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  • Jaw Dislocation

    Jaw Dislocation/Fracture: 
    Dislocation of the jaw is a displacement
    of the temmporomandibular joint.  Fracture of the jaw is a break in
    one or both of the two maxillas (upper jawbones) or the mandible (low jawbones). 

    Cause:  Simple fractures or dislocations
    are usually caused by a manual blow along the jawline.  More serious
    compound fractures often result from motor vehicle accidents.

    Symptoms:

    Dislocated or fractured jaw may show malocclusion
    (most obvious sign); 

    Mandibular pain; 

    Swelling; ecchymosis; 

    Loss of function; 

    Asymmetry; 

    Possibly anesthesia or paresthesia of the chin
    and lower lip with mandibular fracture, or infraorbital (lying under or
    on the floor of the orbit) paresthesia with maxillary fractures.

    Diagnostic tests:  X-rays confirm
    the diagnosis

    Treatment:

    As in all trauma, check first for airway, breathing,
    and circulation.  Then control hemorrhage and check for other injuries. 

    Surgical reduction and fixation by wiring restores
    mandibular and maxillary alignment.

    Maxillary fractures may also reconstruction and
    repair of soft-tissue injuries.

    Dislocations are usually manually reduced under
    anesthesia.

    Liquid diet

    Pain medication may be ordered by doctor.

  • Pleurisy

    Pleurisy:  An inflammation of the visceral and parietal
    pleurae that line the inside of the thoracic cage and envelop the lungs,
    pleurisy usually begins suddenly.

    Cause:  Pleurisy develops as a complication of pneumonia, tuberculosis,
    viruses, systemic lupus erythematosus, rheumatoid arthritis, uremia, cancer,
    pulmonary infarction, or chest trauma.

    Symptoms:

    Sharp, stabbing pain that increases with respiration may be so severe
    that it limits movement on the affected side during breathing

    Dyspnea

    Auscultation reveals a characteristic pleural friction rub – a coarse,
    creaky sound heard during late inspiration and early expiration, directly
    over the area of pleural inflammation

    Treatment:

    Treatment usually symptomatic

    Anti inflammatory agents

    Analgesics

    Bed rest

    Severe pain may require intercostal nerve block.

    Pleurisy with pleural effusion calls for therapeutic and diagnostic
    thoracentesis

  • Jock Itch

    Jock Itch also known as Tinea cruris or
    fungal
    infection of the groin    :  It is an infection of the groin area
    a fungi called dermatophytes. It is a common skin disorder that occurs
    in men.  It can sometimes accompany athlete’s foot or any of the ringworm
    (Tinea) fungal infections. The fungi that cause jock itch, thrive in moist,
    warm areas.  Poor hygiene, prolonged moist skin are some of the cause
    of tinea infections.  Tinea infections are contagious and can be passed
    by direct contact or by contact with items such as clothing and towels. 
    Jock itch is usually contain to the groin and does not usually does not
    involve the scrotum or penis. 

    Symptoms: 

    Itching of the groin, anal area, and the skin fold of the thigh

    Skin rash redness

    Blister

    Skin may be abnormally dark or light

    Treatment:

    Good hygiene is essential for the prevention of jock itch

    Antifungal medication or drying powders

    Keeping area clean and dry, avoid chafing

    Avoid tight rough textured clothing

    For severe case, or chronic infection , your doctor may prescribed
    and oral antifungal medication and or some oral antibiotic

     * Prompt treatment will eliminate complications, and secondary
    bacterial skin infections.

     * With all medication, use as prescribed by your doctor.

  • Juvenile Rheumatoid Arthritis

    Juvenile Rheumatoid Arthritis:  
    Also known as JRA – is  characterized by joint swelling
    and pain or tenderness, this inflammatory disorder of the connective tissue
    is most common in children ages 2 to 5 and ages 9 to 12.  This disorder
    is considered the major chronic rheumatic disorder of childhood and affects
    over 150,000 in the United States .  Affecting twice as high i girls

    Symptoms:

    Possible signs-

    Fever

    Malaise

    Red macular rash on face, trunk, and extremities

    Arthralgia (joint pain), joint stiffness, swelling
    and mild warmth with some limitation of movement of involved joints.

    Hepatosplenomegaly, abdominal pain

    Lymphadenopathy (disease of the lymph nodes)

    Pleurisy, dyspnea

    Pericarditis, tachycardia

    Growth disturbances

    Diagnostic test:

    Complete Blood Count

    Erythrocyte sedimentation rate

    Antinuclear antibody test

    Treatment:

    Anti-inflammatory drugs

    Physical therapy

    Carefully planned nutrition and exercise

    Regular eye examinations

    Surgery is usually limited to soft tissue releases
    to improve joint mobility.

