What Are The Main Causes of Clubfoot?

clubfoot-ponseti-giftClub Foot is a deformity of the foot and ankle that can completely affect the movement and function of the foot and/or ankle. There are three main types of deformities that can be seen. The actual cause of club foot is debatable.

Some argue that no single cause exists for club foot. As you will read, there is quite a bit of controversy in the cause of this condition.

Often the cause of this diagnosis is called idiopathic – or unknown. This doesn’t sit well with everyone, in fact, I recently received an angry email (she gave permission to make reference) regarding a doctor’s visit she had where the cause was classified as unknown.

At the same time, there are certain syndromes or birth defects that see a higher propensity of having a club foot. Therefore, club foot can happen on its own or because of other genetic or other conditions.

Essentially, club foot is a congenital deformity that happens in 1 out of every 1,000 births. It is seen twice as often in men than in women. It can be seen in screening during the 20th week ultrasound. At that time, the development is advanced enough to get a good look.

low-middle-income-countries-1Screening is somewhat controversial. Many doctors, because this condition can be associated with other birth defects, screening becomes that much more important.

If only the birth defect of club foot is seen, it is called isolated. But if club foot plus another congenital deformity is seen – it becomes complex.

Other birth defects that can be associated with club foot include spina bifida, Edwards syndrome, Growth arrests, and others.

A large cause is not by congenital disorders changes but rather the position of the baby when inside the womb of the mother. Though this topic is another point of controversy. Others believe that this has no bearing on the presence of club foot.  In these cases, the cause is often unknown.

Other risk factors that are considered environmental factors or causes include sex, mother smoking (20 times more likely), family history, decrease in amniotic fluid, illicit drug use, and infections during pregnancy.

child_foot_clubfoot_causes01Some studies have shown that there’s a 2.5% chance that the next sibling born in a family after one with a club foot will also have this condition. If its a girl who has a club foot, there’s a 6.5 percent chance that her next-born sibling will also have a club foot. This is quite interesting.

Learn more about additional risk factors, treatment, different types, and joints affected at the following link – here

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When is too early to give a baby – milk, peanuts, eggs, or fish?

milkAs parents, it has been beaten into our minds that there are foods that shouldn’t be given too early in our baby’s lives.

Be it for reasons such as food allergy, ability to consume, or another reason such as family folklore. It is certain that every parent struggles when to give solid foods, certain foods, and liquids such as milk and water. There are foods such as whole milk, peanut butter, eggs, fish, and more that we’ve been told to wait because of food allergies. Usually we are waiting until our children reach at least one year until we even consider giving these foods.

Could the time to give these food items actually be sooner than previous recommendations?

 

Old Recommendations

Back in 2000 – The American Academy of Pediatrics (AAP) suggested that Milk was to be given after 1 year of age.  Eggs were to be given after 2 years of age. Peanuts and Fish weren’t to be given before age 3.

In 2008 and 20111 – The recommendations were changed by the American Academy of Pediatrics (AAP) – they indicated that no data was present to continue with their previous recommendations. But that had been 8 years of Parents, Pediatricians, and other providers believing and following the recommendations. It has been hard, even from a provider’s standpoint, to change those recommendations given to parents when the question was asked.

peanuts

New Recommendations

Recently, this topic has been looked at by the American Academy of Allergy, Asthma & Immunology. Further evaluation on when was the right time to give foods is a highly debated topic. The findings from the American Academy of Allergy, Asthma & Immunology suggest that milk, eggs, fish, and peanut butter can be given safely as early as 4 – 6 months of age. In addition, it is believed that this may actually prevent a child from developing allergies to these items in the future.

Dr. David Fleisher, a lead author and an Associate Professor of Pediatrics at National Jewish Health at the University of Colorado said, “The key point is that there is no reason why you can’t introduce them early for most children. Children with moderate to severe eczema that is difficult to treat or ones who have already been diagnosed with a [different type of] food allergy are at higher risk. So you may want to wait until they are tested before introducing peanuts or eggs.

eggs

Medical providers, Physicians, and Specialists should advise parents to introduced plain floods such as fruits, vegetables, cereal before offering the other choices. It is not recommended that milk, eggs, fish, or peanuts be the first solid food a baby receives.

 

Reactions to food allergens can be highly varied.

This is important to understand. There is an entire spectrum of reactions to foods. Some will have very mild symptoms that may not even be noticed. There may be some headaches, itchiness, Inflammation, or other symptoms.

That is a far contrast to a more serious type of reaction that can cause difficulty breathing or wheezing.

Very serious effects can be seen with throat closing and life-threatening anaphylaxis.

