Shingles (Herpes zoster)

Description:

-Shingles present as a painful unilateral skin lesion that follows a particular nerve on one side of our body (dermatome).
-Shingles is a reactivation of the chickenpox virus that has been dormant in a dorsal root ganglia of a nerve in our body.
-Shingles occurrence increases with age.
-Postherpetic neuralgia (pain affecting the nerves) increases with age:
4% in people 30 to 50 years of age
50% in people over 80 years of age
-Postherpetic neuralgia is defined as a pain persisting at least one month after the rash as healed.

Signs and Symptoms:

Prodromal phase:
-Consisting of tingling, itching, burning sensation, knifelike pain over the involved dermatome prior to the appearance of the rash.

Acute phase:
-Could present with fatigue, headache, low grade fever
-Rash on a dermatomal presentation.
-Redness on one side of the body, followed by grouped vesicules who become pustular or hemorrhagic after 3 to 4 days.
-The rash resolves with the appearance of crusts
-Thoracic and lumbar dermatomes are most commonly affected

Herpes zoster (shingles)

-However any dermatome can be affected and also could presents itself as a disseminated zoster


Chronic phase:
-Postherpetic neuralgia can present in 15% of patients overall and this increases with age
-A small percentage may affect a motor nerve and can cause weakness



Risk factors:
-The vast majority of people don’t have any underlying illness
-Increases with age
-Immuno-compromised patients (HIV, cancer patients, patients with organ transplants on medications)
-History of chickenpox


Treatment:
Time is of essence. The sooner the treatment is started after the appearance of the characteristic rash the more it could be resolved without any complications and the postherpetic neuralgia.
-Antivirals should be started within 48 to 72 hours after the appearance of the rash for maximum benefits. They can prevent the postherpetic neuralgia.
Usually your doctor will use Valtrex® or Famvir® for 7 days of treatment.

-Local treatment with wet dressings of tap water with Burow’s applied 30 to 60 minutes, 4 to 6 times a day.
Calamine could also be used.
Lidoderm® patches can be applied only after skin rash as resolved over the painful area.

-Analgesics such as Tylenol® and anti-inflammatory medication can help but sometimes we will need to use opioids such as Morphine® to relieve the pain.

-Tricyclic antidepressants at low dose such as Elavil® could be started to treat postherpetic neuralgia.

-Neurontin® can also help for postherpetic neuralgia.

-Consultation with an anaesthesiologist or a Pain Clinic for peridural injections can help relieve the pain.

-Evolution of the disease is usually self-limited

Complications:

-Shingles can be transmitted to susceptible persons such as immuno-compromised patients and children who never had Chickenpox.
-Postherpetic neuralgia
-Ocular involvement with facial zoster
-Facial zoster can also cause the Ramsay Hunt syndrome: facial palsy, loss of taste, lesions in the ear canal
-Skin infection over the lesions
-Guillain-Barré syndrome
-Encephalatis
-Transverse myelitis



Prevention:

-Varicella zoster immunoglobulin is recommended for immunocompromised patients who have no history of chickenpox or shingles and who were exposed to someone with chickenpox or shingles.
-Chickenpox vaccine (varicella vaccine) may be administered to patients who never got chickenpox or the shingles.


Disclaimer: Please see your doctor to determine if these treatments are right for you. Don`t auto diagnose or treat yourself before asking your doctor.

Drfeelgood

Bipolar disease

What is Bipolar disease?
-Bipolar disease is a medical condition just like diabetes.It is a condition that causes extreme mood swings.
People who suffer from this disease experience recurring episodes of emotional highs (mania) and lows (depression).

What are the symptoms of Bipolar disease ?

Manic phase
-extremely happy mood and euphoria
-increased energy and restlessness; talking very fast,racing thoughts and trying to do more than one thing at a time
-difficulty sleeping; needing little rest
-easily distracted and inability to concentrate
-extreme irritability and aggressive behaviour
-poor judgement
-spending too much money
-high sex drive
-denial of any problem

Depressive state
-a constant feeling of sadness and anxiety
-feeling of hopelessness,guilt, and helplessness
persitent negative thoughts
-no interest in daily or routine activities
-low energy, fatigue, and irritability
-difficulty concentrating
-sleep disturbance
suicidal thoughts

Am I at risk?