    Usually, the prognosis for JRA is good though
    disabilities can occur.

  • Kidney Infection

    Acute pyelonephritis or kidney infection: 
    One of the most common renal diseases.  Pyelonephritis most commonly
    results from an ascending infection.  The most common infecting organism
    is Escherichia coli.  Others are Proteus, Pseudomonas, Staphylococcus
    aureus, and Streptococcus faecalis.  It primarily affects the interstitial
    area and the renal pelvis and, less often, the renal tubules.  Risk
    factors can include diagnostic and therapeutic use of instruments, as in
    catheterization, cystoscopy, or urologic surgery.  Inability to empty
    the bladder, urine stasis (stoppage), urinary obstruction from tumors,
    strictures, or benign prostatic hypertrophy can also lead to pyelonephritis. 
    Other risk factors includes; sexual activity in women (intercourse increases
    the risk of bacterial contamination), pregnancy – approx. 5% of pregnant
    women develop asymptomatic bacteriuria, if left untreated, about 40% 
    develop pyelonephritis.  diabetes are also prone to develop pyelonephritis
    (glycosuria may support bacterial growth in the urine) 

    Symptoms: 

    Urinary urgency

    urinary frequency

    Burning during urination

    Dysuria (difficulty and or painful urination)

    Nocturia (excessive urination at night)

    Hematuria (blood in the urine) usually microscopic but possibly gross
    (visible)

    Possible cloudy urine

    urine may have a foul smell – fishy odor

    Fever of 102 degrees or higher

    Chills, shaking chills

    Flank pain

    Anorexia

    Fatigue

    Treatment:

    Antibiotic therapy for specific infecting organism.

    If the infecting organism can’t be identified, treatment consist of
    a broad – spectrum antibiotic.

  • Kidney Stones

    Renal calculi also called Kidney stones: 
    Kidney stones may form anywhere in the urinary tract but usually develop
    in the renal pelvis or calyces.  Such formation follows precipitation
    of substances normally dissolved in the urine ( calcium oxalate, calcium
    phosphate, magnesium ammonium phosphate, or, occasionally, urate or cystine
    ).  The causes are unknown, risk factors include: 

     * Dehydration – decreased urine production concentrates calculus
    – forming substances. 

     * Infection – damage and infected tissue serves as a site for
    calculus development; pH changes provide a favorable medium for calculus
    formation (especially for magnesium ammonium phosphate or calcium phosphate
    calculi ); or infected calculi (such as; magnesium ammonium phosphate or
    staghorn calculi ) may develop if bacteria serve as the nucleus in calculus
    formation.  Such infections may promote destruction of renal parenchyma
    ( functional elements of an organ ).

     * Obstruction – Urine stasis ( as in immobility from spinal cord
    injury ) allows calculus constituents to collect and adhere, forming calculi. 
    Obstruction also promotes infection, which in turn, compounds the obstruction.

     * Metabolic factors – Hyperparathyroidism, renal tubular acidosis,
    elevated uric acid levels (usually with gout ), defective metabolism of
    oxalate, genetically defective metabolism of cystine, and excessive intake
    of vitamin D or dietary calcium may predispose to renal calculi.

    Kidney stones or renal calculi vary in size and may be solitary or
    multiple.  They may remain in the renal pelvis or enter the ureter
    and may damage renal parenchyma.  Large calculi cause pressure necrosis,
    and may cause obstruction depending on location.

    Symptoms:

    Symptoms varies with size, location, and cause of the calculus.

    Pain – the pain of classic renal colic travels from the costovertebral
    angle to the flank, the supra pubic region, and the external genitalia. 
    The pain fluctuates in intensity and may be excruciating at its peak. 
    If the stone or calculi are in the renal pelvis and calyces, pain may
    be more constant and dul    l.  Back pain occurs from calculi
    that produce and obstruction within a kidney.  Nausea and vomiting
    usually
    accompany severe pain.  Patient may have abdominal distention,
    fever and chills, with possibly hematuria (blood in
    urine), pyuria (pus in the urine), and rarely, anuria (suppression
    of urine).

    Treatment:

    Because 90% of renal calculi are smaller than 5 mm in diameter, treatment
    usually consists of measures to promote their natural passage.  Along
    with increase, vigorous hydration, such treatment includes antimicrobial
    therapy     for the infection, varying with the cultured organism. 
    Your doctor may prescribed an analgesics for pain, and diuretics
    to prevent urine stasis and further calculus formation.  Prophylaxis
    to prevent calculus formation includes; a low calcium diet , and
    daily intake of ascorbic acid to acidify the urine.