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Genetic Issues with Allergies

There is obvious a genetic complexity with parents and offspring having allergies. It could be a cousin, grandmother, or sibling. But this is not true in all cases. Caution should be given when family members have food allergies. It doesn’t mean that we shouldn’t give peanuts to our child in those cases, but we need to be cautious and careful.

There are currently no genetic testing that can be done during pregnancy that can help determine if our children will have allergies.

Hope is that this will be a future area where medical advancement and research can be seen.

 

Common Food Allergies

Food allergies in children is on the rise.

Currently around 1 in 12 or 1 in 15 – In the United States – have food allergies.

Most common food allergy is Peanuts

Milk is second most common followed by Shellfish.

Other foods include nuts, fish, wheat, soy, mushrooms, and others.

Children with food allergy also have higher rates of Asthma, skin complaints (Eczema), and Allergies.

 

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5 Important Questions about IUDs

The following are 5 important questions about Intrauterine Device – IUD’s. This type of contraception is used by millions of women. Initial questions are usually easy to find. These questions really help understand what we can expect and it helps answers concerns we might have.

IUD_mirena

1.)  What kinds of IUD or Intrauterine Devices are there?

2 main types.

1.)  Non-hormonal Copper IUD  (ParaGard)

2.)  Hormonal IUD  (Mirena)

Copper IUD is a copper wire that wraps around the T shape device.

Hormonal IUD releases a hormone Levonorgestrel. The Copper IUD is good for 10 years while the Hormonal IUD is good for 5 years.

breastfeeding

2.)  Can an IUD be used during breastfeeding?

Yes. Neither will result in side effects or are harmful to the infant. The quality or quantity of the Breast milk is not affected.

 

 

condom contraception 3.)  Should I use another form of contraception during the first month of an IUD?

For the copper IUD -  It is effective the moment it is placed.  In some cases, it can be effective within the first 5 days after intercourse. This would be considered as Emergency Contraceptive and would be more effective than oral pills.

For the Hormonal IUD -  Immediately effective if placed within 7 days after you started your period. Otherwise, used alternative contraception for the first 7 days.

 

menstrual period4.)  Will an IUD affect my period?

Copper IUD -  May cause irregular menstrual periods. Your periods might become heavier and last longer than you are used to. Cramping can be seen. Complete absence of a period is unlikely.

Hormonal IUD -  Irregular menstrual periods are possible. Decrease in duration and intensity of your period is often seen. You may experience less cramping. Complete absence of a period is likely but doesn’t occur in all cases.

*** Sometimes heavy menstrual periods or very painful menstrual periods are the primary reasons to get a hormonal IUD.

 

pregnant-iud-15.)  Can I get pregnant while I have an IUD

Yes. Although this rarely happens. It is possible. If you think that you could be, meet with your provider immediately.

They may want to ensure you aren’t having an ectopic pregnancy. Ultrasound, exam, blood work, and other evaluations may occur.

If you have a normal pregnancy you can than choose whether to continue the pregnancy.

If you choose to continue with the pregnancy the IUD will be removed immediately. If you keep the IUD during pregnancy  you will risk your health and your baby’s health.

There is a risk of miscarriage when removing the IUD.

If the IUD can’t be removed, you will be monitored closely during pregnancy.

 

Learn more specifics about the IUD or Intrauterine Device – Here

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What really is Pyloric Stenosis and why did it affect my child?

Take a look at our most recent medical question sent in. It isn’t for everyone – but it’s some useful information.

Our child recent underwent surgery for Pyloric Stenosis. We were shocked by the news that our baby was sick. We are hopeful that this will help. Can you please get out the news.

Pyloric Stenosis is an interesting and well understood condition. It affects boys much more than girls. In fact, it often affects the first born males almost 4 times more than others. I am not sure if that is the case from our email reader. But it something to think about.

10281When you have your well child check ups – this is something that is often looked for. It “develops” in the first six weeks of life. Sometimes it can be seen in older children, but this is unlikely. The presenting symptoms is often projectile vomiting. Of course, projectile vomiting can happen in several other diseases – but this needs to be considered each time.

An exam will happen and a mass can be felt in the abdomen in most cases. The word “mass” is often never a good sign. In this case, the mass comes from the functional problem of this condition. Stenosis means narrowing and Pyloric often refers to the stomach and means gate. In this case therefore – a narrowing of the gate is occurring. The location is near the end of the stomach and the Small Intestines.

Food enters the stomach and gets broken down. Some digesting of the food happens in the stomach, but more digesting happens in the intestines. In infants with pyloric stenosis – the food can’t pass from the stomach to the intestines and it therefore is vomited back out the mouth. It needs to go somewhere.

