It is not always Piles or Fissures!
Posted by on Saturday, 23rd March 2013
A 19 yr boy studying in college came with complaints of constipation, bleeding & pain while defecating since 3 months. He had consulted many nearby family physicians. They told him that it was a piles problem and they had given him different types of oral laxatives and local ointments. However, unfortunately none of them had ever examined him. He was even advised piles surgery. He latter consulted an Ayurvedic doctor, who examined him & said that it was not piles but anal fissure. He carried out a minor surgery for same in his clinic. The patient has no relief and his bleeding & pain did not subside. Feeling frustrated at last he came to Bhaktivedanta hospital. Details of patient were noted & a proper rectal examination was performed. He had no piles or fissure. On examination it was found that he had a large tumor which would bleed on touching. The provisional clinical diagnosis was "Cancer of rectum" He was asked to undergo a Colonoscopy and CT scan. The diagnosis was confirmed. The patient was nicely counselled and was advised further treatment in the form of surgery.
Lesson: ALWAYS TAKE EXPERT OPINION FOR YOUR PROBLEMS. NEVER RELY ON G.P. FOR PROBLEMS PERSISTING BEYOND ONE WEEK OF TREATMENT.
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Blood vomiting – Almost died
Posted by on Friday, 22nd March 2013
A rare surgery for a rare disease
Sushma Bagwe came with severe blood vomiting and with feeble pulse and blood pressure. An emergency upper GI scopy was performed by me as the bleeding was profuse. With all the blood in stomach it was a tricky job. I noticed that she had a tumor growing in her stomach that was heavily bleeding. This tumor did not appear like a typical stomach cancer or a peptic ulcer. In order to stop the bleeding, using the endoscope I injected medication around the tumor That stopped the bleeding. Subsequently she was shifted back to ICU and was transfused four units of blood to restore her blood. I also took mulitple biopsies to know what was the nature of the tumor but to my dismay it did not indicate much. I repeated the biopsy again but that also was not conclusive. Subsequently CT scan was performed but even that was not conclusive of the nature of the tumor. I planned out the surgery for her. Instead of opening her abdomen with a large incision, I decided to give her the benefit of Minimally invasive surgery. I performed a total Laparoscopic partial stomach removal (Partial gastrectomy) using harmonic scalpel and endostaplers. This gave her the benefit of fast recovery, minimal post operative pain and almost invisible scar. The diagnosis of the tumour was leiomyoma – benign stomach tumor. Her condition was solved. Thus minimally invasive procedure that I used on this patient (endoscopy and laparoscopy) once again saved the life of a patient and cured her from her disease with minimal pain.
You can visit my site http://drbcshah.com/blood-vomiting-almost-died/ for more information and photos.
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Diarrhoea
Posted by on Saturday, 16th March 2013
Introduction
Diarrhoea is passing loose or watery faeces more than three times a day. It affects almost everyone from time to time and is usually nothing to worry about.
A common cause in both children and adults is gastroenteritis, an infection of the bowel. Gastroenteritis may be caused by:
A virus, such as a norovirus or rotavirus
Bacteria, which is often found in contaminated food
A parasite
Bouts of diarrhoea in adults may also be brought on by anxiety or drinking too much coffee or alcohol. Diarrhoea may also be a side effect of a medication.
Recovery
In adults, diarrhoea caused by gastroenteritis will usually clear up in two to four days when the infection has cleared.
Taking antidiarrhoeal medicine is usually not necessary unless it is important that you shorten the length of time your diarrhoea lasts (for example, if you need to take a long-haul flight). Children should not take this medicine.
Diarrhoea in children usually passes within five to seven days, and will usually clear within two weeks. Seek medical advice if your child has diarrhoea for longer than this.
When to see Dr. B C Shah
Diarrhoea in adults that lasts for more than a few weeks may be a sign of a more serious condition, such as Crohn's disease. It should be investigated Dr. B C Shah – especially if you have blood or pus in your faeces. It may indicate other conditions such as irritable bowel syndrome.
If your baby or child has had six or more episodes of diarrhoea in the last 24 hours, see Dr. B C Shah. Diarrhoea can be serious in babies because of the risk of dehydration.
Symptoms of diarrhoea
Diarrhoea can range in severity from slightly watery faeces and a brief upset stomach to longer term, extremely watery faeces and cramping tummy pains. Many people have a frequent, urgent need to go to the toilet.
Other common symptoms associated with diarrhoea are:
Nausea or vomiting
A temperature of 38ºC (100.4ºF) or higher
Headache
Loss of appetite
When to contact Dr. B C Shah
Babies
Contact Dr. B C Shah urgently for advice if your baby has had six or more episodes of diarrhoea in the past 24 hours.