    Stones (calculi) too large for natural passage may require surgical
    removal. When calculus in in the ureter, a cystoscope may be inserted through
    the urethra and the calculus manipulated with catheters or retrieval instruments. 
    Extraction of calculi from other areas may necessitate a flank or lower
    abdominal approach.  Percutaneous ultrasonic lithotripsy and extracorporeal
    shock wave lithotripsy shatter the calculus into fragments for removal
    by suction or natural passage.

  • Laryngitis

    Larynx:  the organ of voice; the air passage
    between the lower pharynx and the trachea, containing the vocal cords and
    formed by nine cartilages.

    Laryngitis:  inflammation of the larynx

    Acute laryngitis may occur as an isolated infection or as part of a
    generalized bacterial or viral upper respiratory tract infection. 

    Cause:  Acute laryngitis results from infection, excessive use
    of the voice, inhalation of smoke and or fumes, and aspiration of caustic
    chemicals.

    Chronic laryngitis results from upper respiratory tract infection such
    as, sinusitis, bronchitis, allergy, and nasal polyps. It is also associated
    with constant exposure to dust or other irritants, smoking, alcohol abuse,
    and mouth breathing.

    Symptoms: 

    Hoarseness

    Pain – especially when swallowing and or speaking

    Fever

    Dry cough

    Malaise

    Laryngeal edema

    Chronic laryngitis – A persistent cough

    Treatment:

    Resting the voice would be the primary treatment.

    Analgesics and throat lozenges for pain – for viral infection

    Antibiotic therapy – for bacterial infection

    May require hospitalization – for severe, acute laryngitis

    Occasionally, when laryngeal edema results in airway obstruction, a
    tracheotomy (incision of an opening into the trachea through the skin and
    the muscles of the neck) may be necessary.

    In chronic laryngitis, effective treatment must eliminate the underlying
    cause.

    Suggestion:  Patient should maintain adequate humidification by
    using a vaporizer or humidifier during the winter, by avoiding air conditioning
    during the summer (because it dehumidifies), by using medicated throat
    lozenges, and by not smoking.  Completing the prescribed antibiotic
    therapy.  Modification of predisposing habits.

  • Legionnaires’ Disease

    Legionnaires’ Disease  or Legionella
    pneumophila :      It derives its name and notoriety from the peculiar,
    highly publicized disease that struck 182 people ( 29 of whom died) at
    na American Legion convention in Philadelphia in July 1976.

    Legionnaires’ disease is an acute bronchopneumonia produced by a gram-negative
    bacillus.  This disease may occur epidemically or sporadically, usually
    in late summer or early fall.  Its severity ranges from a mild illness,
    with or without pneumonitis, to multilobar pneumonia, with a mortality
    as high as 15%.  Pontiac syndrome mimics Legionnaires’ disease but
    produces few or no respiratory symptoms, no pneumonia, and no fatalities,
    but it leaves the patient fatigued for several weeks.

    Cause:  Legionnaires’ disease bacterium (LDB), is an aerobic,
    gram-negative bacillus that probably is transmitted by an airborne route. 
    In may be spread through cooling towers or evaporation condensers in air-conditioning
    systems, in soil and excavation sites. (it is not spread from person to
    person).

    LDB, usually affects more often in men than in women and is most likely
    to affect:

    Middle aged and elderly persons

    Immunocompromised patients

    Patients with a chronic underlying disease

    Alcoholics

    Symptoms:

    Onset of the disease may be gradual or sudden

    After a 2 to 10 day  incubation period, nonspecific, prodromal
    signs and symptoms appear, including:

    Diarrhea

    Anorexia

    Malaise

    Diffuse myalgias and generalized weakness

    Headache

    Recurrent chills

    Unremitting fever ( which may develop within 12 to 48 hours with a
    temperature that may reach 105 degree F

    Cough – initially nonproductive but eventually may produce grayish,
    nonpurulent and occasionally blood streaked sputum.

    Nausea & vomiting

    May become disorientated, confused and may have mild temporary amnesia

    Pleuritic chest pain

    Tachypnea

    Dyspnea

    May experience bradycardia

    Patient who develop pneumonia may also experience hypoxia

    Other complication include hypotension, delirium, acute respiratory
    failure, renal failure, and shock (usually fatal).

    **  See your doctor promptly if you have the above symptoms.

    Treatment:

    Antibiotic therapy

    Antipyretics

    Fluid replacement

    May require oxygen therapy

  • Leukemia

    Leukemia:  a progressive, malignant disease
    of the blood forming organs, marked by distorted proliferation (the reproduction
    or multiplication of similar forms, especially cells) and development of
    leukocytes (WBC) and their precursors (something that precedes) in the
    blood and bone marrow.  It’s most common forms include acute lymphoblastic
    (lymphocytic)
    leukemia
    (ALL)    , involving abnormal growth of lymphocyte precursors (lymphoblasts);
    acute
    myeloblastic
    (myelogenous) leukemia (AML), involving
    rapid accumulation of myeloid precursors (myeloblasts); and acute
    monoblastic     (monocytic)
    leukemia, or Schilling’s
    type,     involving marked increases in monocyte precursors (monoblasts).

