Conditions we Treat
ABSCESS - INCISION & DRAINAGE
An abscess (sometimes called a “boil”) is a pocket of pus under the skin that starts when bacteria get trapped under the skin and begin to grow. This can occur with an infected hair root, oil gland, “pimple,” cyst, or puncture wound. This is usually treated with an incision to drain the pus from the abscess, although the use of “drawing salves such as Ichthymmol Ointment can be trialed. If the abscess pocket was large, it may be necessary to insert a gauze packing. Antibiotics may not be required in the treatment of a simple abscess, unless the infection spreads into the skin around the wound (known as “cellulitis”). It will take about 1 to 2 weeks for the wound to heal depending on the size of the abscess.
There are many causes of abdominal pain. Pain can mean a serious problem (such as appendicitis) requiring surgery, or an innocent problem (such as a viral infection) that goes away on its own. Often, time must pass to determine the cause of your pain. Since many different things can cause stomach pain, further exams, lab tests, or x-rays may be needed. You will need to watch for any new symptoms or if your condition gets worse. Some cases of abdominal pain can be treated with oral or intravenous medication while others require more extensive workup and treatment.
Allergies and allergic reactions may cause an itchy rash, runny nose, cough, dizziness, fainting, trouble breathing or swallowing, and swelling of the face or other parts of the body. This can be caused by exposure to something in your surroundings that you have become sensitive to. This could be due to a drug or food that you swallowed. This could also be due to something you put on your skin or in your hair or something in the air. Often it is not possible to find out exactly what has caused your reaction, but your treatment can still be successful. The goal of treatment is to prevent re-exposure and to relieve symptoms. The rash will usually fade over several days, but can sometimes last up to two weeks. Antihistamines and steroids are often prescribed to reduce symptoms.
ANIMAL BITES AND INSECT STINGS
Animal bites are often heavily contaminated with bacteria. If an animal has bitten you, and the wound is deep enough to bleed, an infection may occur. If you live in an area where rabies occurs in wild animals, and if a dog, cat, skunk, raccoon, fox, coyote, bobcat, woodchuck, bat or other meat-eating animal has bitten you, there may be some risk to you of getting the rabies virus. If a wild animal or stray pet has bitten you, contact the county Animal Control Department for information on capture, quarantine, and animal rabies testing. Large wounds may require suturing after internal cleansing. Because of the risk of infection, some wounds may remain unstitched. Despite thorough cleansing and proper treatment, your wound may become infected. Bite wounds to the hand are especially prone to this complication.
An insect sting can cause pain, an itchy rash, or swelling in the face or other parts of the body. This may also cause dizziness, fainting and trouble breathing or swallowing. Insect stings may also become infected 1 to 3 days later, so watch for the warning signs below. Allergic reactions usually occur within a few minutes of the sting. They can be life threatening and require immediate medical attention. Adrenaline shots, antihistamine medicine, and IV fluids may be needed to treat these reactions. Allergy desensitizing shots may be needed to prevent further allergic reactions to insect stings. Ask your doctor or an allergy specialist about your need for allergy shots
Athlete’s foot is caused by a fungal infection in the skin. It affects the skin between the toes, where it causes fissures (cracks in the skin). It can also affect the bottom of the foot where it causes dry white scales and peeling of the skin. This infection is more likely to occur when the foot is in hot or sweaty socks and shoes for long periods of time. This infection is treated with skin creams or oral medicine. Treatment often takes week before the infection is completely gone.
ANXIETY AND DEPRESSION
Anxiety is the feeling we all get when we think something bad is about to happen. It is a normal response to stress and usually causes only a mild reaction. When anxiety becomes more severe, emotions may interfere with daily life. In some cases, you may not even be aware what it is you are anxious about! During an anxiety reaction, you may feel like you are helpless, nervous, depressed or irritable. Your body may show signs of anxiety in many ways, including: dry mouth, shakiness, dizziness, weakness, trouble breathing, chest pressure, headache, nausea, diarrhea, tiredness, inability to sleep, or sexual problems. Talking therapy, mindfulness meditation, and sometimes medication may be prescribed to alleviate symptoms and treat the underlying disease.