Children
Contact Dr. B C Shah if your child has:
Had six or more episodes of diarrhoea in the past 24 hours
Diarrhoea and is vomiting at the same time
Diarrhoea that is particularly watery
Diarrhoea that has blood in it
Diarrhoea that lasts for longer than two weeks
Adults
Contact Dr. B C Shah if you have:
Recently been treated in hospital
Recently been treated with antibiotics
Diarrhoea that has blood in it
Diarrhoea and persistent vomiting
Unexplained weight loss
Bleeding from your rectum (back passage)
Passed large volumes of very watery diarrhoea – you may be at risk of dehydration
Symptoms at night that are disturbing your sleep
Diarrhoea that lasts longer than a week
Symptoms of dehydration
If diarrhoea is severe or persistent, it can cause dehydration.
Dehydration in children
Symptoms of dehydration in children include:
Appearing to get more unwell
Being irritable or drowsy
Passing urine infrequently
Pale or mottled skin
Cold hands and feet
Dehydration in adults
Symptoms of dehydration in adults include:
Lacking energy or feeling tired
Loss of appetite
Nausea
Feeling light-headed
Dizziness, especially when standing up
Dry tongue
Sunken eyes
Muscle cramps
Rapid heartbeat
Causes of diarrhoea
Diarrhoea usually occurs when fluid cannot be absorbed from your bowel contents, or when extra fluid is secreted into the bowel, causing watery faeces (see How diarrhoea happens, left).
Conditions causing short-term diarrhoea
Diarrhoea is usually a symptom of gastroenteritis, an infection of the bowel. Gastroenteritis may be caused by:
A virus, such as norovirus or rotavirus
Bacteria, such as campylobacter, Clostridium difficile (C. difficile), Escherichia coli (E. coli), salmonella and shigella – these may all cause food poisoning
Parasites, such as the Giardia intestinalis parasite that causes giardiasis.
Diarrhoea caused by contaminated food or water from a foreign country is known as Travellers' diarrhoea.
Other short-term causes
Other short-term causes of diarrhoea include:
Emotional upset or anxiety
Drinking too much alcohol
Drinking too much much coffee
A food allergy
Appendicitis (swelling of the appendix)
Damage to the lining of the intestines due to radiotherapy
Damage to the intestines due to reduced blood supply, for example, because of a hernia
Medicines
Diarrhoea can also be a side effect of many different medicines, including:
Antibiotics
Antacid medicines that contain magnesium
Some medicines used in chemotherapy
Non-steroidal anti-inflammatory drugs
Selective serotonin reuptake inhibitors
Statins (cholesterol-lowering medicines)
Laxatives – a type of medicine that can help you empty your bowels if you are having trouble going to the toilet
The patient information leaflet that comes with your medicine should state whether diarrhoea is a possible side effect.
Conditions causing persistent diarrhoea
Conditions that can cause persistent diarrhoea include:
Irritable bowel syndrome – a poorly understood condition where the normal functions of the bowel are disrupted
Coeliac disease – a digestive condition where you are intolerant to the protein gluten
Crohn's disease – a condition that causes inflammation of the lining of the digestive system
Cystic fibrosis – an inherited condition that affects the lungs and digestive system
Diabetes – a condition caused by too much glucose in the blood
Diverticular disease – when small pouches (diverticula) form in the large intestine, causing symptoms such as diarrhoea
Gastrectomy – a surgical procedure to remove part of the stomach, for example, to treat stomach cancer
Lactose intolerance – lactose is a natural sugar that is found in milk
Microscopic colitis – a type of inflammatory bowel disease that causes watery diarrhoea
Chronic pancreatitis – inflammation of the pancreas, a small organ that produces hormones and digestive juices
Ulcerative colitis – a condition that affects the colon (large intestine)
Bowel cancer – cancer in the bowel can cause diarrhoea and blood in your stools
Diagnosing diarrhoea
Diarrhoea is likely to settle within a week and you may not need to see Dr. B C Shah for a diagnosis.
The below information explains what will happen if you need to see Dr. B C Shah.
