DOC I HAVE GOITER
Goiter is the abnormal diffuse enlargement of the thyroid gland.
People who are at risk of Goiter are:
1.Goiter are more common in females than in male.
2.Goiter occurs in all edge groups but is more common in the 30- 60 age group.
3.Goiter may be endemic in areas of deficient iodine intake.
The causes of Goiter are:
1.Toxic goiter caused by hyperthyroidism usually diffuse with signs of hyperthyroidism
2.Autoimmune bacterial or viral thyroiditis(Hashimoto's disease) also presents with smooth diffuse goiter.
3.Benign tumors of the thyroid such as adenoma, cyst may presents more of nodular form of goiter.
4.Malignant tumors of the thyroid may be nodular or diffuse
5.Inherited disorders of thyroid gland metabolism may also manifest as goiter
6.Nontoxic or simple goiter is common in those people deficient in iodine intake.
7.Some goiters are caused by ingestion of goiter stimulating agents or medicines such as thyroxine
The symptoms and signs of Goiter are:
Symptoms:
1.Obvious swelling in the thyroid gland present for some time
2.Painful swelling are suggestive of bacterial or viral infection-
3.Hoarseness of voice may occur if there is pressure on the vocal cord or recurrent nerve to vocal cord
4.Dyspnea or breathlessness if there is pressure on the trachea
5.Dysphagia or difficuly in swallowing due to pressure on the oesophagus
Signs:
1.Goiter or swelling of thyroid may be smooth, diffuse or nodular.
The swelling moves on swallowing.
2.Cystic nodules may feel hard while solid nodules may be soft to firm.
3.Thyroid hormones may be normal, increased or decreased
4.Neck lymph nodes are enlarged
The diagnosis of Goiter is made using:
1.blood test for thyroid hormones(T$ and T3), TSH levels and thyroid stimulating immunoglobulins
2.fine needle aspiration biopsy is a simple way to determine if a nodule is benign or malignant.
3.ultrasound scans are done to differentiate between solid, diffuse and cystic nodules,
4.thyroid scans which help to show if a nodule is producing excessive thyroid hormone(hot) or not.
5.CT Scan or MRI are not routine to Goiter investigation except where there is suspected compression of teachea.
The Treatment of Goiter is:
Benign lumps can be monitored by doctors at regular intervals.
If there are symptoms of compressing a neighbouring organ or the nodule is cancerous, surgery is required.
Patients who has symptoms of hyperthyroidism are advised to go for medical treatment with carbimazole, radioactive iodine treatment or surgery.
Beta blockers are given in hyperthyroid cases where the heart beat is very fast.
Iodine deficient goiter patients may require iodine supplements.
Goiter due to Hashimoto disease or simple nontoxic goiter may become smaller with thyroxine treatment.
Prognosis of Goiter is good in all benign cases.
Malignant Goiter are slow growing and have good prognosis.
The prognosis of the more serious carcinoma will depend on any spread to other organs.
Hyperthyroid patients recovers after 2 years of anti-thyroid medications and 30 per cent remains in remission after withdrawal of anti-thyroid medications
Thursday, July 14, 2011
Tuesday, July 12, 2011
A Family Doctor's Tale - EAR CANAL POLYPS
DOC I HAVE EAR CANAL POLYPS
Ear canal polyps or aural polyps are benign swellings that grow from the skin or glands of the external ear canal or from the lining of the ear drum.
Ear canal polyps occurs as a result of chronic irritation of the skin of the ear canal or eardrum usually from infections of the external ear canal.
The symptoms and signs of ear canal polyps are:
Symptoms:
1.pain in the ear
2.Itchiness
3.ear discharge
4.loss of hearing
Signs:
1.Presence of polyps in the ear canal
2.Infection in the ear canal
Diagnosis or ear canal polyps:
1.Otoscopy usually show the presence of pedunculated soft fleshy swellings in the ear canal
2.Infection may be present in ear canal with pus and debris
3.MRI or CAT SCAN may be done to exclude the presence of cholesteatoma (also a chronic infected ear cyst in the middle ear or inner ear) which can damage the bone in the inner ear and spread to the brain causing infection.