A muscle that helps with the closing of the Stomach when empty becomes quite enlarged. This muscle does not allow for the complete opening of the stomach into the intestines. This portion of the intestines is known as the duodenum. AS the muscle thickens – the opening becomes smaller and smaller.

The real concern of this condition is malnutrition and dehydration. As both consequences advance, serious complications can be seen by the infant. Loss of weight, abdominal pain, food hungers, crying can be seen.

The treatment of this condition is Surgery. A 3-4 cm incision used to be the treatment of choice. Now, laproscopy is the preferred treatment. IV fluids will often be given prior to and after surgery. A child may remain in the hospital for 1-2 days – more if a complication is experienced. Recovery is often seen.

pyloric_stenosis1

The main question about this condition is cause. Functionally – an enlarged muscle is the answer. But, an exact cause is often unknown. Genetics is a likely cause and some see Erythomycin given in the first month of life as another cause possibility. It is believed that a baby is not born with the condition but develops it early in life.

Learn more about Pyloric Stenosis here:

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Medical Question – Addison Crisis

I recently received an email asking about Addison Crisis.

It reads:  My sister-in law just was sent to the hospital and came back with a Diagnosis of Addison Disease and was told she had a crisis. What does this mean?

The answer is interesting.

 

The first thing to understand is about Addison’s Disease:

In this condition, the the Adrenal Gland does not produce enough steroid hormones. (Glucocorticoids as well as mineralocorticoids)

It is a rare condition that affects the Endocrine System. This condition can also be called:  Chronic Adrenal Insufficiency. 70-80% of the time, there is an insufficiency of the adrenal hormone called Cortisol.

Often the cause is damage from one’s own Immune System. This can be referred to as Primary Adrenal Insufficiency. Tumors can be seen, but this is a rare cause agent.

**** Addison’s disease is named after Dr. Thomas Addison, the British physician who first described the condition in 1849

 

Now, onto Addison Crisis!!

It is really called an Addisonian Crisis. This occurs possibly as the result of an undiagnosed condition or a serious change in adrenal function. This is a medical emergency and potentially life-threatening situation. Hospitalization is often necessary part of this disease.

Symptoms of this are:

1.)  Sudden pain in legs, lower back, or abdomen
2.)  Severe vomiting and diarrhea
3.)  Dehydration
4.)  Low blood pressure
5.)  Syncope – Loss of consciousness or ability to stand
6.)  Hypoglycemia [Low blood sugar]
7.)  Fevers
8.)  Confusion
9.)  Psychosis
10.)  Slurred Speech
11.)  Lethargy
12.)  Convulsions

Treatment for Crisis

Standard therapy involves injections of hormones. Large volumes of IV fluid including Dextrose. Fluid by mouth is the next treatment when patient becomes more stable.

Take a look at this to get a better understanding:

Click on the picture to get a better view!

 

 

 

 

 

 

 

 

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Why in the World does your Hair turn Grey?

This question has been asked of me several times now. It is an interesting question, wouldn’t you say? The reason it is so intriguing is that it happens to almost all of us.

Therefore, one would think, it would be a genetic thing. And the answer is yes and no.

The estimate is that a normal person (whatever that really means anyways) has around 100,000 – 150,000 strands of hair on your head. That doesn’t take into account arm, back, leg, or genital hairs. The numbers could be twice that amount or more.

Hair cells, divide so often, that they can duplicate themselves in a few short hours. Some divide faster, that is why some hair grows quicker. As we get older, the cell division, for the most part, slows down. Only the cells of bone marrow grow quicker.

Hair is actually white pigments change the color. There are two types of pigments – Dark (eumelanin) and light (phaeomelanin).  These two pigments will blend together and create the individual hair color.

 

On a Genetic Level

Our genes are the basic code that determines our hair color. We will discuss a chemical called melanin that is closely related to hair color. But our genes are equally as important. Our genes from our parents give us our hair color. There are many aspects of genes involved that is why shades of color are important.

There isn’t a single gene for blond if so….that would mean only a few basic hair colors.

That would be so boring!!

 

Cell Growth of Hair

At the base of each hair is a hair follicle. This is the pigment of cells responsible for hair growth. Pigment cells are also what are responsible for the color of the hair. A chemical is produced called melanin. This substance is what is responsible for our hair color: red, black, blond, brown or another combination.

The amount, type, and mixture of melanin will lead to hair color.

 

Going Grey

This can occur at any age. Part of this may have to do with genetics. If your Dad or Mom went gray at twenty you are at risk of doing the same thing. Gray can come immediately or over time. Genetics and some other things play a role in this. Probably the most important role is genetics.