Diagnosing the cause
To diagnose the cause of your diarrhoea, Dr. B C Shah may ask a number of questions, such as:
What your faeces are like – for example, if they are very watery or contain blood
How often you have had diarrhoea
What other symptoms you have, such as fever
Whether you have been in contact with anyone else who has diarrhoea (as you may have caught an infection)
Whether you have eaten out anywhere (as you may have food poisoning)
Whether you have recently travelled abroad (to rule out travellers’ diarrhoea)
What medication you are taking and if this has recently changed
Whether you have been stressed or anxious
How much alcohol you drink
Stool sample
Dr. B C Shah may ask for a stool sample to investigate for bacteria or parasites if you have:
Persistent diarrhoea lasting more than a week
Other symptoms, such as blood or pus in your stools
Symptoms that affect your whole body, such as fever or dehydration
A weakened immune system, for example because you have HIV
Recently travelled abroad
Recently been in hospital or been taking antibiotics
Blood tests
Dr. B C Shah may suggest blood tests if an underlying health condition is possibly causing your diarrhoea. For example, your blood can be tested for signs of inflammation, which may suggest an inflammatory bowel disease.
Rectal examination
If you have unexplained persistent diarrhoea, or if you are over 50 years old, Dr. B C Shah may suggest a digital rectal examination. During a digital rectal examination, Dr. B C Shah inserts their finger into your anus (back passage) and rectum. It can be useful in diagnosing conditions that affect your rectum and bowels.
Referral
Dr. B C Shah may need to refer you for further investigations to identify the cause. For example, you may have:
A sigmoidoscopy – a procedure that involves inserting a sigmoidoscope (a thin, flexible tube attached to a small camera and light) into your rectum then up into your bowel
A colonoscopy – a similar procedure that uses a larger tube, called a colonoscope, to examine your entire bowel
Treating diarrhoea
Diarrhoea often goes away without treatment after a few days, because your immune system (the body’s natural defence system) automatically fights the infection.
In children, the symptoms of diarrhoea usually pass within five to seven days. Most children's diarrhoea symptoms do not last more than two weeks.
In adults, the symptoms of diarrhoea usually improve within two to four days. The time that diarrhoea usually lasts for in particular infections can be:
Rotavirus: three to eight days
Norovirus: around two days
Campylobacter and salmonella bacterial infections: two to seven days
Giardiasis (infection with the Giardia intestinalis parasite): several weeks
In the meantime, you can ease your symptoms by following the steps below.
Drink fluids
You can avoid dehydration by drinking lots of fluids. Take small, frequent sips of water. You are more likely to be dehydrated if you are also vomiting.
It is especially important that babies and small children do not become dehydrated. Even if your child vomits, still give them frequent sips of water. A small amount of fluid is better than none. Fruit juice and fizzy drinks should be avoided, as these can make diarrhoea worse in children.
If your child shows signs of dehydration, contact Dr. B C Shah immediately. Signs of dehydration include:
Appearing to get more unwell
Being irritable or drowsy
Passing urine infrequently
Pale or mottled skin
Cold hands and feet
Children at risk of dehydration
Your child may be at increased risk of dehydration if they:
Are younger than one, particularly if they are younger than six months
Are less than two years old and born with a low birth weight
Have had more than five episodes of diarrhoea in the last 24 hours
Have vomited more than twice in the last 24 hours
Have not been able to hold down fluids
Have suddenly stopped breastfeeding
Continue breastfeeding or bottle-feeding
If you are breastfeeding or bottle-feeding your child and they have diarrhoea, continue breastfeeding or bottle-feeding them as normal. Rehydration drinks should also be given if your child is at risk of dehydration.
Oral rehydration solutions (ORS)
Dr. B C Shah may suggest drinking an oral rehydration solution (ORS) if you are more vulnerable to the effects of dehydration, for example because:
You are 60 years old or older
You are frail
You have another pre-existing condition, such as cardiovascular disease
Rehydration drinks usually come in sachets that are available without a prescription from your local pharmacist. They are dissolved in water and they help to replace salt, glucose and other important minerals that you may be losing through dehydration.
Rehydration drinks do not cure diarrhoea, but can prevent or treat dehydration. Do not use homemade salt or sugar drinks.
Children and Oral rehydration solution (ORS)
Dr. B C Shah may also recommend an oral rehydration solution for your child if they are dehydrated or at risk of dehydration .
It is usually recommended that your child drinks an ORS each time they have an episode of diarrhoea. The exact amount of ORS they should drink will depend on their size and weight. Your pharmacist will be able to advise you. The manufacturer’s instructions that come with the ORS also give information about the recommended dose.
Advice about eating
Expert opinion is divided over when and what you should eat if you have diarrhoea, but most agree that you should eat solid food as soon as you feel able to. Eat small, light meals and avoid fatty, spicy or heavy foods.
If you feel you cannot eat, it should not do you any harm, but make sure that you continue drinking fluids, and eat as soon as you can.
