A Family Doctor's Tale - HALLUX VALGUS

DOC I HAVE HALLUX VALGUS

HALLUX VALGUS also known as BUNION deformity is the deformity of the big toe metatarsopharyngeal(MTP) joint in whivh there is medial protrusion and lateral deviation of the great toe.

Shoewear does not cause hallux valgus.

HALLUX VALGUS occur as a result of :
1.heredity

2.flat foot (pes planus)

3.metatarsal primus varus

4.hypermobile first metarsal cuneiform joints

5.abnormal length of first metatarsal

6.joint laxity

Symptoms:
The onset is usually gradual with a wide spectrum of manifestations from simple deviation to severe deviation and deformity.

1.Normal intermetatarsal angle (the angle between the first and second metatarsals is 9 degrees or less.

2.the normal first MTP joint angle is less than 15 degrees.
Any increase of 15 degrees angle is considered as lateral deviation of the first metatarsopharygeal joint.

3.The big toe is turned inwards towards the second causing a medial protrusion of the MTP joint called a bunion.

4.in severe cases the first toe can overlap the second toe or the second toe may cover the inturned big toe.

5.there is pain on walking

6.there is difficulty in wearing shoes

Treatment:
Conservative:
1.In mild cases no treatment is required

2.Shoe wear modifications to increase the width of the toe box will relieve pressure of the MTP joint and help in walking.

3.Pads and splints may also help to relieve symptoms.

Surgery:
The main purpose is to restore the normal anatomical relation of the big toe MTP joint.
1.Osteotomy to realign the first metatarsal

2.Fusion of MTP joint

Prognosis:
90 per cent of patients will have good results after surgery

Conservative treatment can relieve the pain on walking but the deviation may still become worse.

A Family Doctor's Tale - TACHYCARDIA

DOC I HAVE TACHYCARDIA


Tachycardia is a symptom defined as heart rate above 100 per minute.

Causes of Tachycardia:

1.Abnormality of the sinus or atrial node in the heart may be continuous or paroxymal in nature

2.Abnormalities of the ventricular conducting system: a.ischemic heart disease b.congenital heart disease

3.Underlying systemic disease:

a.fever

b.anemia

c.thyrotoxicosis

4.Medicines:

a.ephedrine or pseudoephedrine

b.asthmatic drugs like ventolin or bricanyl

c.anticholinergic drugs like atropine, buscopan

5.Psychosomatic like anxiety, emotional upsets, panic attacks

Symptoms:

.palpitations

2.breathlessness

3.fainting

4.polyuria

Signs:

1.heart beat above 100 per minute

2.abnormal heart rhythm

3.ECG will determine

a.location of stimulus of fast heart beat

b.abnormal rhythm -flutter or fibrillation

Treatment of Tachycardia is:


1. Atrial tachycardia can be slowed by carotid sinus massage or Valsalva maneuver

2. Paroxysmal atrial Tachycardia can be terminated by vagal stimulation maneuvers (Valsalva or carotid sinus pressure).

3.Acute atrial attacks if not improved after vagal massage can be treated with: a.digoxin

b.beta blockers such as propanolol or atenolol

c.calcium channel blockers like nefidipine

d.anti-cholinesterase like edrophonium

e.alpha blockers

4.Persistent atrial tachycardia can be treated with a.quinidine, b.beta blockers or c.digoxin or dilatrend

5.Ventricular tachycardia is more dangerous usually associated with coronary heart disease or infarction may be treated with:

a.lidocaine 1-2mg per kg stat followed by infusion of 2-4 mg per kg per min

b.Electo-cardioversion

c.radiofrequency ablation

6. Treat underlying conditions such as thyrotoxicosis

7. No smoking, alcohol or caffiene intake

8.No strenuous exertion or stress

Prognosis:

1.atrial tachycardia may occur in normal young adults and may not indicate heart disease

2.Ventricular tachycardia may herald more serious illness such as life threatening arrthythmia or infarction

A Family Doctor's Tale -BRADYCARDIA

DOC I HAVE BRADYCARDIA

Bradycardia is a symptom defined as heart rate below 55 per minute.

Causes of Bradycardia:
1.Bradycardia can occur normally in athletes as a result of training through increased cardiac vagal tone.

2.Abnormalities of the heart conducting system:
a.complete heart block

b.ischemic heart disease

c.congeital heart disease

3.Underlying systemic disease:
a.myxedema

b.increased intracranial disease

4.Medicines:
a.Beta blockers

b.digoxin overdosage

c.reserpine

Symptoms:
1.slow pulse at wrist

2.confirmation with ECG

3.fainting

4.asymptomatic in many cases

Treatment of bradycardia:
1. None if no symptoms and no underlying cause

2. Cardiac bradycardia from heart block may be treated with atropine

3.Sympathommetics such as isoproterenol may be given as temporary measure before treatment of underlying conditions or insertion of pacemaker

4. Treat underlying conditions such as myxedema

5. heart blocks or asystole may need pacemaker implantation

Prognosis:
1.depends on underlying cause -myxedema is less serious than intracranial pressure

2.Patient receiving pacemakers often have an excellent long term survival

A Family Doctor's Tale - CHILD SCHOOL PROBLEMS

DOC WHY DOES MY CHILD DOES NOT DO WELL IN SCHOOL?

This is an article written by my daughter Carolyn Kee who is the senior Child Psychologist at the Child Guidance Clinic in the Singapore Medical News recently.

She has been working with children and adolescents who feel anxious, depressed or troubled.

She has been with the Child Guidance Clinic for the past 15 years.

Her work includes psychological assessment, individual and group therapy, school consultation, emergency behavior management, as well as conducting talks and workshops on mental health issues.

She has written books and contributed articles on depression,
stress and other mental health conditions.

Her illustrated children’s books on attention deficit hyperactivity disorder (ADHD) and eating disorder (Anorexia Nervosa) are currently being sold at the CGC and other helping agencies.

Although I have written posts on ADHD, anorexia nervosa, autism, dyslexia, depression, anxiety and stress, nothing beats the hands on approach and experience of these dedicated psychologists and psychiatrists at the Child Guidance Clinic in Singapore.

Here is the url to her article:

http://news.sma.org.sg/4302/Child.pdf