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 2017 Better health


 2017 Better health

Why is my son having persistent fever

Answered by: Dr Monica Mahajan
Senior Consultant, Internal Medicine, Max Hospital, New Delhi
Q. My 10 years old son is suffering from fever especially in the evening for the last one month. We got him admitted to the hospital and there they have done all kinds of tests, which came normal. But he is still suffering from fever. Why is he suffering from persistent fever

A.  Since the fever is almost a month's duration and not responding to current medication, we should investigate further. Apart from routine tests like chest x-ray and ultrasound abdomen, tests like mantoux test, TB gold quantiferon, urine culture,stool culture, ANA-IF, CRP,Echocardiography maybe conducted. In certain cases it maybe worthwhile to do a CT scan chest and abdomen since it has a better diagnostic yield compared to chest x-ray and ultrasound. Your paediatrician will have to order tests based on the clinical examination of your child.




Is sleepwalking a disorder

Answered by: Ravi Singareddy, MD
Assistant Professor, Sleep Research & Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, USA


Q. My seven years old son has been sleepwalking everyday within a couple of hours of sleeping for the last four days. He talks, walks, sometimes cries and sometimes makes some playing gestures. I have heard that children do sleepwalk but the daily occurrence is making me tense. Is my son suffering from any psychological disorder?
A.  Sleepwalking is common in children and subsides as they grow. Some causes for increased frequency could be not sleeping enough (sleep deprivation), certain stimulants like coffee/coke etc. There are usually no underlying psychological issues.

Make sure that your son is getting enough time in bed. Avoid any activity prior to bedtime and completely eliminate any kind of stimulants. Also, make sure that there are no obstacles in the path that he sleepwalks; especially sharp things that may hurt him. If he continues to have frequent sleepwalking despite simple measures there are medications that may help. In such case you can take him to a paediatrician who can start him on meds. However, I strongly suggest that you take the simple measures prior to considering medications.




Are repetitive seizures linked to fever

Answered by: Dr RK Sabharwal
Senior Consultant, Child Neurology & Epilepsy, Sir Ganga Ram Hospital, New Delhi


Q. My 15 months old daughter was vaccinated with MMR and pneumonia and after a day, she had an episode of seizure with high fever (102 degree Fahrenheit). She again had seizures twice for less than a minute. Doctor suggested an MRI, LP and CSF, all came normal. She was on Eption and P 250. The doctor concluded that it was due to viral fever and asked us to come after 2 weeks and do an EEG. She has been passing motion frequently (greenish colour).
A.  Your child had provoked seizures. The seizures were atypical febrile seizures (2 or more in 24 hours). MMR vaccination can produce a fever, and therefore increases the risk of a febrile seizure. The absolute risk is one or two per 1,000 doses of vaccine. Children with a personal history of febrile seizures have a higher risk. I would suggest stopping Eptoin. Use preventive clobazam at the onset of subsequent fevers for 3 days. Your pediatrician will guide you on the administration. Secondly, intranasal midazolam (INSED NASAL SPRAY) is available in the market that can be used in an emergency in case the seizure lasts longer than 1 to 2 minutes. Further, the greenish diarrhoea is unlikely to be related to phenytoin.




Are our children at risk of hypothyroidism

Answered by: Prof Dinesh Dhanwal
Prof of Medicine and Head of Endocrinology, Maulana Azad Medical College, New Delhi


Q. I am a 25 years old male suffering from hypothyroidism. My wife is also suffering from the same. Are our children at risk of hypothyroidism?
A.  Hypothyroidism especially autoimmune type (majority of cases have this type of disease) has a strong genetic background. This has been proven in Indian subjects as well. Due to genetic background there are higher chances of your children to have hypothyroidism. There are no specific preventive measures but avoid cauliflower, cabbage and broccoli. Excessive weight gain may also predispose to hypothyroidism. More important is to keep looking for symptoms of hypothyroidism in your children to detect it early. The symptoms in children include lethargy, weight gain, cold intolerance, poor school performance. To know whether you have autoimmune thyroid disease or not, get anti-TPO test done.