Children and eating
If your child is dehydrated, do not give them any solid food until they have drunk enough fluids. Once they have stopped showing signs of dehydration, they can start eating their normal diet.
If your child is not dehydrated, offer them their normal diet. If your child refuses to eat, continue to offer drinks and wait until their appetite returns.
Medicines
Antidiarrhoeal medicines
Antidiarrhoeal medicines may reduce the diarrhoea and shorten how long it lasts by around 24 hours. However, they are not usually necessary unless shortening the duration of your diarrhoea helps you get back to your essential activities sooner.
Loperamide is the preferred antidiarrhoeal medicine because it causes fewer side effects and there is more evidence of its effectiveness. Loperamide slows down muscle movements in your gut, which leads to more water being absorbed from your faeces. Your faeces then become firmer and are passed less frequently.
Some antidiarrhoeal medicines can be bought from a pharmacy without a prescription. Check the patient information leaflet that comes with the medicine to find out if it is suitable for you and what dose you should take. Ask your pharmacist for advice if you are unsure.
You should not take antidiarrhoeal medicines if:
There is blood or mucus in your stools
You have a high temperature
Contact Dr. B C Shah instead.
Children should not be given antidiarrhoeal medicines.
Painkillers
Although painkillers will not help the diarrhoea, you can take the recommended dose of paracetamol or ibuprofen if you have a fever or headache. Do not take ibuprofen if you have asthma, or if you have stomach, liver or kidney problems.
Liquid paracetamol or ibuprofen can also be given to your child if necessary. Check the patient information leaflet to find out if it is suitable for your child. Children under 16 years old should not take aspirin.
Antibiotics
Antibiotics are not recommended for diarrhoea if the cause is unknown. This is because:
They do not work if the diarrhoea is caused by a virus
They can cause unpleasant side effects
Every time you use antibiotics to treat a mild condition, it is more likely that their effectiveness for treating more serious conditions is reduced
However, if your diarrhoea is particularly severe and a specific bacterial cause has been identified, antibiotics may be recommended.
Antibiotics may also be recommended if you have a pre-existing risk factor that makes you more vulnerable to infection, such as having a weakened immune system.
Treatment in hospital
Hospital treatment may be necessary if you or your child has serious dehydration caused by diarrhoea.
Hospital treatment involves administering fluids and nutrients directly into the vein (intravenously).
Preventing diarrhoea
Infection control
You can help prevent diarrhoea caused by infections by taking steps to prevent the infection spreading. These include:
Washing your hands thoroughly after going to the toilet and before eating or preparing food
Cleaning the toilet, including the handle and the seat, with disinfectant after each bout of diarrhoea
Not sharing towels, flannels, cutlery or utensils with other household members
Not returning to work until 48 hours after your last bout of diarrhoea
How long should I stay at home?
If you or your child has diarrhoea, you should stay at home until at least 48 hours since the last episode of diarrhoea.
If it was suspected or confirmed that the parasite cryptosporidium caused the diarrhoea, you or your child should not go in swimming pools for two weeks after the last episode of diarrhoea.
Food hygiene
Practising good food hygiene will help you to avoid getting diarrhoea as a result of food poisoning. Some ways of doing this are:
Regularly washing your hands, surfaces and utensils with hot, soapy water
Never storing raw and cooked foods together
Making sure that food is kept properly refrigerated
Always cooking your food thoroughly
Never eating food that is past its sell-by date
Preventing travellers’ diarrhoe
If you are travelling in a country where the standards of public hygiene are low and there is a risk of water contamination, such as in some African or Asian countries, you may need to avoid the following food and drink:
Tap water
Fruit juices (if sold by a street vendor)
Ice cream or ice cubes
Shellfish
Eggs
Salads
Raw or undercooked meat
Peeled fruit
Mayonnaise
Sauces
Food and drink that are generally safe to eat include:
Sealed bottled water that is produced by a recognised international manufacturer
Cooked food, such as soup or stir-fry
Canned food or food in sealed packs
Fresh bread
Unpeeled fruit
Tea or coffee
Alcohol
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Osteomyelitis
Posted by on Tuesday, 12th March 2013
Introduction
Osteomyelitis is a medical term that describes an infection of bone. The infection is usually bacterial. Symptoms of osteomyelitis may include:
high temperature (fever) of 38°C (100.4°F) or above
pain in the affected area, which can often be intense
swelling in the affected area
a passageway that opens in the skin through which pus or fluid leaks (this is known as a discharging sinus)
Types of osteomyelitis
There are two main types of osteomyelitis:
Acute osteomyelitis is where the bone infection develops within two weeks of an initial infection, injury or underlying disease and may respond to antibiotic treatment.