-doctors are not sure what causes Bipolar disease but suspect that biologic, genetic and environmental factors may trigger an episode
-family history of Bipolar disease plays a big role in whether or not you are at risk of getting Bipolar disease.
_first degree relatives of someone with Bipolar disease has a 5 to 20%
chance of being affected
-should you suspect to have this disease, you should see your doctor who has
tools and ressources to help you

How is it treated?

Medications
-mood stabilizers such as lithium, divalproex,and carbamazepine etc.
-antidepressants such as paroxetine, fluoxetine, sertraline etc.
-antipsychotics such as olanzapine,quitapine etc.

Psychotherapy
-you can see a psychologist or psychiatrist to talk about how you feel. Sometimes psychotherapy can help you identify overwhelming problems, emotions and attitudes, how they are affecting you and what you can do about them.

Most of the times we combine these two methods of treatment.


What can I do to get better?

Most people with Bipolar disease can control their disease and live normal lives with proper treatment.
Bipolar disease can recurr so it is important to continue with the treatment to prevent another episode.
-continue to take your medication even though you feel better
-see your doctor regularly and report any periods of extreme moodiness
-learn how to recognize the signs and symptoms of an episode
-listen to family and friends if they notice a change in your behaviour
-stay away from alcohol and drugs
-join a support group in your area to learn more coping skills.

Some websites for more info:
-Centre for Addiction and Mental Health: http://www.camh.net
-National Alliance on Mental Illness: http://www.nami.org
-National Institutes of Mental Health (Bipolar disease): http://www.nimh.nih.gov/HealthInformation/bipolarmenu.cfm

Podometer: a wonderful tool for getting active, staying healthy and to lose weight

You were always told to do at least 30 minutes of physical activity daily.
No one told you at what intensity nor what type of physical activity would be adequate for your condition, so most people just simply don’t start exercising.
Well no more excuses, this exercise (walking) is adequate for of almost anyone.
A podometer is a useful tool to get active and stay fit, it could also motivate someone to start and keep pushing further.
It is a simple tool that we attach to our belt in a vertical position and it counts the number of steps we do in our daily life, while exercising, or both.
The podometer can help determine the level of activity in your regular day.
It can help determine goals to achieve.
It can help see the progress you’ve attained since you decided to get active.
Before you begin, determine in which level of activity you correspond to in your daily life:
- < 5000 steps per day: sedentary lifestyle
- 5000 to 7499 steps per day: little active lifestyle
- 7500 to 9999 steps per day: moderately active lifestyle
- > 10 000 steps per day: active lifestyle
- > 12 500 steps per day: very active lifestyle


Studies say that healthy adults do 7000 to 13 000 steps per day in a typical day. When these adults are not doing any physical activities, they do 6000 to 7000 steps per day.
Studies also determined that an inactive person does 2000 to 4000 steps per day.
Scientists estimate that a walk at a moderate intensity for 30 minutes represents 3000 to 4000 steps.

So with these 30 minutes of walk we obtain 9000 to 11 000 steps for an healthy adult that didn’t do any physical activity in his day. This is why most people recommend 10 000 steps a day for the general healthy population.

With obese patients or patients who wish to lose weight we aim for 15 000 to 18 000 steps per day, to lose the weight and keep it off.

For older patients and sick patients we aim for 3000 to 6500 steps per day depending on their disease.
-If you are a type 2 diabetic patient, you should aim for 4500 steps per day.
-If you suffer from heart failure you should aim for 3500 to 3700 steps per day.
-If you suffer from chronic obstructive lung disease aim for 3800 steps per day.
-If you have an articular prosthesis aim for 3500 to 6000 steps per day.

Don’t forget to start slowly and raise the number of steps progressively.
Don’t forget to set realistic objectives.

I leave you with some tips to achieve these goals: take the stairs instead of the elevator at work, park the car a little further and walk, walk your pet.

Get active…

Drfeelgood

Hypertension and the non pharmacological treatment

Many Canadians suffer from high blood pressure and many don't even know they are hypertensive. In fact high blood pressure is asymptomatic in most cases.
I often ask patients to buy a machine so they could take the blood pressure themselves or go to the pharmacy to take it.
The new values to attain for your blood pressure are different depending on your health status.
If your are healthy, we aim for a pressure of less then 140 over 90 mmm Hg for both values.
If your are diabetic, we aim for a pressure of less then 130 over 80 mmm Hg for both values.
If you suffer from chronic renal problems, we aim for a pressure of less then 130 over 80 mmm Hg for both values.

