan and ultrasound
What are the complications of Amoebiasis?
-------------------------------------------------------
Amoebiasis is a disease which can kill espcially through its complications:
1.Perforation of bowel leading to peritonitis or inta-abdominal abscesses
2.Severe hemorrhage uncommon but can cause death
3.Intussusception or insertion of part of colon into another part of colon is rare but can follow amebic ulceration and may cause intestinal obstruction
4.irritable bowel syndrome may persist for some months
5.Lung and pericardial involvement rare but can pose danger
6. cutaneous amebiasis cause deep painful and rapidly spreading ulceration
7.Liver infection can cause damage to liver and result in cirrhosis
8.Liver abscess may perforate and cause peritonitis or produce lung abscess or amebic pericarditis
9.Amebic brain abscess are rare but can occur.
How is Amoebiasis treated?
-------------------------------------
Amoebiasis is an infectious disease which can spread to other people through contaminated food and water.
1.Anti-parasitic medicines like metronidazole 750mg three times a day for 10 days should work for mild to moderate disease.
2.Metronidazole 750mg three times a day for 10 days and chloroquine or diiodohydroquin (1000mg for 2 days followed by 500mg per day up to 3 weeks) for hepatic amebiosis
3.Emetine hydrochloride 1mg pere kg per day by intramuscular injections for 5 days in acute amebic dysenery
4.tetracycline 250mg four times a day for 10 days my be needed for some with invasive intestinal disease.
5.Diloxanide furoate 500mg three a day for 10 days for asymptomatic amebic cyst carrier
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to harden the stools such as kaolin
4.slow down the intestinal movement (lomotil or loperamide).
Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
Get plenty of rest.
How is Amoebiasis prevented?
----------------------------------------
Prevention of Amoebiasis can be by:
1.boil drinking and cooking water for 5 minutes
2.Proper filtration of water
3.Examination of stools of food handlers
4.Avoid eating or drinking foods or liquids that might be contaminated especially by flies
5.Good food hygience and hand washing
What is the prognosis of Amoebiasis?
------------------------------------------------
Prognosis depends on the stage of disease
It is excellent with prompt treatment of amebic infection.
Luminal disease or dysentery usually respond well to treatment.
In refractory cases chloroquine may be added to metronidazole.
Surgery is rarely necessary.
------------------------------------------
What is Amoebiasis?
---------------------------
Amoebiasis is an acute infectious illness caused by the parasite Entoamoeba histolytica.
What is the cause of Amoebiasis?
----------------------------------
The bacteria which causes Amoebiasis is the Entmoeba histytica which is an extremely hardy parasite able to live in polluted water, contaminated food and soiled clothes.
Amebic infections occur most common in the cacum and rectosigmoid region of the colon.
Initial infections are small ulcers, usually discrete erosions whhich may extend more deeply ,coalescing to form bigger lesions resulting in extensive mucosal loss.
Penetration through the muscle lining may occur causing peritonitis.
Liver involvement may occur with the ameba traveling through the portal vein.
Liver abscesses consists of necrotic liver tissue.
Secondary bacterial infection are rare.
Most liver abscesses are solitary, rarely multiple and occur long after clinically evident bowel ulceration.
Single and multiple liver abscesses may occur shortly after a bout of amebic dysentry.
Abscesses of the brain and lung may occur.
Ulcers heal rapidly after treatment and permanent scarring is rare.
What are symptoms of Amoebiasis?
----------------------------------------------
The main symptoms of Amoebiasis are
1. Many people with E.histolytica in stools are passive carrier
2. Invasive bowel disease begins 1-6 months after infection sometimes later
3. abdominal pain especially at the sides
4. altered bowel habit
5.diarrhea with blood or mucus in stools
6.foul stools
7.adominal bloating or gas
8.tenderness on palpation at caecum or sigmoid colon regions
Severe cases may have:
1.more severe symptoms as above
2.bloody stools
3.fever
4.weight loss
5.liver enlargement and tenderness on palpation
6.dehydration and its effects such as delirium and disorientation
7. lassitude and tiredness
8. convulsions
9.tender abdominal mass with obstruction
How is the diagnosis of Amoebiasis made?
-----------------------------------------------------
Doctors generally diagnose Amoebiasis based on:
1. stool cultures.
2.blood tests
3.colonoscopy
4.liver scan and ultrasound
What are the complications of Amoebiasis?
-------------------------------------------------------
Amoebiasis is a disease which can kill espcially through its complications:
1.Perforation of bowel leading to peritonitis or inta-abdominal abscesses
2.Severe hemorrhage uncommon but can cause death
3.Intussusception or insertion of part of colon into another part of colon is rare but can follow amebic ulceration and may cause intestinal obstruction
4.irritable bowel syndrome may persist for some months
5.Lung and pericardial involvement rare but can pose danger
6. cutaneous amebiasis cause deep painful and rapidly spreading ulceration
7.Liver infection can cause damage to liver and result in cirrhosis
8.Liver abscess may perforate and cause peritonitis or produce lung abscess or amebic pericarditis
9.Amebic brain abscess are rare but can occur.
How is Amoebiasis treated?
-------------------------------------
Amoebiasis is an infectious disease which can spread to other people through contaminated food and water.
1.Anti-parasitic medicines like metronidazole 750mg three times a day for 10 days should work for mild to moderate disease.
2.Metronidazole 750mg three times a day for 10 days and chloroquine or diiodohydroquin (1000mg for 2 days followed by 500mg per day up to 3 weeks) for hepatic amebiosis
3.Emetine hydrochloride 1mg pere kg per day by intramuscular injections for 5 days in acute amebic dysenery
4.tetracycline 250mg four times a day for 10 days my be needed for some with invasive intestinal disease.