Chronic osteomyelitis is where the bone infection has produced irreversible bony changes that cannot be treated by antibiotics alone.
Acute osteomyelitis
There are two ways that acute osteomyelitis can occur:
Contiguous osteomyelitis is where an infection spreads directly into the bone as a result of an injury, such as a fractured bone or animal bite, during surgery, or as a result of another condition such as diabetes or vascular disease.
Haematogenous osteomyelitis is where an infection spreads into a bone from the bloodstream.
Contiguous osteomyelitis is the most common type of acute osteomyelitis, accounting for four out of five cases. It mainly affects adults.
People who have a condition that affects the blood supply to certain parts of their body, such as type 2 diabetes, have an increased risk of developing contiguous osteomyelitis. Any surgical procedure on the skeleton may introduce infection into bone.
Haematogenous osteomyelitis mostly affects younger children, although adult cases may occur in anyone with a weakened immune system, such as those with rheumatoid arthritis or HIV.
People who regularly inject drugs, such as heroin, also have an increased risk of developing haematogenous osteomyelitis.
Chronic osteomyelitis
Chronic osteomyelitis can sometimes start as acute osteomyelitis. If acute osteomyelitis is not treated properly it can become established and produce permanent, destructive changes to bone, resulting in pain, discharge and loss of function.
As with acute osteomyelitis, the infection can be spread through the blood or directly into the bone as a result of injury or other trauma.
Chronic osteomyelitis can also develop as a complication of a pre-existing infection such as tuberculosis (a bacterial infection) or syphilis (a sexually transmitted infection).
How common is osteomyelitis?
At present, there are limited data on how widespread osteomyelitis is in adults.
Acute osteomyelitis is rare in children. It is estimated that one child in every 1,000 children under the age of one, and one in every 5,000 over the age of one will develop acute osteomyelitis.
The condition is known to be a common complication of certain health conditions. For example:
30-40% of people with diabetes who experience a puncture injury to their foot will develop osteomyelitis
One in every 200 people with sickle cell anaemia (a hereditary blood condition) will develop osteomyelitis in any given year
Outlook
The outlook for acute osteomyelitis is generally good because the condition usually responds well to antibiotics. However, for people with underlying risk factors for osteomyelitis, such as diabetes, there is a chance that the infection could come back.
The outlook for chronic osteomyelitis is mixed because the infection can be more challenging to treat, particularly if significant bone damage has occurred. Most cases will require a combination of antibiotics and surgery.
Symptoms of osteomyelitis
Acute osteomyelitis
Most cases of acute osteomyelitis involve one of the long bones in the legs. However, sometimes the bones in the arm or the vertebrae (in the back) can be affected.
The symptoms of acute osteomyelitis include:
A sudden high temperature (fever) of 38°C (100.4°F) or above, although this symptom is often absent in children under one year old
Bone pain, which can often be severe
Swelling, redness and warmth at the site of the infection
A general sense of feeling unwell
The affected body part is tender to touch
The range of movement in the affected body part is restricted
Lymph nodes (glands) near the affected body part may be swollen
Young children who cannot talk may be unable to report their painful symptoms to you. You should look out for the following signs and symptoms:
Irritability
Eating much less than usual
Reluctance to use the affected body part
Chronic osteomyelitis
Once chronic osteomyelitis is established, the person affected may have periods of almost no symptoms. However, symptoms can flare up at any time. For example, you may experience:
Bone pain
Feeling persistently tired
Pus draining from the sinus tract (a passageway that develops near the infected bone)
Local swelling
Skin changes
Excessive sweating
Chills
When to seek medical advice
You should always visit Dr. B C Shah if you or your child develops a high temperature (fever) and persistent bone pain.
Causes of osteomyelitis
Routes of infection
Your bones are usually resistant to infection. Bone can become infected when:
A pre-existing infection in the blood spreads to a bone
There is an injury, such as a bone fracture, or a complication from a surgical procedure
There is a pre-existing health condition, such as diabetes, which means the bone does not get a steady blood supply, so infection-fighting white blood cells cannot reach the site of injury
Blood infections that spread to the bone are more common in children than adults. This may be because children’s bones are still developing, which makes them more vulnerable to this type of blood-borne infection than adult bones, which are fully grown.
In addition, a child's immune system (the body’s natural defence against infection and illness) is still developing, so it is less effective than an adult’s at fighting off infection.
When a bone becomes infected
When an infection develops inside a bone, the immune system will attempt to stop it by sending infection-fighting white blood cells known as neutrophils to the source of the infection.