4.Ear canal polyp biopsy to exclude malignancy
The complications of ear canal polyps are:
1.Rarely Ear canal polyps may become malignant
2.In diabetes or immune deficient patients severe infections called malignant otitis externs may spread to the mastoid and spread to the brain causing brain abscess, facial paralysis, deafness, meningitis, and osteomyelitis of the base of the
skull
Treatment of ear canal polyps is by:
1.Topical steroid cream and antibiotic ear drops
2.For chronic or repeat infections, steroid creams and white table vinegar (5% acetic acid) usually help to dissolve the polyps
3.Antifungal drops and creams are used for fungal infection.
4.Surgery of ear tubes may be necessay for ear canal Polyps developing from ear tubes if eardrop treatment is not effective.
5.Cholesteatoma-generated polyps may require drops and oral antibiotics
Some side effects of the medications used are:
1.allergic reaction
2.severe itching,
3.blistering,
4.redness,
5.thickening of the ear canal skin.
These medicines must be stopped if any of these symptoms develop.
Surgical removal of ear canal polyps may have pain and bleeding as side effects.
Prognosis of Ear canal polyp is:
In most cases, the infection and the ear canal polyp should resolve with treatment
Recurrence of the ear infection is common.
Reappearance of symptoms of ear discharge, hearing loss, bleeding, and itching may indicate the underlying infection has recurred.
In these cases, maintenance steroid drops, vinegar irrigations, or antifungal agents may be needed.
Ear canal polyps or aural polyps are benign swellings that grow from the skin or glands of the external ear canal or from the lining of the ear drum.
Ear canal polyps occurs as a result of chronic irritation of the skin of the ear canal or eardrum usually from infections of the external ear canal.
The symptoms and signs of ear canal polyps are:
Symptoms:
1.pain in the ear
2.Itchiness
3.ear discharge
4.loss of hearing
Signs:
1.Presence of polyps in the ear canal
2.Infection in the ear canal
Diagnosis or ear canal polyps:
1.Otoscopy usually show the presence of pedunculated soft fleshy swellings in the ear canal
2.Infection may be present in ear canal with pus and debris
3.MRI or CAT SCAN may be done to exclude the presence of cholesteatoma (also a chronic infected ear cyst in the middle ear or inner ear) which can damage the bone in the inner ear and spread to the brain causing infection.
4.Ear canal polyp biopsy to exclude malignancy
The complications of ear canal polyps are:
1.Rarely Ear canal polyps may become malignant
2.In diabetes or immune deficient patients severe infections called malignant otitis externs may spread to the mastoid and spread to the brain causing brain abscess, facial paralysis, deafness, meningitis, and osteomyelitis of the base of the
skull
Treatment of ear canal polyps is by:
1.Topical steroid cream and antibiotic ear drops
2.For chronic or repeat infections, steroid creams and white table vinegar (5% acetic acid) usually help to dissolve the polyps
3.Antifungal drops and creams are used for fungal infection.
4.Surgery of ear tubes may be necessay for ear canal Polyps developing from ear tubes if eardrop treatment is not effective.
5.Cholesteatoma-generated polyps may require drops and oral antibiotics
Some side effects of the medications used are:
1.allergic reaction
2.severe itching,
3.blistering,
4.redness,
5.thickening of the ear canal skin.
These medicines must be stopped if any of these symptoms develop.
Surgical removal of ear canal polyps may have pain and bleeding as side effects.
Prognosis of Ear canal polyp is:
In most cases, the infection and the ear canal polyp should resolve with treatment
Recurrence of the ear infection is common.
Reappearance of symptoms of ear discharge, hearing loss, bleeding, and itching may indicate the underlying infection has recurred.
In these cases, maintenance steroid drops, vinegar irrigations, or antifungal agents may be needed.
