Constipation

1. Constipation In Children

Hard stool, infrequent bowel movement in Children are very common

Symptoms:

Hard Stool
Bowel movement every 2nd or 3rd day
Bloating/Gas
Abdominal Pain while passing stool

Causes:

- Fear of passing stool
- Less fibers in Diet 
- Drinking less or infrequent water
- Milk allergy
- Certain pain medicines or antidepressant medicines
- Rarely low thyroid hormone 

Treatment/Solution:

1. Make sure child is not afraid of passing stool.
These happen while starting toilet training or when child starts school. Child avoid going to toilet and hold stool, which cause stool to get dry and hard.
- Make a habit to make child sit on toilet for 10 minutes in the morning and evening. Once they stat passing stool at a regular time fear will go away.

2. Add more fibers in diet / Make child Eat at least two fruits and vegetables in a day
These include banana, apples, green vegetables, whole grains like roti and bread. Taking 2 prunes a day really helps.

3. Ask child to drink more water
Keep eye on how much water your child drink. 5 year old should drink atleast 5 glass of water a day.

4. Try changing milk or stopping milk for couple of days and see if that helps

5. Make sure child is active and doing enough exercise
Activity helps to relieve constipation. Play with child such as hide and sick, or tag or dancing. Now a days when outdoor games are becoming less and less and TV has made life sedentary, exercise is needed in form of free play.

5. If child is taking medicines which can cause constipation, stop medicines if not needed or try taking fiber tablets to avoid constipation

6. If constipation is associated with obesity and concentration problem, check child's thyroid hormone level with your physician.

More information can be found on following link by mayo clinic on constipation in children.

https://www.mayoclinic.org/diseases-conditions/constipation-in-children/symptoms-causes/syc-20354242


2. Costipation in Adults

Two type of constipation in adult. Acute which can be due to bowel obstruction and chronic. Here we will discuss only on chronic constipation. 

Symptoms;

- Straining while passing stool,
- difficulty in passing stool
- irregular/infrequent bowel movement.

long term non-treated constipation can cause following side effect

-Piles/ hemorrhoids - due to straining
-Anal Fissure- as hard stool rub and damage anal mucosa


Causes:

- Sedentary Life style
- Drinking less water
- Less fibers in Diet
- Obesity
- Drinking coffee and soda
- Pregnancy
- low thyroid hormone
- Antidepressant, codeine or opioid pain medicines

Solution:

1. Avoid coffee/ excessive black tea and sodas
2. Try changing or stopping milk
2. Drink plenty of water - 8 to 10 glass a day
3. Eat more fibers in Diet: fruits, vegetables, prune and prune juice helps
4. Exercise regularly- walk 20- 30 minutes a day
6. Use Castor oil coated rice, wheat and lentils rather than dry lentils
7. Reduce weight, check thyroid hormone and get treatment if you have hypothyroidism
8. Use fiber tablets and stool softner in case you also have anal fissure or piles

Beware of Pain medicines?

NSAIDS/ AntiInflammatory or Pain relieving medicines

Ibuprofen
Naproxan
Diclofenac

These are easily available medicines for pain without doctor's prescription.But, It has serious side effects.

Most common side effects:

1. Heartburn/Acidity
It can cause blockage of protective enzyme receptor and increase acid in the stomach. It can cause ulcers and bleeding in stomach. Watch for black stool while taking these medicines on long term.

2. Liver failure
High dose and long term use can cause damage to liver cells and liver failure specially in people with fatty liver.

3. Kidney(Renal) failure
High dose and long term use can damage kidney cells and can cause slow renal dysfunction. Specially in patient with mild renal problem or diabetes caution is needed.

These medicine can be used safely if for short time/few days, but long term >1week use should be avoided. 


Opioids/ Narcotics

Morphine
Hydrocodone
Tramadol

These medicines will not be available without doctor's prescription.

Side effects;

1. Constipation
Most common side effect. 

2. Tolerance
Meaning you no longer respond to drug the same way you responded earlier. Overtime you will need higher doses to get same pain relieving effects

3. Dependence
High chance of becoming mentally addicted and or physically dependent. You get unpleasant symptoms while trying to get rid of that medicine after a longterm use.

4. Respiratory depression 
At higher dose it can cause respiratory depression and death.

These medicine are only for severe pain, its controlled medicines, and should be taken under strict guidance of physician. 

It should be taken only for sort time/3-4 days to avoid dependence. 

• Other remedies for pain:

Supportive / alternatives to pain medicines:

- Use hot and cold compression
- Bed rest when needed (ex. Disc problems). Avoid more than 3 days of complete bed rest.
- Avoid certain posture ( Ex. For knee pain avoid sitting on the floor, for back pain avoid carrying heavy weight)
- 'Get up and go'. Try to keep mind busy by activities and productive work. 
- Avoid Stress.
- Swimming and Walking are good exercise
- Ginger, Turmeric and Capsaicin, Lavender oil and Eucalyptus oil are natural remedies which might help.

Stroke

What is Stroke?

  

Signs and symptoms that are experienced due to lack of blood supply to certain part of brain. It can be due to blockage of one of the artery supplying brain or due to bleeding in the brain due to tear or rupture of the artery supplying the brain.

It's an emergency. Time is very crucial in it. Each passing minute after stroke without treatment, increases the chances of permanent disability.