The neutrophils will try to kill the bacterial or fungal cells that are causing the infection, but sometimes they are unable to do so. If the infection is not treated, a collection of dead neutrophils will build up inside the bone, forming a pocket of pus known as an abscess.
In cases of chronic osteomyelitis, abscesses can block the blood supply to the bone, which will eventually cause the bone to die. Dead bone with no blood supply must be removed if infection is to be cleared.
Risk factors
There are several risk factors that can make people more vulnerable to developing osteomyelitis. They include:
Weakened immune system
Poor circulation
Diabetes and foot injury
Injury and trauma
Orthopaedic surgery
Intravenous drug use
These risk factors are described below.
Weakened immune system
If your immune system is weakened, it is more likely that an infection that develops in one part of your body will spread to a bone. Your immune system may become weakened for any of the following reasons:
You have a health condition, such as HIV or AIDS
You are taking certain treatments, such as chemotherapy, radiotherapy or a long-term dose of steroid tablets
You have malnutrition, which is when your diet does not contain all the nutrients needed for good health
Poor circulation
People with health conditions that affect the blood flow are at greater risk of developing osteomyelitis. This is because their bones may not be getting a steady supply of infection-fighting white blood cells.
Conditions that are known to cause poor circulation include:
Type 1 diabetes and type 2 diabetes
Sickle cell anaemia, which is an inherited blood disorder where the red blood cells do not function properly
Atherosclerosis, which is narrowing of the arteries, often caused by eating a high-fat diet and/or smoking
Peripheral arterial disease, which is where the main arteries in the legs get clogged up by a build-up of fat
Diabetes and foot injury
People with diabetes are particularly vulnerable to osteomyelitis because they are at risk of developing foot injuries.
Increased levels of glucose in the blood can cause nerve damage. This means that people with poorly controlled diabetes may begin to lose sensation in their feet so small cuts or injuries to the feet go unnoticed. Due to poor circulation, a serious infection can quickly develop in the feet before spreading to the bone.
Injury and trauma
If you break a bone or have a serious puncture injury that exposes deep tissue to germs, there is a chance you will develop osteomyelitis. This risk is increased if you also have a weakened immune system and/or poor circulation. Any broken bone with a loss of skin cover needs emergency surgery to clean the wound, get rid of dead tissue and stabilise the fracture.
Orthopaedic surgery
If you have orthopaedic surgery (surgery that involves the bones or joints) or you have had metalwork implanted, there is a small chance you may develop osteomyelitis. The risk is less than 1%.
Intravenous drug misuse
People who regularly inject themselves with illegal drugs such as heroin or methamphetamine (crystal meth) have an increased risk of developing osteomyelitis. This is because many people who misuse drugs do not use properly sterilised needles, which significantly increases the risk of introducing bacteria into their bloodstream.
Diagnosing osteomyelitis
Physical examination
To confirm a diagnosis of suspected osteomyelitis, Dr. B C Shah will first carry out a physical examination of your affected body part to check for signs of redness, swelling and tenderness.
They will want to know about your recent medical history, such as whether you have recently had an injury, surgery or a previous infection.
Blood test
Dr. B C Shah may refer you for a blood test. This cannot confirm osteomyelitis, but it can indicate whether you have a high number of white blood cells in your blood, which may suggest that you have an infection. Also, if the osteomyelitis was caused by bacteria spreading in your blood, a blood test may be useful for detecting the bacteria.
Imaging tests
If osteomyelitis is suspected, it is likely that you will be referred for further imaging testing. There are several imaging tests that may be able to detect bone damage caused by osteomyelitis. They include:
X-rays, in which low levels of radiation are used to create an image of the affected bone
Magnetic resonance imaging (MRI) scan, which is where a strong magnetic field and radio waves are used to build up a picture of the inside of the affected bone
Computerised tomography (CT) scan, which is where a series of X-rays of your affected bone are taken and a computer is used to assemble them into a more detailed three-dimensional image
Ultrasound scan, which is where high-frequency sound waves are used to create an image of the affected bone to highlight any abnormalities
Biopsy
If earlier testing suggests that you have osteomyelitis, it is usually necessary to remove a small sample of bone for further testing. This is known as a biopsy.
A biopsy is usually necessary to confirm a diagnosis of osteomyelitis and it can help to establish the exact type of bacteria or fungus that is causing your infection. This can be very useful when deciding on the most effective treatment.
A biopsy is usually combined with surgery in chronic cases.
Treating osteomyelitis
Treating acute osteomyelitis
Acute osteomyelitis can usually be successfully treated using antibiotics
These medicines are usually given as a six-week course. For part of the treatment course you will need to take the medicine intravenously (directly into a vein).