ARTHRITIS AND BURSITIS
Osteoarthritis (also called “degenerative joint disease”) is the most common form of arthritis in adults over 50. It is not the same as Rheumatoid Arthritis. The exact cause is not known, but may be related to excess “wear and tear” on the joint over a long period. Prior injury to that joint, or repeated stress on a joint can also cause this type of arthritis. The most common symptoms are joint stiffness, pain, and swelling.
The large joints of the body are surrounded by “bursa”. These are small flat liquid filled sacks, which help the gliding motion of the muscles and tendons over the joints. Bursitis is an inflammation of the bursa due to injury, overuse of the joint, or infection of the bursa itself. Symptoms include pain and tenderness of the joint that is made worse with movement. The most common sites for bursitis are the elbow, shoulder, hip, and knee. Bursitis is treated with an anti-inflammatory medicine and by resting the joint. More severe cases require injection of medicine directly into the bursa. If you have an infection antibiotics may be prescribed. Sometimes surgical drainage of the bursa by a specialist is needed.
During an asthma attack the small air passages within the lung go into spasm and restrict the flow of air. This causes a wheezing sound with each breath. The causes may include such things as the common cold, bronchitis, pneumonia, emotional upset, and particles in the air (smoke, dust, mold, pollen, and animal dander). Skipping doses of daily asthma medicine can also bring on an asthma attack. Treatment is often bronchodilators, steroids, and fluids.
Bell’s palsy is a problem involving the nerve that controls the muscles on one side of the face. Often, patients worry they are having a stroke, however this is not caused by blood clots in the brain. The cause is unknown, but may be related to inflammation of the nerve. 80% of people with this problem recover completely within a few weeks. Symptoms on the involved side of the face may include: inability to close the upper eye lid, excess tearing, facial drooping with uneven mouth shape, drooling, facial numbness or pain, changes in taste, and sensitivity to sound. The most serious problem is possible injury to the eye. Since you cannot blink normally, you must protect your eye from flying dust particles, wind, etc. Also, since tears cannot lubricate the eye without blinking, there is danger that the cornea (clear part in front of the colored iris) will dry out and form an ulcer. This could permanently affect vision. Treatment may include antiviral medication, antibiotics for those in Lyme-infected areas of the country, and steroids.
Bronchitis means that the airways to your lungs are inflamed. Symptoms can include cough, difficulty breathing, fever, colored sputum or phlegm, and wheezing. Causes include viruses, bacterial, allergies or environmental irritants. People who smoke are more likely to experiences repeated episodes. Treatment may include bronchodilators, cough medicine, antibiotics, increasing fluids, and avoiding irritants. Treatment can improve symptoms after hours or days. Sometime the cough remains for weeks or longer.
A burn occurs when skin is exposed to excessive heat, sun, or harsh chemicals. A first degree burn causes redness only, like sunburn, and heals in a few days. A second-degree burn is deeper and causes a blister to form. This may take up to two weeks to heal. A third-degree burn injures all layers of the skin and is very serious. It may take a month or more to heal. Antibiotics are usually not indicated. Burn dressings may help with pain and healing.
CHRONIC BRONCHITIS AND EMPHYSEMA (COPD)
Both Chronic Bronchitis and Emphysema are forms of Chronic Obstructive Pulmonary Disease (COPD) and is most often caused by many years of smoking tobacco. Other causes include asthma, recurring infection, and inhaling toxic chemicals. Many things can make your lung disease suddenly get worse. These causes include the common cold, pneumonia, acute bronchitis, missing doses of your regular breathing medicines and exposure to smoke, dust, or other air pollutants. Symptoms of chronic lung disease include a chronic productive cough, frequent respiratory infections, wheezing, and shortness of breath. Symptoms are often worse during periods of air pollution. Treatment options include bronchodilators, sputum drying agents, steroids, antibiotics, and cough medication. Avoiding triggers such as smoking is critically important.