These few steps can help lower your blood pressure without any medication.

-exercise at least 30 to 60 minutes a day at an average intensity (walking,cycling,swimming) at least 4 days a week but aim for 7 days a week.
-stop smoking
-loose some weight. Any weight that is lost is better than nothing.
For every 4,5kg lost the blood pressure diminishes 7.2/5.9 mm Hg in average. Take simple steps: cut one dessert per day if you take several desserts. Cut on soft drinks and favor water. Lower the portions you eat. Don't eat before going to bed. Cut on glucides (sugar). See a nutritionist.
We aim for a body mass index between 18.5 and 24.9 mg/Kg2. We also aim for waist circumference of less than 102 cm for men and less than 88 cm for women.
-Eat healthy: favor fruits and vegetables, milk products low in fat, food low in saturated fats. Diminish your intake of salt.
-Lower your alcohol intake: less than 2 drinks per day.
Men should take 14 drinks or less per week.
Women should take 9 drinks or less per week.
-Control your stress. Take yoga lessons or anything to calm you down.

This should help you stay healthier and live longer.

Drfeelgood

Irritable bowel syndrome (IBS)

IBS or Irritable bowel syndrome

Frequent syndrome present in 12% of the population.
Three times more frequent in women than men.
Usually occurs in young adults.
It is a motricity and sensitivity problem of the digestive system.

To diagnose IBS we need these following criterias:

-Chronic pain or discomfort that lasts at least three months in the last year, and not necessarily consecutively.
-At least 2 of these 3 criterias:
1. pain relieved by defecation and /or
2. associated with changes in the consistency of the stools
3. associated with a change in the frequency of stools
-Presence of bloating,mucus in the stools, diarrhea, constipation,and difficulty in defecation. These symptoms are in favor of the diagnosis but are not obligatory criterias.

What else could it be?

-Crohn`s disease or Ulcerative colitis
-Celiac disease
-Lactose intelorance
-Colon cancer

Is there any special tests my doctor should do?

Not necessarily if you are young and don`t present any of the following symptoms:
-Symptoms starting after 40 years of age
-Weight loss without any reasons
-Blood in stools

If any of these symptoms are present your doctor might refer you to a gastoenterologist for a colonoscopy.

If none of these symptoms are present your doctor will do a blood work-up with a thyroid test and stool cultures if diarrhea is present.

Normally a person with IBS has a stable clinical presentation.

Treatment:

The treatment depends on the symptoms.

-If diarrhea is the dominant symptom your doctor might try loperamide (Imodium ®) or cholestyramine (Questran ®)
-If pain is the dominant symptom your doctor might prescribe small doses of an antidepressant such as amytriptyline (Elavil ®) at night and raise the dose slowly.
-If constipation is the dominant sympton:
-exercise, drinking a lot of water and eating a lot of fibers should help
-laxatives such as sodium docusate (Colace ®) or mineral oils could be used.
Caution in the use of laxatives because they could cause cramps and hence pain.
-tegaserod (Zelnorm ®) as shown some benefits.

Disclaimer: Please see your doctor to determine if these treatments are right for you. Don`t auto diagnose or treat yourself before asking your doctor.

Drfeelgood

Hyperhidrosis (excessive sweating)

Definition:

Sweating that is excessive and more than needed to regulate the body temperature.
The most affected areas are the axillae (arm pits), the palms of your hands,and the soles of your feet.


Symptoms:

It could be embarrassing for some people and it could affect social life or lack of it...
Other symptoms include: bad odors produced by decomposition of cellular debris by bacterias and yeast on the skin.
Skin maceration and fissuring are possible.

What to do:

See your doctor to make sure that no other systemic disease is present(diabetes,thyroid problems,tuberculosis, menopause, Hodgkin`s disease and a febrile illness).
Ask your doctor if certain medications that you are taking could cause excessive sweating.

Treatment:

-Soaps containing chlorhexidine or deoderants such as SECRET ® are easily accesible and worth trying.
-Drysol 20% applied nightly and then reduce the frequency of application to the minimum needed to control the condition.
You can cover the area with Saran Wrap ® if possible.
Irritation can be minimized by washing off the treated erea in the morning.
-Ditropan ® (oxybutynin) should be used at the lowest dose that is effective because it can cause blurred vision,dry mouth,dry eyes,constipation and urinary retention.
-Iontophoresis: treatment that consists of passing a direct current across the skin and mostly used for the palms and soles. You can find this at some dermatologists who have it in their offices or you could buy it directly from the makers.
The treatment is performed daily for 20 to 30 minutes. Once effective control is achieved the lowest frequency needed to maintain the control should be used.
-Botox ®: response rate is excellent ­over 90%.
The sweating control could last anywhere from 4 to 12 months.
-Surgical treatment are possible but reserved for more severe cases that didn`t respond to the medical treatment.