How to deal with a child suffering from ADHD

Answered by: Ms Ritu Khanna
Psychologist, New Delhi


Q. My six years old son is suffering from attention deficit hyperactivity disorder (ADHD). He makes careless mistakes, but he is a quick learner. Sometimes, he throws temper tantrums and talks too much. He can easily be distracted by things happening around him. How should I deal with him?
A.  There's a lot that you can do with your child to help him. Children with ADHD do well when there are schedules, order and routines in the house. They require clear expectations, help with executing tasks and a lot of positive reinforcement. When structuring their time its important to engage them in constructive fun activities rather than watch TV or play video games. Also keeping them off junk food, sugar, caffeine etc and encouraging them to get adequate sleep is important.

Also parents need to learn to ignore certain things rather than set perfectionist expectations. Also take care of your own health and take breaks from childcare.

All children, especially those requiring more than average attention, tend to become scapegoats for parental frustration and anger. This is something to remain mindful of.



How can abdominal pain be treated

Answered by: Dr Anjan Dhar
Consultant Gastroenterologist, Bishop Auckland Hospital, UK


Q. My 24 years old wife is suffering from pain in the abdomen. She underwent an X-ray, ultrasound, endoscopy and CT-scan of her abdomen but all these reports came normal. They are terming it as functional pain. The pain started a month back but it stopped after we stayed in the hospital for two nights. The doctors gave her painkillers and antibiotics. But the pain recurred after 15 days. This time it was more severe and she became unconscious with pain and was again readmitted to the hospital for 5 days. She was fine for another 10-12 days and now the pain has started again four days back, but this time it is bearable. The doctor found some erosion inside her stomach on endoscopy. She was given these medicines – Clonotril - 0.5, Razo 20 and Paracetamol (650 mg). Normally the pain starts in the abdomen then spreads to back as well. She is having her periods regularly but they are usually painful. Four days back, when pain started, her menses had started. But now the bleeding has stopped but not the pain.
A.  I would recommend a CT enterography to rule out any small bowel pathology, a Meckel’s scan and a urine porphyria screen in the first place before the pain can be labelled functional. Also, a trial of treatment with Mebeverine 135mg TID for 4 weeks will tell whether the pain is functional or not.




What is pulmonary embolism

Answered by: Dr Sai Praveen Haranath
Specialist in Pulmonary and Critical Care MedicineKaiser Permanente Medical Center/The Permanente Medical GroupWalnut Creek, CA 94596


Q. I am a 32 years old man recently admitted in the hospital for severe pain in abdomen and chest pain. After a CT scan and various other tests, it was found that I have pulmonary embolism. What is pulmonary embolism? Is it a lifelong disease?
A.  Pulmonary embolism is a condition where there is blockage of blood vessels in the lung by clots that started in the veins of the legs and lower abdomen. This causes shortness of breath and can cause low blood pressure due to lack of blood flow in the part of the lung affected and less chance for oxygen uptake. The heart has to work harder also for this. The cause can be a congenital genetic risk for increased clotting, injury to legs causing blood to clot, other illnesses like autoimmune problems, cancer, certain medications and sometimes unknown reasons.

Generally blood thinners are needed for about three months but this decision is made by your treating doctor. You should consider seeing an internal medicine specialist, a blood specialist and if there is any leg swelling perhaps a vascular surgeon also to evaluate measures to prevent long term changes due to blood clots in the legs. It can be a life threatening disease if not treated. Generally the risk of getting a second deep venous thrombosis (clot in the veins of the legs) is higher if you have had one before but this is again very individual dependent and you should discuss your risks with your doctor. From the history you have given I am not sure why you had abdominal pain.



How can supraumbilical and umbilical ventral hernias be treated?

Answered by: Prof Suneet Sood
Consultant Surgeon, Malaysia


Q. My 35 years old friend underwent a CT scan, which shows that she has supraumbilical and umbilical ventral hernias. How can this be managed? She just had surgery to repair a ventral hernia.
A.  The diagnosis of an umbilical hernia, supraumbilical hernia, or of almost any other abdominal wall ventral hernia is "clinical", which means that it does not depend on a CT scan or on any other investigation.

