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
Monday, March 14, 2011
Saturday, March 12, 2011
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
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
Thursday, March 10, 2011
A Simple Guide to Threadworms
A Simple Guide to Threadworms
---------------------------------
What is Threadworms?
---------------------------
Threadworms are parasitic worms (also called pinworms) which are found in the intestines of children in undeveloped countries.
It is rare in developed countries because of the modern sanitary conditions and better hygiene.
Several members of the same household may be infested at the same time so all the family should be treated together.
What is the cause of Threadworms infection?
------------------------------------------
Threadworms eggs or larva are present on the hands or food prepared by people who has threadworms infestations. When the eggs or larvae are swallowed they developed into adult worms in the intestines. The adult worms will cling on to the mucosal lining of the intestine and absorb nutrients from the food taken into the intestines by the affected person.
The female worms emerge from the rectum at night to lay their eggs on the skin around the anus.
What are symptoms of Threadworms?
----------------------------------------------
The main symptoms of Threadworms are
1. Itch in the anal region especialy at night when the worms lay the eggs.
2. Itch in the vulva in girls
3. inflammation of the anus as a result of constant scratching.
4.Rarely tiny white worms can be seen wriggling in the feces.
How is the diagnosis of Threadworms made?
-----------------------------------------------------
Doctors generally diagnose Threadworms based on:
1.sticky tape pressed to the anal area in the morning before the patient bathes or go to the toilet will collect the eggs for microscopic examination and confirmation of the presence of threadworms
2.Stool examination and culture
Treatment of threadworm infestation is by the use of anti-parasitic medicine:
1.Zentel or Abendazole 400mg in a single dose
2.Pyrantel pamoate 10mg/kg in a single dose
3.Mebendazole 100mg in a single dose
A single dose will usually cure the patient of threadworms but to prevent re-infection a second dosage is taken 2 weeks later.
All the family members should also be treated.
Prevention is through:
1.good personal hygiene and hand washing
2. good food hygiene
What is the prognosis of Threadworms?
-------------------------------------
Prognosis is excellent with treatment.
---------------------------------
What is Threadworms?
---------------------------
Threadworms are parasitic worms (also called pinworms) which are found in the intestines of children in undeveloped countries.
It is rare in developed countries because of the modern sanitary conditions and better hygiene.
Several members of the same household may be infested at the same time so all the family should be treated together.
What is the cause of Threadworms infection?
------------------------------------------
Threadworms eggs or larva are present on the hands or food prepared by people who has threadworms infestations. When the eggs or larvae are swallowed they developed into adult worms in the intestines. The adult worms will cling on to the mucosal lining of the intestine and absorb nutrients from the food taken into the intestines by the affected person.
The female worms emerge from the rectum at night to lay their eggs on the skin around the anus.
What are symptoms of Threadworms?
----------------------------------------------
The main symptoms of Threadworms are
1. Itch in the anal region especialy at night when the worms lay the eggs.
2. Itch in the vulva in girls
3. inflammation of the anus as a result of constant scratching.
4.Rarely tiny white worms can be seen wriggling in the feces.
How is the diagnosis of Threadworms made?
-----------------------------------------------------
Doctors generally diagnose Threadworms based on:
1.sticky tape pressed to the anal area in the morning before the patient bathes or go to the toilet will collect the eggs for microscopic examination and confirmation of the presence of threadworms
2.Stool examination and culture
Treatment of threadworm infestation is by the use of anti-parasitic medicine:
1.Zentel or Abendazole 400mg in a single dose
2.Pyrantel pamoate 10mg/kg in a single dose
3.Mebendazole 100mg in a single dose
A single dose will usually cure the patient of threadworms but to prevent re-infection a second dosage is taken 2 weeks later.
All the family members should also be treated.
Prevention is through:
1.good personal hygiene and hand washing
2. good food hygiene
What is the prognosis of Threadworms?
-------------------------------------
Prognosis is excellent with treatment.
A Family Doctor's Tale -ECU tendonitis
DOC I HAVE EXTENSOR CARPI ULNARIS TENDONITIS
EXTENSOR CARPI ULNARIS TENDONITIS OR ECU is the inflammation of the tendon sheath of the tendon to the small finger at wrist region.
EXTENSOR CARPI ULNARIS TENDONITIS occur occur as a result of narrowing of the tendon sheath of the thumb and the inflammation of the tendon at the level of the wrist.