Depending on your general state of health, you may need to stay in hospital during this time. Otherwise, you may be able to receive the injections as an outpatient (where you go home the same day). You will usually be able to switch to tablets for the rest of the treatment course once you are well.
In cases of osteomyelitis, there is usually a choice of antibiotics available to treat the infection and often two antibiotics are used in combination. This is known as dual therapy.
Occasionally, the bacteria causing the infection are resistant to standard antibiotics and less-frequently-used antibiotics are needed.
All antibiotics have side effects, which you should discuss with Dr. B C Shah in charge of your care.
A much less common cause of osteomyelitis is a fungal infection.
In cases of fungal osteomyelitis, an antifungal medication called voriconazole is usually the treatment of choice.
Treating chronic osteomyelitis
People with chronic osteomyelitis will usually require a combination of antibiotics medication and surgery to remove any damaged bone. Dr. B C Shah may need to make an incision (cut) near the site of the infection to drain away any pus.
If there is extensive bone damage, it will be necessary to surgically remove any diseased bone and tissue. This procedure is known as debridement. Debridement can often leave an empty space in the bone, which is sometimes packed with antibiotic-loaded cement. If Dr. B C Shah does this, a second operation will be required to remove the cement within a few weeks of the first. Not all centres use cement and no difference is found in the clearance of infection.
In some cases, it may also be necessary to transfer muscle and skin from another part of the body to repair the tissue surrounding the affected bone.
Hyperbaric oxygen therapy
Some researchers have argued that a type of non-surgical treatment called hyperbaric oxygen therapy may be useful in treating cases of both acute and chronic osteomyelitis that do not respond to conventional treatment.
During hyperbaric oxygen therapy, you are placed in a specially designed chamber that is similar to a decompression chamber used by divers.
The chamber is filled with oxygen, which is administered at a much higher pressure (hyperbaric) than the normal level of oxygen in the atmosphere. The high levels of oxygen are thought to speed up the healing process and slow the spread of infection.
There is currently only limited evidence supporting the effectiveness of hyperbaric oxygen therapy for treating osteomyelitis. From the evidence available, it would appear that it is most effective in treating osteomyelitis associated with a diabetic foot ulcer.
Complications of osteomyelitis
Recurring osteomyelitis
The underlying factors that often cause osteomyelitis, such as poor circulation or a weakened immune system, can be difficult to treat, particularly if you have severe diabetes or HIV. Therefore, if you have had a previous episode of osteomyelitis, there is a chance that it could return.
The risk factors for recurring osteomyelitis vary depending on your circumstances. It may be possible to reduce your risk by making lifestyle changes, such as lowering the amount of saturated fat in your diet and by taking precautions against infection.
Amputation
Amputation is sometimes necessary when someone has a condition, such as diabetes or peripheral vascular disease, that affects the normal blood supply to parts of their body. With a reduced blood supply, the affected body part will receive fewer infection-fighting blood cells. This means that the infection may spread beyond the bone and into the surrounding soft tissue. The tissue will then begin to die, which is known as gangrene.
Once gangrene develops, it is sometimes necessary to amputate the affected limb to prevent the spread of infection and prevent further damage to healthy tissue.
Preventing osteomyelitis
If you have a weakened immune system, take extra precautions to avoid infection and boost your immune system:
Do not smoke, because it will weaken your immune system.
Keep your vaccinations up to date. Dr. B C Shah will be able to advise you about this.
Eat a healthy diet to help boost your immune system.
Take regular exercise to help boost your immune system.
Wash your hands regularly with soap and hot water, particularly after going to the toilet, before and after preparing food and after being in crowded places.
If you have poor circulation, avoid activities that could make it worse, such as smoking. Some lifestyle changes will also help to improve your circulation, such as taking regular exercise.
Stop smoking (if you smoke)
Smoking cigarettes can clog up your arteries and increase your blood pressure, both of which are bad for your circulation.
If you smoke, it is strongly recommended that you quit as soon as possible. Dr. B C Shah will be able to recommend and prescribe medication that can help you give up.
Eat a healthy diet
High fat foods can cause a build-up of fatty plaques (deposits) in your arteries, and being overweight can lead to high blood pressure.
To improve your circulation, a low-fat high-fibre diet is recommended, including plenty of fresh fruit and vegetables (at least five portions a day) and wholegrains.
It is also recommended that you eat a Mediterranean-style diet. This means you should eat more bread, fruit, vegetables and fish and less meat. Replace butter and cheese with products that are vegetable and plant-oil based, such as olive oil.