Sunday, July 10, 2011
A Family Doctor's Tale -DEMENTIA
DOC I HAVE DEMENTIA
Dementia is a disease in which brain tissue degenerates to the extent of loss of memory and other intellectual abilities serious enough to interfere with daily life.
In Dementia there is a severe and progressive decline in mental function.
It affects a person's ability to:
1.think,remember and reason
2.learn new information and skills
3.solve problems and make judgement
The causes of Dementia are :
There are several different factors which may contribute to its development.
They can be divided into:
1.Irreversible conditions
a.Aging is one important risk factor.
Alzeimer's Disease
b.Stroke
c.Parkinson's disease
2.Reversible conditions
a.Hypothyroidism
b.Vitamin B12 deficiency
c.Alcohol dependence diseases
Irreversible Dementia cannot be cured but it may be possible to slow down the progression of the disease.
It may be possible treat the cognitive symptoms.
Potentially reversible dementia may be curable.
The Symptoms of Dementia are:
1.Memory loss or Forgetfulness is often one of the earliest symptoms (Patients may forget dates, names of common objects and familiar people)
2.Confusion(Disorientation in time and place) ,
3.Trouble with organizing
4.Misplacing things,
5.Difficulty in expressing thoughts,
6.Difficulty performing familiar tasks
7.Difficulty understanding others
8.Poor or decreased judgment
9.Wandering and getting lost in familiar places
10.Changes in mood and behaviour (They may become easily agitated or depressed)
a.Changes in personality
b.paranoia
c.hallucinations
d.agitation
e.anxiety
f.sleep problems
Dementia should be assessed and investigated.
Diagnosis can be based on :
1.History of depression, anxiety, hallucination, paranoia, agitation or sleep problems
2.Various tests may be done to exclude other conditions that may be causing the same problems:
a.blood sugar, thyroid hormone, vitamin B12 level
b.CT Scan or MRI of the brain to exclude tumors or stroke
The family doctor can refer the patient to a psychiatrist for further assessment if dementia is suspected.
The Management of Dementia is by:
Dementia is quite common in old people.
Referral to a psychiatrist may then be necessary for assessement and advice on management.
Management of dementia usually involve :
1.Treatment of reversible causes and risk factors:
a.treatment of any reversible causes such as hypothyroidism(thyroxine tabs), Vitamin B12 deficiency(injections of Vitamin B12 or B12 oral tablets)
b.reduction of risk facors for stroke such as diabetes, hypertension, high cholesterol
c.Use of blood thinning medicines such aspirin, plavix, ticlid, warfarin to prevent stroke
2.At the present moment there is no cure for non reversible Dementia but there are many ways to reduce the behavioural and psychological symptoms.
These including having
a.a fixed routine daily,
b.making the home and surroundings safe and familiar
c.using memory aids like diaries and calendars.
d.social interactions and contacts with other patients
e.activity programs
3.There are now drugs available to help delay or prevent symptoms from becoming worse:
a.One group of drugs helps improve the ability to think, understand, and remember.(Donepezil, Rivastigmine, Galantamine, Memantine) .
There may be improvement of the symptoms but ultimately they do not prevent the disease from getting worse.
b.Another group of drugs is also to help with behavioural problems associated with Dementia, such as aggressiveness, agitation, depression, and anxiety.(Prozac, Seroxat, Zoloft)
4.Caring for a patient with dementia can be frustrating and stressful.
It gets worse as the disease progresses.
There are now support groups and organisations which can help caregivers providing:.
a.education on dementia and caretaker skills
b.individual and family couseling
c.caretaker support groups
d.dementia day care service
Dementia is a disease in which brain tissue degenerates to the extent of loss of memory and other intellectual abilities serious enough to interfere with daily life.
In Dementia there is a severe and progressive decline in mental function.
It affects a person's ability to:
1.think,remember and reason
2.learn new information and skills
3.solve problems and make judgement
The causes of Dementia are :
There are several different factors which may contribute to its development.