When the tendon gets caught in the narrowed sheath, the finger becomes locked in the narrowed tendon sheath resulting in pain and swelling.
Women are affected more than men.
Local causes:
-------------
1.trauma of the tendon of the small finger from repetitive weight bearing of the wrist
2.direct injury on the tendon of the wrist from a direct blow to the hand
3.repetitive use of the wrist on keyboard of computer
4.tenosynovitis(inflammation of the tendon and their synovial sheath)as the tendon becomes swollen in the tendon shift as a result of overusage of the wrist
5.common among young and active especially those who play racket sports and basketball
Symptoms:
The onset is usually spontaneous with gradual increasing pains and tightness of the wrist tendons which causes the patient to seek treatment:
1.swelling and pain of the back of the wrist near the small finger side (opposite De Quarvian's Disease)
2.unable to move wrist or carry heavy objects
Physical examination
1.tendon nodules in flexor tendon of the small finger at wrist level
2.tenderness on flexion of the wrist
2.diagnosis is confirmed with CAT scan or MRI
Treatment:
1.Rest and splinting of affected finger and wrist
2.wrist exercise usually good.
3.Non-steroidal anti-inflammatory drugs for inflammation and pain
4.Corticosteroid injection to reduce inflammation under the narrowed sheath
5.Surgery as last resort to release the tendon by cutting the top part of the narrowed inflammed sheath
Complication:
If left untreated. it can lead to the permanent loss of rotation of the wrist
Prognosis :
1.usually good with injection of corticosteroid
2.recurrence may occur after injection in which case surgery should be done
Prevention:
1.Avoid forceful use of the wrist and small finger
2.Avoid repetitive movement of the wrist.
EXTENSOR CARPI ULNARIS TENDONITIS OR ECU is the inflammation of the tendon sheath of the tendon to the small finger at wrist region.
EXTENSOR CARPI ULNARIS TENDONITIS occur occur as a result of narrowing of the tendon sheath of the thumb and the inflammation of the tendon at the level of the wrist.
When the tendon gets caught in the narrowed sheath, the finger becomes locked in the narrowed tendon sheath resulting in pain and swelling.
Women are affected more than men.
Local causes:
-------------
1.trauma of the tendon of the small finger from repetitive weight bearing of the wrist
2.direct injury on the tendon of the wrist from a direct blow to the hand
3.repetitive use of the wrist on keyboard of computer
4.tenosynovitis(inflammation of the tendon and their synovial sheath)as the tendon becomes swollen in the tendon shift as a result of overusage of the wrist
5.common among young and active especially those who play racket sports and basketball
Symptoms:
The onset is usually spontaneous with gradual increasing pains and tightness of the wrist tendons which causes the patient to seek treatment:
1.swelling and pain of the back of the wrist near the small finger side (opposite De Quarvian's Disease)
2.unable to move wrist or carry heavy objects
Physical examination
1.tendon nodules in flexor tendon of the small finger at wrist level
2.tenderness on flexion of the wrist
2.diagnosis is confirmed with CAT scan or MRI
Treatment:
1.Rest and splinting of affected finger and wrist
2.wrist exercise usually good.
3.Non-steroidal anti-inflammatory drugs for inflammation and pain
4.Corticosteroid injection to reduce inflammation under the narrowed sheath
5.Surgery as last resort to release the tendon by cutting the top part of the narrowed inflammed sheath
Complication:
If left untreated. it can lead to the permanent loss of rotation of the wrist
Prognosis :
1.usually good with injection of corticosteroid
2.recurrence may occur after injection in which case surgery should be done
Prevention:
1.Avoid forceful use of the wrist and small finger
2.Avoid repetitive movement of the wrist.
Tuesday, March 8, 2011
A Family Doctor's Tale - DE QUARVIAN'S DISEASE
DOC I HAVE DE QUERVAIN'S DISEASE
DE QUERVAIN'S DISEASE is the compression of the tendon sheath of one of the two tendons to the thumb at wrist region.
The tendon sheath is a protective cover for the tendon which provides protection for the tendon as it travels across the radius bone especially at the joints.
DE QUERVAIN'S DISEASE occur as a result of narrowing of the tendon sheath of the thumb and the inflammation of the tendon at the level of the wrist.
When the tendon gets caught in the narrowed sheath, the finger becomes locked in the narrowed tendon sheath resulting in pain and swelling
Women are affected more than men.