Symptoms

-Sudden slurring of speech
-Facial paralysis / One side of face droops down when attempting to smile
-Sudden inability to move one sided upper and or lower limb
-Sudden balance problem with inability to stand steady
-Nausea, vomiting associated with Severe Headache

Sort form to remember is FAST that is developed by American stroke association.
1. Facial droop
2. Arm weakness
3. Speech difficulty
4. Time to call 911 in USA or 108 in India
https://www.stroke.org/understand-stroke/recognizing-stroke/act-fast/

Causes

Uncontrolled High blood pressure
Blood clot usually traveled from heart 
Aneurysm/ abnormal dilatation of blood vessels supplying brain

Treatment

Its based on weather its due to a block or bleeding.  CT scan of brain is needed to find it out. Treatment is like a two way sword in a stroke.

1. Block in vessel due to clot

Thrombolytic agents should be ideally given within 1 hour of last well known time but can be given up to 4 hours. NOT after it. Higher chances of full recovery if given in first hour but it also have risk of bleeding.

Also, thrombectomy, a surgical procedure to remove clot, can be done in first 24 hours in eligible patients. But only few doctors are trained to do it at very few hospitals.

After 24 hours of stroke, any treatment given is a supportive care to prevent another stroke. Intense physical therapy might help with recovery rate.

2. Bleeding 

Any agents like aspirin or any blood thinner increase further chance of bleeding. Immediately stop it. They usually put a drain in the brain called EVD to decrease intracranial pressure. Also some supportive treatment like controlling blood pressure is highly important.

Take home message: With any of above mention symptom of stroke, immediately call 911 in USA or 108 in India, and go to the hospital where CT scan facility is available.

Prevention: 

Controlling blood pressure and healthy life style are keys to prevent stroke.


More information about the stroke can be found on the following website by American Heart Association/ American Stroke Association.
https://www.stroke.org/understand-stroke/

Allergy

What allergy means in simple words?

Allergy simply means reaction to a thing(allergen) that our body don't like or reject. That reaction occurs by our immune system cells which tries hard to get rid of that stuff.


What are the symptoms:


Mild symptoms:


Hives/Rashes: looks similar to what we see when an ant or mosquito bites us, but this will be multiple either all over body or locally. It is mostly associated with itching.



Diarrhea, vomiting


Severe Symptoms:

Mouth swelling, difficulty to breath due to laryngeal edema, Dizziness, skin pilling or blisters- Immediately go to Hospital if any of this severe symptoms appears.




Treatment:

Only one: Find out what substance you are allergic to and avoid it.
Once you get in contact with allergen, after you get rid of it, it will take couple of days until body stop reacting to that allergen.
For Symptomatic Care: Use antiallergen or antihistaminics
Example:
1. Syrup. Benadryl 5ml for children >5year age, and 10ml for adults for two to three times a day for 2-3 days
or
2. Tablet Cetrizine10mg - one tablet once a day for adult and half tablet once a day for children more than 5 year of age, for 2-3 days.
3. Calamine lotion : It will help with itching and burning
4. For Difficulty in breathing/asthma: Use albuterol inhaler if available immediately until you reach to physician


How to find out what is causing allergy?

It usually take 1-2 days to develop allergic symptoms first time but it will take just few minutes to a hour for second time exposure.  Think what new thing you used or try in past couple of days.
Think of followings:
New food?
Most common are:
Nuts (peanut can cause severe allergy),
Milk (Lactose allergy can cause bloating and diarrhea),
Chocolate/Candy,
Wheat( diarrhea, rashes),
Fatty food (foul smelling stool),
Oil,
eggs/ meat/fish
New weather?
New weather like sudden cold weather or sudden rainy wet weather can cause reaction in airway which can cause difficulty in breathing
New body soap/ Detergents?
Can cause small rashes all over body
New cloths?
Can causes rashes on contact area
New Medicine?
Any including multivitamins can cause mild to severe allergic reactions
Mold in house/ backyard?
It mainly causes breathing problems/ asthma
Animal contact/ Animal dropping/hair contact?
Animal contact or contact with their dropping or hair can causes rashes and itching
Dust allergy?
It usually causes breathing problems, such as asthma, nasal congestion,and coughing.
Keep the house clean specially sleeping area. Get rid of carpets as it hold dust, plus in a day today life we don't clean carpets everyday. Wooden floor or tile floor is much better than carpet as you can see dust on it.



If symptoms remain persistent and you are unable to find out what causing allergy, then take appointment with allergy/immunology specialist to get various allergen testing done.

CPR

When I visited India last time about 6 months ago, my father in law passed away with sudden death. He did not get any CPR (Cardio Pulmonary Resuscitation) at that time and we were not near them at that moment. For increasing chances of survival for anyone who suddenly become unresponsive CPR can be given by anyone nearby until medical ambulance or care is available. 

There are the simple steps of CPR that everyone should know.

https://www.redcross.org/take-a-class/cpr/performing-cpr/cpr-steps

1. Tap person hardly and ask Are you ok, If no answer then

2. Call for help. 911 at USA or 108 in India for assistance

3. Open the mouth,  with the person lying on his or her back, tilt the head back  

4. Check for breathing. Check putting hand near nose or look for chest movement. If  no breathing begin CPR.

Steps of CPR: 

x

1. Chest Compression: 100 compression per minute

Place your hands, one on top of the other like making a bird sign with hand. Put it in the middle of the chest just above the abdomen. Keep the elbow straight. So, your body weight can help you do deep compressions that are at least 5 cms deep. Do atleast 100 compressions per minute. Push hard, push fast. 

2. Breething: 2 blows per minutes

Tilt person's head back, pinch nose, open his mouth and blow in to his/her mouth so the person's chest can raise. Blow two times and then continue with chest compression. 

Continue CPR steps. Keep doing chest compressions and breathing at a ratio of 100:2 until the person starts breathing or ambulance or doctor arrives. 

Ready for your questions?

I will try to answer your question regarding heath and will provide you information and suggestion to the best of my knowledge and with article search.

Jay Shree Krishna