They can be divided into:
1.Irreversible conditions
a.Aging is one important risk factor.
Alzeimer's Disease
b.Stroke
c.Parkinson's disease
2.Reversible conditions
a.Hypothyroidism
b.Vitamin B12 deficiency
c.Alcohol dependence diseases
Irreversible Dementia cannot be cured but it may be possible to slow down the progression of the disease.
It may be possible treat the cognitive symptoms.
Potentially reversible dementia may be curable.
The Symptoms of Dementia are:
1.Memory loss or Forgetfulness is often one of the earliest symptoms (Patients may forget dates, names of common objects and familiar people)
2.Confusion(Disorientation in time and place) ,
3.Trouble with organizing
4.Misplacing things,
5.Difficulty in expressing thoughts,
6.Difficulty performing familiar tasks
7.Difficulty understanding others
8.Poor or decreased judgment
9.Wandering and getting lost in familiar places
10.Changes in mood and behaviour (They may become easily agitated or depressed)
a.Changes in personality
b.paranoia
c.hallucinations
d.agitation
e.anxiety
f.sleep problems
Dementia should be assessed and investigated.
Diagnosis can be based on :
1.History of depression, anxiety, hallucination, paranoia, agitation or sleep problems
2.Various tests may be done to exclude other conditions that may be causing the same problems:
a.blood sugar, thyroid hormone, vitamin B12 level
b.CT Scan or MRI of the brain to exclude tumors or stroke
The family doctor can refer the patient to a psychiatrist for further assessment if dementia is suspected.
The Management of Dementia is by:
Dementia is quite common in old people.
Referral to a psychiatrist may then be necessary for assessement and advice on management.
Management of dementia usually involve :
1.Treatment of reversible causes and risk factors:
a.treatment of any reversible causes such as hypothyroidism(thyroxine tabs), Vitamin B12 deficiency(injections of Vitamin B12 or B12 oral tablets)
b.reduction of risk facors for stroke such as diabetes, hypertension, high cholesterol
c.Use of blood thinning medicines such aspirin, plavix, ticlid, warfarin to prevent stroke
2.At the present moment there is no cure for non reversible Dementia but there are many ways to reduce the behavioural and psychological symptoms.
These including having
a.a fixed routine daily,
b.making the home and surroundings safe and familiar
c.using memory aids like diaries and calendars.
d.social interactions and contacts with other patients
e.activity programs
3.There are now drugs available to help delay or prevent symptoms from becoming worse:
a.One group of drugs helps improve the ability to think, understand, and remember.(Donepezil, Rivastigmine, Galantamine, Memantine) .
There may be improvement of the symptoms but ultimately they do not prevent the disease from getting worse.
b.Another group of drugs is also to help with behavioural problems associated with Dementia, such as aggressiveness, agitation, depression, and anxiety.(Prozac, Seroxat, Zoloft)
4.Caring for a patient with dementia can be frustrating and stressful.
It gets worse as the disease progresses.
There are now support groups and organisations which can help caregivers providing:.
a.education on dementia and caretaker skills
b.individual and family couseling
c.caretaker support groups
d.dementia day care service
Friday, July 8, 2011
A Family Doctor's Tale - ROSEOLA INFANTUM
DOC I HAVE ROSEOLA INFANTUM
Roseola Infantum is usually a contagious childhood infection caused by the Roseola Infantum virus.
It is also known as "false measles" because of the appearance of its rashes which appear from the face and spread down to the legs and fever.
It is characterized by typical prodromal symptoms of fever, runny nose , cough, generalised rash and cervical lymphadenopathy
Any one at any age can contract Roseola Infantum but it usually occurs before the age of 2 years old because by that time most of the children has immunity to the virus.
Spread is usually by infected persons either from mucous discharges from their coughing and sneezing, or from contact with their skin rash,contaminated items and surfaces.
Usually a person is contagious for about two days before symptoms appear, and up to five days after appearance of the rash.