5.Diloxanide furoate 500mg three a day for 10 days for asymptomatic amebic cyst carrier
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to harden the stools such as kaolin
4.slow down the intestinal movement (lomotil or loperamide).
Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
Get plenty of rest.
How is Amoebiasis prevented?
----------------------------------------
Prevention of Amoebiasis can be by:
1.boil drinking and cooking water for 5 minutes
2.Proper filtration of water
3.Examination of stools of food handlers
4.Avoid eating or drinking foods or liquids that might be contaminated especially by flies
5.Good food hygience and hand washing
What is the prognosis of Amoebiasis?
------------------------------------------------
Prognosis depends on the stage of disease
It is excellent with prompt treatment of amebic infection.
Luminal disease or dysentery usually respond well to treatment.
In refractory cases chloroquine may be added to metronidazole.
Surgery is rarely necessary.
Wednesday, February 23, 2011
A Simple guide to Reye's Syndrome
A Simple Guide to Reye's Syndrome
--------------------------------------------------
What is Reye's Syndrome?
-----------------------
Reye's Syndrome is an acute hepatitis and metabolic encephalopathy occurring in children.
1.Liver usually shows microvesicular fatty infiltration
2. The brain shows cerebral edema with herniation
Causes are not completely known but:
1.Aspirin and salicylate has been suspected as an aggravating cause
2.A number of fatty acids has been postulated as toxic agents
What are the Signs and Symptoms of Reye's Syndrome
----------------------------------------------------------------------
Symptoms:
1.mild prodromal illness like influenza
Mild cases occur without progression to coma.
2.acute onset with:
a.vomiting
b.delirium
c.lethargy
d.stupor
e.coma within 24-48 hours
Signs:
1.Liver enzymes markedly elevated with normal alkaline phosphatase
2.Increased serum ammonia
3.Raised prothrombin time
4.Low blood glucose especially in younger children
5.Intracranial pressure markedly increased
6.Cerebrospinal fluid normal except for increased protein.
7.Respiratory alkalosis with metabolic alkalosis may occur
Clinical progression with marked cerebral edema occurs with improving liver function.
Outcome depends on reversibility and control of intracranial hypertension
Worse case scenerio will be rapid progression to coma and death.
What are the complications of Reye's Syndrome?
---------------------------------------------
The complications are:
1.liver damage
2.brain damage
What is the Treatment of Reye's Syndrome?
--------------------------------------------
Treatment is urgent:
1.Hospitalization with intensive care management
2.Respiratory support
3.Intravenous fluid and glucose to maintain blood glucose
4.Immediate treatment of intracranial pressure important
5.In coma cases, intracranial pressure monitoring with treatment of pressure over 30mm mercury with mannitol, hyper ventilation and removal of CSF if necessary through spinal tap
6. No protein given by mouth because of liver condition
7.Vitamin K as well as fresh blood platelets transfusion to control coagulation problems
Other treatments include:
1.exchange blood transfusion
2.dialysis
3.plasmapheresis
4.Glucose plus insulin
5.citrulline
Prognosis:
Mortality is 50% if inital ammonia is more than 300micrograms per dl and coma present on admission
Outcome depends on management of intra cranial pressure
Subclinal cases are more common than previously thought
--------------------------------------------------
What is Reye's Syndrome?
-----------------------
Reye's Syndrome is an acute hepatitis and metabolic encephalopathy occurring in children.
1.Liver usually shows microvesicular fatty infiltration
2. The brain shows cerebral edema with herniation
Causes are not completely known but:
1.Aspirin and salicylate has been suspected as an aggravating cause
2.A number of fatty acids has been postulated as toxic agents
What are the Signs and Symptoms of Reye's Syndrome
----------------------------------------------------------------------
Symptoms:
1.mild prodromal illness like influenza
Mild cases occur without progression to coma.
2.acute onset with:
a.vomiting
b.delirium
c.lethargy
d.stupor
e.coma within 24-48 hours
Signs:
1.Liver enzymes markedly elevated with normal alkaline phosphatase
2.Increased serum ammonia
3.Raised prothrombin time
4.Low blood glucose especially in younger children
5.Intracranial pressure markedly increased
6.Cerebrospinal fluid normal except for increased protein.
7.Respiratory alkalosis with metabolic alkalosis may occur
Clinical progression with marked cerebral edema occurs with improving liver function.
Outcome depends on reversibility and control of intracranial hypertension
Worse case scenerio will be rapid progression to coma and death.
What are the complications of Reye's Syndrome?
---------------------------------------------
The complications are:
1.liver damage
2.brain damage
What is the Treatment of Reye's Syndrome?
--------------------------------------------
Treatment is urgent:
1.Hospitalization with intensive care management
2.Respiratory support
3.Intravenous fluid and glucose to maintain blood glucose
4.Immediate treatment of intracranial pressure important
5.In coma cases, intracranial pressure monitoring with treatment of pressure over 30mm mercury with mannitol, hyper ventilation and removal of CSF if necessary through spinal tap
6. No protein given by mouth because of liver condition
7.Vitamin K as well as fresh blood platelets transfusion to control coagulation problems
Other treatments include:
1.exchange blood transfusion
2.dialysis
3.plasmapheresis
4.Glucose plus insulin
5.citrulline
Prognosis:
Mortality is 50% if inital ammonia is more than 300micrograms per dl and coma present on admission
Outcome depends on management of intra cranial pressure
Subclinal cases are more common than previously thought
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