    Acute leukemia is most common in children, and ranks 20th as a cause
    of cancer related deaths among people of all age groups. Untreated, acute leukemia invariably leads to death, usually the result
    of complications that result from leukemic cell infiltration of bone marrow
    or vital organs.  With treatment, prognosis varies. (Studies shows)-In
    acute lymphoblastic leukemia, treatment induces remissions in 90% of children
    (average survival time: 5 years) and in 65% of adults (average survival
    time: 1 to 2 years).  Children between ages 2 and 8 have the best
    survival rate – about 50% with intensive therapy.  In acute myeloblastic
    leukemia, the average survival time is only 1 year after diagnosis, even
    with aggressive treatment.  In acute monoblastic leukemia, treatment
    induces remissions lasting 2 to 10 months in 40% of children.  Adults
    survive only about 1 year after diagnosis, even with treatment.

    Causes:  The exact cause of acute leukemia is unknown. 
    Risk factors are thought to include some combination of viruses,, genetic
    and immunologic factors, and exposure to radiation and certain chemicals.

    Symptoms:

    Sudden onset of high fever/low grade fever

    Abnormal bleeding (example: nosebleeds, gingival bleeding, purpura,
    ecchymoses, petechiae)

    Bruising (even if it’s a minor trauma)

    Prolonged menses (females)

    Weakness

    Pallor

    Dyspnea

    Fatigue

    malaise

    Tachycardia

    Palpitations

    Abdominal or bone pain.

    Headache

    Treatment:

    Systemic chemotherapy 

    Chemotherapy varies with the specific disorder:

    Bone marrow transplant is now possible in some cases.

    Antibiotic therapy, antifungal, and antiviral drugs may be ordered.

    Transfusions 

    Chronic Myelogenous Myelocytic) Leukemia
    (CML):      Known also as: Granulocytic Leukemia,
    produces abnormal overgrowth of granulocyte precursors (myeloblasts, promyelocytes,
    metamyelocytes, and myelocytes) in bone marrow, peripheral blood, and body
    tissues. 

    CML progresses in three distinct phases: 
    the insidious chronic phase, with anemia and bleeding abnormalities;
    an accelerated phase; and, eventually, the acute phase (blastic
    crisis), in with myeloblasts, the most primitive granulocyte precursors,
    proliferate rapidly.  This disease is invariably fatal. Studies shows
    average survival time is 3 to 4 years after onset of the chronic phase
    and 3 to 6 months after onset of the acute phase.

    Causes:  Just about 90% of patients
    with CML have the Philadelphia (Ph1) chromosome.  Radiation and carcinogenic
    chemicals may induces this chromosome abnormality.  Myeloproliferative
    diseases also seem to increase the incidence of this disease.  Also
    believe to be a cause is that of an unidentified virus.

    Symptoms:

    Anemia

    Fatigue

    Weakness

    Decreased exercise tolerance

    Pallor

    Dyspnea

    Tachycardia

    Headache

    Thrombocytopenia  (decrease in number of
    platelets in circulating blood – resulting in bleeding and clotting disorders,
    such as retinal hemorrhage, ecchymosis, hematuria, melena, bleeding gums,
    nosebleeds, and easy bruising).

    Hepatosplenomegaly (enlargement of the liver
    and spleen), with abdominal discomfort and pain.

    Sternal and rib tenderness

    Low grade fever

    Weight loss

    Anorexia

    Prolonged infection and ankle edema

    Treatment:

    Chemotherapy

    Radiation therapy

    Splenectomy (controversial)

  • Lung Abscess

    Lung Abscess:  Lung infection that is accompanied by
    pus accumulation and tissue destruction.  It often has a well defined
    border.  Anaerobic or aerobic bacteria can cause lung abscess. 
    Antibiotics has made the condition much less common now than formerly. 
    Poor oral hygiene with dental or gingival (gum) disease is strongly associated
    with putrid lung abscess.

    Symptoms:

    Cough – may produce bloody, purulent, or foul smelling sputum.

    Pleuritic chest pain

    Dyspnea (difficulty breathing)

    Excessive sweating -Diaphoresis

    Chills Fever

    Headache

    Malaise

    Weight Loss

    Crackles

    Diminished breath sounds

    Treatment:

    Prolonged antibiotic therapy

    Postural drainage may help discharge necrotic material into upper airways,
    where expectoration is possible.

    Oxygen therapy may be needed

    Poor therapeutic response requires resection of the lesion or removal
    of the diseased section of the lung. 

    All patients need rigorous follow up and serial chest X-rays.