Your risk of going grey – on average – increase around 10-20% for every decade of life after 30.

 

Death of the Follicle

Over time, as we age, the pigment aspect of the follicle starts to die. It may not be all at once or all the follicles at once. This turns the color or the hair loses color. The result may be grey, white, silver, or some combination.

 

Other causes of a Grey color

Since Genes aren’t the only issue what are other things to consider. Well, where you live can play a huge role. A very dry climate can be harsh on the hair. It can lead or be a risk factor to color change. Just as when you were a kid, and played at the beach, and your color lightened a similar thing can happened.

Next, things like toxins, chemical exposure and pollutants all can affect hair color. These aren’t necessarily a short term thing. But for long exposure can be the culprit.

 

Stress, Children, and Medical Issues

There are many who would argue – despite chemical changes – stress and children can lead to grey hair.

Truthfully, the jury is still out on this. Obviously there are people we’ve seen that have dramatically changed their hair color – no of their own choosing.

But we can’t be certain – it wouldn’t have happened otherwise.

I see the proof in some photos of those who’ve had a difficult time. Some – but not all have had dramatic changes.

Therefore – stress has to be at least a consideration.

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Should Gardasil be a Required Vaccination for Boys?

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Gardasil is one of the few available vaccines for HPV.  Human Papillomavirus or more commonly known as HPV is a virus that is sexually transmitted. It has several types, but only a few types have been directly linked to cervical cancer.

Recently the The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted and approved the use of Cervarix for girls 11 and 12.

Gardasil has been approved for use since 2006.

Cervarix was approved by the Food and Drug Administration on October 16th

The panel also voted to approved the use of Gardasil to males between the age of 9 through 26.

The dosing for Gardasil and Cervarix will be approved and allowed in the Government’s Vaccines for Children program

This program will provide immunizations free for uninsured and under-insured children.

Dosing for both will be given in 3 doses

-    1st shot:
-    2nd shot:   1-2 months following the 1st shot
-    3rd shot:   6 months following 1st shot

Gardasil is made by Merck & Co
Cervarix is made by GlaxoSmithKline

Will Boys choose to have Vaccine?

This appears one of the main questions.   Since men don’t get cervical cancer they may not feel the responsibility.   Although the vaccination does not  just cover cervical cancer but covers genital warts as well.

It is believed that only 1% of sexually active males in the U.S. develop genital warts.   Genital warts are not life threatening.

The true benefit would return back to the female.

Some argue to require or mandate a vaccination and prompt health insures to pay for this vaccination.

Currently no mandate has been put into place but the CDC will begin debating this argument in the next few weeks.

A Harvard University study recently placed in the British Medical Journal this mouth found no cost benefit by vaccinating boys. Consideration for the benefit that women would gain was added into this study, though it didn’t change the outcome.   However, Mereck did their own study and found the results were different from the study done at Harvard University.

“It may seem unfair:   Should this burden be borne by only girls and women?” asked Nancy Berlinger of the Hastings Center, a nonprofit bioethics research institute.

http://online.wsj.com/article/SB125572545935790741

Check out the blog article entitled:  HPV Vaccine may do more than prevent Cervical Cancer, it may cause girls to be more cautious about sexual activity

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To have a C-Section or not to have a C-Section? – That is the question!!

birth - delivery

Recently I spoke with a women who was not very far along in her pregnancy.  We discussed several issues such as:  how long she had been trying, what she was giving up, her “planned pregnancy“,  her worries, her symptoms, and other concerns.   Then she threw me for a loop by saying that she was planning on having a C-section rather than vaginal delivery because she didn’t want to go through the pains of childbirth.

I wasn’t even sure that was an option.  Is elective C-section so planned that one may decide to have a C-section for non medical reasons?  A very interesting concept and can be a great argument starter at family parties.  My personal jury is still out deciding on a verdict…. but what do you think?

Background

Giving birth by Cesarean section or also called Caesarean section and C-section can be a difficult choice.  For many it becomes a life saving measure during an emergency while giving birth.  It is another option other than vaginal delivery

The raise in number of C-sections is astounding.  Consider that in 1970 only 6 percent of all births were by C-section.  Back in 2005 that number had increased 5 times to over 30% of pregnancies.

C-section is a abdominal surgery then through the uterus to allow for the birth of a child. It is often considered riskier than vaginal birth but both procedures cause a risk for  mortality of both the baby and the mother.