Don`t be shy anymore, talk to your doctor about this problem.

For more information: http://sweathelp.org/English/

Disclaimer: Please see your doctor to determine if these treatments are right for you. Don`t auto diagnose or treat yourself before asking your doctor.

Drfeelgood

Febrile convulsions

One of the sad moments in the ER is when parents of young children come in after seeing their child convulse.
They usually have a feeling of helplessness and great anxiety.
Usually the episode of convulsion is of short duration (less than 15 minutes)but seems like an eternity.
What they usually describe is the child with a loss of consciousness, the eyes are white(eyes looking upwards),drooling,and rythmic movements of the arms and legs.

What are febrile convulsions?
Febrile convulsions usually occur when the child has fever of more than 39°C or more then 102°F.
The child is between 6 months of age to 6 years of age.
The peak occurence is at 2 years of age.
The convulsions last generally less than 15 minutes.
Usually no other neurologic pathology is present.
They usually do not go on to have epilepsy later in life.

What is the treatment?
The treatment remains conservative and we aim to lower the temperature.
Call 9-1-1
While waiting, protect the child and lie him down on the left side to avoid any aspiration of his vomitus.
We use 15mg/kg of acetaminophen (Tempra®,Tylenol®)every four hours.
You could use a suppository via the rectum if the child is unconscious, never introduce anything by the mouth if unconscious.
We can also use ibuprofen (Advil®, Motrin®) 10mg/kg every 6 to 8 hours.
At times we also use both if the temperature does not go down.
Most of the times when the temperature is not controlled, it is because the dose is insufficient.
As an example if the child weighs 10kg; we would give 150mg of acetaminophen.
We get this dosage:15mg/kg = (15mg x 10kg).
You have to verify the dosage on the bottle and do a little math.
For example acetaminophen comes in different concentrations 80mg/ml or 160mg/5ml.
If we need 150mg (15mg x 10kg):
If the bottle contains(80mg/ml) 80mg ----> for 1 ml
150mg ---> x ML

if we need 150mg the math is:

(150x1)/80= 1,875ml so we give between 1,75ml and 2 ml every 4 hours.



If the bottle contains (160mg/5ml) 160mg ----> for 5 ml
150mg ---> x ML

if we need 150mg the math is:

(150x5)/160= 4.68ml so we give between 4,5ml to 4,75ml every 4 hours.

For ibuprofen which also comes in different concentrations 100mg/5ml etc...
If we need 100mg (10mg x 10kg):
if the bottle contains (100mg/5ml) 100mg ----> for 5 ml
100mg ---> x ML


if we need 100mg the math is:

(100x5)/100= 5 ml every 6 to 8 hours.


What can we do to avoid another event?
Well sadly not much BUT we can tell parents to check their child.
If the child is usually very lively and suddenly he becomes quiet or calm take a rectal temperature and if it is over 38°C or 100°F start one of the medications above to avoid that the temperature goes up.
Usually this should be enough to control the fever hence the febrile convulsions.
The child will need to see a doctor to determine the site of infection and treat accordingly.

DrFeelgood

Treatment for hemorroids

This is a recurrent and a pesky disease.
There are 2 types of hemorrhoids:
-external
-internal

They usually occur when constipated or on straining with defecation.
The hemorrhoids may be accompanied with mild bleeding on paper or in the bowl.
They can be itchy and at times very painful especially when thrombosed.

Treatment is mostly conservative:
-Avoid prolonged sitting on the bowl
-Avoid straining
-Avoid constipation through a sufficient liquid intake and a diet rich in fibers (veggies, fruits, grains...)
-Use stool softeners
-Sitz baths or with sugar to get an osmotic effect (1 cup of sugar for 2 quarts of water;this is less irritating than salt)
-Anti-inflammatory medication for pain and to diminish the inflammation
-Any hemorrhoid ointment that is sold over the counter preferably with hydrocortisone +/- anesthetic

The surgeons tend to operate less and favor a more conservative treatment as mentionned above.

Drfeelgood