Presuming that ventral hernia, which was just repaired, was infra-umbilical, meaning below the umbilicus: If she had a ventral hernia that needed repair, the doctor would ordinarily have diagnosed this without a CT scan. The doctor would also have picked up any associated umbilical hernia or supraumbilical hernia, and if these were present, the doctor would have repaired them at the same time. I don't know why she has undergone a CT scan now, but if she actually does have an umbilical hernia and/or a supraumbilical hernia, these should have been picked up before her surgery for ventral hernia. You should ask the doctor why he/she did not detect these before surgery.

Presuming that ventral hernia, which was just repaired, was umbilical or supraumbilical: If she now has an umbilical / supraumbilical hernia, she probably has a recurrence after surgery. Recurrence after surgery used to occur in 10-35% of patients in the past. Now, with the use of a mesh, the recurrence rate is less than 5%.

I don't know why a CT scan has been done after surgery for ventral hernia. Did the doctor notice an umbilical bulge and try to confirm the nature of the bulge?

Referring to your question, "how can this be managed", the answer is that she needs surgery if she really has umbilical / supraumbilical hernias. The timing of the surgery can be discussed, but there is no other treatment.

I hope this helps. This is an unusual situation, and I may be addressing the wrong angle.




Why do I have a poor appetite

Answered by: Dr Monica Mahajan
Senior Consultant, Internal Medicine, Max Hospital, New Delhi


Q. I am a 65 years old woman having a poor appetite. If I try to eat even a little more than my usual I feel very heavy in the stomach and nauseous. What could it be? I am taking Folitrax 2.5mg, Eltroxin, Folvite for thyroid breast malignancy and polymyalgia rheumatica. Please advise.
A.  Poor appetite and related symptoms of fullness are either related to your current medical conditions or to methotrexate (Folitrax) use.

You need to do the following and consult a gastroenterologist:
Haemogram, LFT
Stool routine and stool occult blood (x 3 samples)
Ultrasound abdomen
Upper GI endoscopy




Why do I feel burning sensation and pain in stomach
Answered by: Dr Chandra M Gulhati
Editor, MIMS, New Delhi


Q. I am a 45 years old man having pain and burning sensation in my stomach. I am having hyperacidity, gas formation and cannot tolerate spicy food and some items like potato, rice, milk etc. My digestion is very slow too. I am taking Nebicard - 5 and Franxit for the last year for high blood pressure and depression. I have tried homeopathy and ayurvedic medicines but it gave no relief. Please advise.
A.  The first step should be to diagnose the cause of hyperacidity whether it is due to reflux oesophagitis or H. pylori infection (often missed) or even a malfunctioning gall bladder. With regard to high blood pressure drugs belonging to the beta-blocker class such as nebivolol (Nebicard) should not be the first option in sexually active males because of their potential adverse effect on sexual function and risk of developing diabetes. The first line therapy in young males should be enalapril (sold as Envas) 5-10 mg 1-2 times daily as required. Franxit contains two drugs: flupenthixol 0.5 mg, melitracen 10 mg and is being promoted for all sorts of depressive ailments. The product was first discovered by a company in Denmark but never allowed to be sold in that country due to problems of efficacy and safety. It has a number of side effects such as nervous system disturbances including extrapyramidal symptoms (uncontrollable involuntary neck stiffness), neuroleptic malignant syndrome (serious disorder), dry mouth, blurred vision, blood dyscrasias, acute dystonias and dyskinesia (involuntary movement of muscles), Parkinsonism, hyperprolactinaemia, ECG abnormality (QT prolongation on ECG), respiratory depression, nasal stuffiness, rash, photosensitivity, diabetes, impaired temperature regulation, convulsions, breathlessness, hyperhidrosis (increased sweating), male sexual dysfunction, gynaecomastia (enlargement of the male breast), muscle pain (myalgia), abnormal liver function tests, fatigue, agranulocytosis (lack of white cells), jaundice, suicidal ideation and attempted suicides. These side effects may be seen in some, not all, patients. Have you tried yoga for depression?


Comments

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dr. moshaks said…
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