Birth C-section

The following are several reasons to have a C-section planned:

1.)  A previous C-section – although not must – having a previous C-section does not prohibit you from ever having a vaginal delivery again

2.)  Your baby is breech   [Bottom first]

3.)  Your baby is transverse  [sideways]

4.)  More than one baby – C-section may be an option

5.)  You develop a conditon known as Placenta previa

6.)  Mother having HIV and a high viral load    [HIV isn't passed through the placenta but can be transferred
during vaginal delivery

7.)  Complication to baby that otherwise would worsen with vaginal delivery

8.)  A very large baby

9.)  Others

birth - premature
Unplanned C-sections

1.)  Difficulty during birth

2.)  Distress of baby during birth

3.)  Umbilical cord concerns

4.)  Placenta abruption  [when the placenta unattaches from uterine wall - loss of oxygen to baby]

5.)  Others
*** – remember that over 90% of preterm deliveries are done by C-section   http://www.marchofdimes.com/aboutus/22684_30185.asp

birth - 1

Elective C-section

-       Some doctors endorse c-sections for medical reasons

-       Some OBGYN clinics in Italy have a 80-90% C-section rate to prevent lawsuits

-       In Brazil  -  hospitals are allowing 80% of births to be done by C-section

-       Increase number of C-sections are being done for non medical reasons

My recent conversation isn’t unheard of and is increasing in value for many women.  Some women report watching family members with difficult deliveries and others want an uncomplicated delivery.  A reported increase in the number of women waiting to become pregnant until later in their lives may also be a factor. This is just one of many areas that women and physicians alike have drawn lines and have begun to debate the idea of non medical elective C-sections.

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Swine Flu Questions

Q:    What is the Swine Flu?

The  Swine Flu is a type of Influenza Virus, it is also referred to as H1N1. Several other types of virus can transmit from animal to humans when mutated.  Such as avian, horse, dog, and pig.

It was first found in Mexico in April of 2009.       This type of virus from a class of viruses called Orthomyxoviruses

There are 5 main types of this virus and the swine influenza is a subtype of one of the 5.   Influenza A is the major player in many flu symptoms and epidemics each year and the Swine flu is a type of Influenza A

Q:     I recently heard that washing your hands won’t help with the Swine Flu? I don’t see how that is possible!!!

This is a great question. I am completely positive that washing your hands helps with most viral and bacterial infections. At least helps prevent. And typically passing soap over your hands and scrubbing can be quite effective in the prevention of passing microbes from person to person.

When it comes to the swine flu however, contributing factors to the passage of infection such as restroom use, touching a door knob, covering your mouth when coughing, passing money and others can not be compensated by washing hands alone.

Recent Studies point to the passage of Swine flu through breathing and inhaling the microscopic particles that are already in the air. This is the main action or transmission of this virus. Sneezing into your hands may not even be a great way passage of the virus is seen. However, droplets from sneezing are airborn and breathed into the lungs causing the infection. This may also be why some believe that you can get the swine flu even after the person sick has left the room. The virus is still in the air and you breath it in.

 Q:    Why is the Swine Flu a Pandemic?

The U.N. Health Officials met in Geneva on Thursday June 11th, 2009 to discuss the H1N1 virus the World Health Organization (WHO) officially declared a 2009 Swine flu pandemic. This is the first such update in over 41 years. . The severity of the virus world wide is rather moderate but the reason for the classification to pandemic is related to how quickly the virus has spread. 

WHO chief Dr. Margaret Chan said The World is moving into the early days of its first influenza pandemic in the 21st century.

Q:    Is there a Vaccine for the Swine Flu in 2009 and 2010?

Yes,  the CDC has helped to provide a vaccine that is available for the public.   The Virus in question has been isolated and several companies have worked hard to find a workable vaccine.

Q:    Who should get the vaccine?

According to the Advisory Committee set up by the CDC, several groups are recommended to get the vaccine:

1.)    Pregnant Women
2.)    Caregivers
3.)    Healthcare professionals
4.)    All individuals 6 months to 24 years of age
5.)    Those from age 25 to 64 who are at risk and have other health coniditons

Q:    Does it protect against the seasonal flu?

No, for protection against both the seasonal flu and the Swine Flu then you will need both vaccines

Q:    How should I decide who gets the Swine Flu Vaccine?

Follow the guidelines or otherwise speak to your health care professional

Q:    Does a product like Lysol help kill Influenza?

It appears so, Lysol Disinfectant spray, wipes and cleaners are reported to be successful in killing the virus

Blogs related to the Swine Flu:

H1N1 Plateau and MutationsNational Emergency – The Swine FluSwine Flu – Heating Up or Exploding??

Let Human Testing Begin!!!

Swine Flu Vaccine Awarded First Contract

Pandemic WHO – Updated with new related deaths

Pandemic WHO

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What do you think about health reform and the new website initiated by Obama?

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