There is a prodromal peroid of 5 to 7 days after contact with a infected person.
Early symptoms include:
1.high fever
2.coughing,
3.runny nose, stuffy nose,
4.tiredness,
5.red eyes, tearing. ,
6.Roseola Infantum rash usually occurs after the onset of fever.
The rash is typically red,maculopapular, and starts from behind the ears and face, then spreads downward to the neck, trunk, limbs, palms and soles.
The rash begins to fade in about four days .
There may be a brownish discoloration in areas of affected skin rahes but this is only temporary.
7. enlarged lymph glands may be felt in the neck and groins
8.inflammation of the eyes (conjunctivitis) with tearing may also occurs.
9. diarrhoea and vomiting may occurs in some patients.
Children who have had Roseola Infantum develop a natural immunity and cannot contract it again.
Complications are rare and include:
1.Ear infection (Otitis Media) is a common complication of Roseola Infantum.
2.pneumonia in very young children may be dangerous.
3.encephalitis (brain infection)may occur in rare cases
There is no cure for Roseola Infantum.
Treatment is therefore symptomatic.
1.Fever symptoms are treated with acetaminophen (Paracetamol).
Children should not be given aspirin due to the risk of Reye's Syndrome which affects the brain
2.Itch may be controlled by antihistamines which can also help to relieve the runny nose.
3.Antibiotics may be given if there is superimposed secondary bacterial infection such as otitis emdia and pneumonia..
4.Cough mixtures may be given to relieve the cough.
5.Plenty of bed rest is necessary.
6.Lots of fluids helps to prevent dehydration.
Most patients recover completely from Roseola Infantum.
Roseola Infantum is usually a contagious childhood infection caused by the Roseola Infantum virus.
It is also known as "false measles" because of the appearance of its rashes which appear from the face and spread down to the legs and fever.
It is characterized by typical prodromal symptoms of fever, runny nose , cough, generalised rash and cervical lymphadenopathy
Any one at any age can contract Roseola Infantum but it usually occurs before the age of 2 years old because by that time most of the children has immunity to the virus.
Spread is usually by infected persons either from mucous discharges from their coughing and sneezing, or from contact with their skin rash,contaminated items and surfaces.
Usually a person is contagious for about two days before symptoms appear, and up to five days after appearance of the rash.
There is a prodromal peroid of 5 to 7 days after contact with a infected person.
Early symptoms include:
1.high fever
2.coughing,
3.runny nose, stuffy nose,
4.tiredness,
5.red eyes, tearing. ,
6.Roseola Infantum rash usually occurs after the onset of fever.
The rash is typically red,maculopapular, and starts from behind the ears and face, then spreads downward to the neck, trunk, limbs, palms and soles.
The rash begins to fade in about four days .
There may be a brownish discoloration in areas of affected skin rahes but this is only temporary.
7. enlarged lymph glands may be felt in the neck and groins
8.inflammation of the eyes (conjunctivitis) with tearing may also occurs.
9. diarrhoea and vomiting may occurs in some patients.
Children who have had Roseola Infantum develop a natural immunity and cannot contract it again.
Complications are rare and include:
1.Ear infection (Otitis Media) is a common complication of Roseola Infantum.
2.pneumonia in very young children may be dangerous.
3.encephalitis (brain infection)may occur in rare cases
There is no cure for Roseola Infantum.
Treatment is therefore symptomatic.
1.Fever symptoms are treated with acetaminophen (Paracetamol).
Children should not be given aspirin due to the risk of Reye's Syndrome which affects the brain
2.Itch may be controlled by antihistamines which can also help to relieve the runny nose.
3.Antibiotics may be given if there is superimposed secondary bacterial infection such as otitis emdia and pneumonia..
4.Cough mixtures may be given to relieve the cough.
5.Plenty of bed rest is necessary.
6.Lots of fluids helps to prevent dehydration.
Most patients recover completely from Roseola Infantum.
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