Oily fish is recommended as it contains a type of fatty acid called omega-3, which can help lower your cholesterol levels. This can help to improve your circulation. Two to four portions of oily fish a week are recommended. Good sources of omega-3 include:
Herrings
Sardines
Mackerel
Salmon
Trout
Tuna
If you are unable or unwilling to eat oily fish, Dr. B C Shah may recommend that you take an omega-3 food supplement. However, you should never take a food supplement without first consulting him. This is because some supplements, such as beta-carotene, can be harmful.
Weight management
If you are overweight or obese, try to lose weight and then maintain a healthy weight by using a combination of a calorie-controlled diet and regular exercise. Once you have achieved a healthy weight it will help keep your blood pressure at a normal level, which will help improve your circulation.
Alcohol
If you drink alcohol, don't exceed the recommended daily limits. These are:
Three to four units a day for men
Two to three units a day for women
A unit of alcohol is roughly half a pint of normal-strength beer, a small glass of wine or a single measure (25ml) of spirits. Regularly exceeding the recommended alcohol limits will raise both your blood pressure and cholesterol level, which will make your circulation worse.
Contact Dr. B C Shah if you are finding it difficult to moderate your drinking. Counselling services and medication can help you to reduce your alcohol intake.
Regular exercise
Regular exercise will lower your blood pressure and make your heart and blood circulatory system more efficient.
For most people, 30 minutes of moderate to vigorous exercise a day, at least five times a week, is recommended. However, if your overall health is poor, it may be necessary for you to exercise using a programme that is tailored specifically to your current needs and fitness level. Dr. B C Shah will be able to advise you about the most suitable level of exercise for you.
Activities that you could incorporate into your exercise programme include:
Brisk walking
Hill climbing
Running
Cycling
Swimming
If you find it difficult to achieve 30 minutes of exercise a day, start at a level that you feel comfortable with. For example, you could do 5 to 10 minutes of light exercise a day before gradually increasing the duration and intensity of your activity as your fitness starts to improve.
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Varicocele
Posted by on Monday, 11th March 2013
A varicocele is a widening of the veins along the cord that holds up a man's testicles (spermatic cord).
Causes, incidence, and risk factors
A varicocele forms when valves inside the veins along the spermatic cord prevent blood from flowing properly. This causes the blood to back up, leading to swelling and widening of the veins. (This is essentially the same process that leads to varicose veins, which are common in the legs.)
Varicoceles usually develop slowly. They are more common in men ages 15 – 25 and are most often seen on the left side of the scrotum.
The sudden appearance of a varicocele in an older man may be caused by a kidney tumor, which can block blood flow to a vein. This is more common on the left side than the right.
Symptoms
Enlarged, twisted veins in the scrotum
Painless testicle lump, scrotal swelling, or bulge in the scrotum
There may not be symptoms.
Signs and tests
Dr. B C Shah will examine the groin area, including the scrotum and testicles. He may feel a twisted growth along the spermatic cord. (It feels like a bag of worms.)
However, the growth may not be able to be seen or felt, especially when you are lying down.
The testicle on the side of the varicocele may be smaller than the one on the other side.
Treatment
A jock strap (scrotal support) or snug underwear may help relieve the pain or discomfort. If pain continues or other symptoms occur, you may need further treatment.
Surgery to correct a varicocele is called varicocelectomy. You will leave the hospital on the same day as your surgery. During this procedure, you will receive some type of numbing medication (anesthesia). The urologist will make a cut, usually in the lower abdomen, and tie off the abnormal veins. Blood will now flow around the area into normal veins. Keep an ice pack on the area for the first 24 hours after surgery to reduce swelling.
An alternative to surgery is varicocele embolization. This method is also done without an overnight hospital stay. It uses a much smaller cut than surgery, so you will heal faster. A small hollow tube called a catheter (tube) is placed into a vein in your groin or neck area.
Using x-rays as a guide, Dr. B C Shah moves the tube into the varicocele. A tiny coil passes through the tube into the varicocele. The coil blocks blood flow to the bad vein, and sends it to normal veins.
After the procedure, you will be told to place ice on the area and wear a scrotal support for a little while.
Expectations (prognosis)
A varicocele is usually harmless and often does not need to be treated.
If you have surgery, your sperm count will likely increase but it will not improve your chances of getting a woman pregnant. In most cases, testicular wasting (atrophy) does not improve unless surgery is done early in adolescence.
Complications
Infertility is a complication of varicocele.
Complications from treatment may include:
Atrophic testis
Blood clot formation
Infection
Injury to the scrotum or nearby blood vessel
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