It is also known as the washer woman's sprain or recently Blackberry thumb after the name of the popular smart phone because of repetitive movement of the thumb on the keys of the phone.
Causes of De Quarvian's Disease:
1.trauma of the tendon sheath of the thumb from too much stress on their thumb from carrying their newborn child especially first time parents
2.pressure on the tendon sheath from weight of the newborn's head on the wrist while feeding the baby
3.repetitive use of the thumb on keyboard of Blackberry phone
4.tenosynovitis (inflammation of the tendon and their synovial sheath) as the tendon becomes swollen in the tendon shift as a result of over usage of the wrist especially when wringing clothes
5.common among middle-aged, housewives and those who often use their thumbs or wrists
Symptoms:
The onset is usually spontaneous with gradual increasing pains and tightness of the wrist tendons which causes the patient to seek treatment:
1.swelling and pain of the thumb side of the wrist
2.unable to open door, bottle caps or wring clothes
Physical examination
1.tendon nodules in flexor tendon of the thumb at wrist level
2.tenderness on flexion of the thumb
3.diagnosis is confirmed with CAT scan or MRI
Treatment of De Quarvian's Disease:
1.Rest and splinting of affected thumb and wrist
2.wrist exercise usually good.
3.Non-steroidal anti-inflammatory drugs for inflammation and pain
4.Corticosteroid injection to reduce inflammation under the narrowed sheath
5.Surgery as last resort to release the tendon by cutting the top part of the narrowed inflamed sheath
Complication of De Quarvian's Disease:
If left untreated. it can lead to the permanent loss of the thumb
Prognosis of De Quarvian's Disease:
1.usually good with injection of corticosteroid
2.recurrence may occur after injection in which case surgery should be done
Prevention of De Quarvian's Disease:
1.Avoid forceful use of the wrist and thumb
2.Avoid carrying newborn baby with head on the wrist
3.Avoid repetitive movement of the thumb.
DE QUERVAIN'S DISEASE is the compression of the tendon sheath of one of the two tendons to the thumb at wrist region.
The tendon sheath is a protective cover for the tendon which provides protection for the tendon as it travels across the radius bone especially at the joints.
DE QUERVAIN'S DISEASE occur as a result of narrowing of the tendon sheath of the thumb and the inflammation of the tendon at the level of the wrist.
When the tendon gets caught in the narrowed sheath, the finger becomes locked in the narrowed tendon sheath resulting in pain and swelling
Women are affected more than men.
It is also known as the washer woman's sprain or recently Blackberry thumb after the name of the popular smart phone because of repetitive movement of the thumb on the keys of the phone.
Causes of De Quarvian's Disease:
1.trauma of the tendon sheath of the thumb from too much stress on their thumb from carrying their newborn child especially first time parents
2.pressure on the tendon sheath from weight of the newborn's head on the wrist while feeding the baby
3.repetitive use of the thumb on keyboard of Blackberry phone
4.tenosynovitis (inflammation of the tendon and their synovial sheath) as the tendon becomes swollen in the tendon shift as a result of over usage of the wrist especially when wringing clothes
5.common among middle-aged, housewives and those who often use their thumbs or wrists
Symptoms:
The onset is usually spontaneous with gradual increasing pains and tightness of the wrist tendons which causes the patient to seek treatment:
1.swelling and pain of the thumb side of the wrist
2.unable to open door, bottle caps or wring clothes
Physical examination
1.tendon nodules in flexor tendon of the thumb at wrist level
2.tenderness on flexion of the thumb
3.diagnosis is confirmed with CAT scan or MRI
Treatment of De Quarvian's Disease:
1.Rest and splinting of affected thumb and wrist
2.wrist exercise usually good.
3.Non-steroidal anti-inflammatory drugs for inflammation and pain
4.Corticosteroid injection to reduce inflammation under the narrowed sheath
5.Surgery as last resort to release the tendon by cutting the top part of the narrowed inflamed sheath
Complication of De Quarvian's Disease:
If left untreated. it can lead to the permanent loss of the thumb
Prognosis of De Quarvian's Disease:
1.usually good with injection of corticosteroid
2.recurrence may occur after injection in which case surgery should be done
Prevention of De Quarvian's Disease:
1.Avoid forceful use of the wrist and thumb
2.Avoid carrying newborn baby with head on the wrist
3.Avoid repetitive movement of the thumb.
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