COLD SORES (HERPES LABIALIS)
Cold sores are a common infection around the lips. They are due to a Herpes virus (type 1) that usually affects the mouth area only, and is spread by touching or kissing. It is different from the Herpes (type 2) virus that causes genital sores, and is spread by sexual contact. The first episode usually occurs in childhood, and causes a group of small painful blisters around the lips or in the mouth. The lip blisters break open, dry up and usually disappear within 10 days. Fever and a flu-like illness occur during the first episode. Cold sores are very contagious for a few days before the onset of an attack until the blisters have dried up. About one-third of persons who get a primary cold sore will have recurrences. Factors that affect recurrence include physical or emotional stress, the presence of another illness (minor cold, stomach flu, or fever from any cause), heavy sun exposure or a menstrual period. Treatment may include topical agents and antiviral prescriptions.
CONJUNCTIVITIS (PINK EYE)
Conjunctivitis can be caused by bacterial or viral infection, allergies, or injuries. There is usually redness of the lining of the eye, itching, discomfort, and sometimes discharge or deposits of matter along the eyelids. A viral infection usually causes a watery discharge, while a bacterial infection causes a yellowish, thick discharge. Pink eye is very contagious and spreads by direct contact. Eye drops or ointment may be prescribed to treat the infection. Wash your hands with soap and water after touching your eyes. Use cold compresses to reduce pain and sunglasses to relieve irritation from light.
Constipation is present when your usual bowel movements become less frequent or when the stools become very hard. This may cause abdominal swelling or bloating, and painful or difficult bowel movements. Constipation is often due to diet or certain medicines, especially pain medicines. This episode of constipation may be treated with enemas, suppositories, laxatives, or stool softeners. A diet high in fiber with plenty of fluids each day is very important. This helps to maintain regular soft bowel movements. The following foods are good sources of dietary fiber:
– Cereals & Breads: Whole grain cereal with bran (Chex, Raisin Bran, Corn Bran), oatmeal, rolled oats, bran muffins, and whole grain breads. – Fruits: All fruits (fresh & dried), raisins, prunes, apricots, berries, figs. – Vegetables: Any fresh vegetables especially peas, broccoli, Brussels sprouts, winter squash, green beans, cauliflower, lima beans and carrots. – Juices: Fruit juices, especially prune juice.
CONSTIPATION IN CHILDREN
Constipation is a difficult or painful bowel movement, with hard, dry stool. It may be caused by certain medicines, diseases or, more commonly, from not drinking enough liquids or eating enough fiber. Bowel habits can vary among children. Some children have three stools a day while others have one stool per week. It is not necessary to have a bowel movement every day. Enemas, suppositories, laxatives or stool softeners may be prescribed. Do not give these medicines unless your doctor has advised you to do so. Give your child a well-balanced, high fiber diet. Fiber makes stool softer and easier to pass. Good foods to give to a child old enough are fruits, vegetables, whole grain breads, oatmeal, brown rice and bran cereal. Avoid foods such as milk, milk products and foods with a lot of sugar. Give your child liquids to drink. Give fruit juice at least once a day and at least eight cups of water a day. Exercise every day. Walking, bike riding, and swimming are a few of the exercises you can try.
Behavior Training: Sometimes your child can learn a behavior pattern of holding back stools. To correct this, a specific time (such as, just after breakfast and dinner) should be set aside each day to sit on the toilet for 15 minutes whether or not there seems to be a “need to go.” There should be no interruptions during this time. Do not punish your child or get angry if there is no bowel movement during this time. The idea is to teach your child to try on a regular basis.
Dehydration occurs when there is an excess fluid loss or inadequate fluid intake. This can happen during repeated vomiting or diarrhea, profuse sweating as during heavy exercise or a high fever. It may occur because of poor fluid intake during times of illness. Improper use of diuretics (water pills) can also cause dehydration. Symptoms include thirst, dizziness, weakness and fatigue or excess drowsiness. Treatment may include medication to reduce vomiting, oral or intravenous fluids, and replacement of lost salts such as sodium and potassium.
A dental abscess is an infection at the base of a tooth. When this is untreated, it spreads to the gum near the tooth causing swelling and pain. More severe infections cause facial swelling. A dental abscess usually starts with a crack or cavity in the tooth. The pain is often made worse by drinking hot or cold fluids, or biting on hard foods and may spread from the tooth to the ear or jaw on the same side. Antibiotics are sometimes prescribed along with pain medication. A dentist should be seen to treat these conditions.
Diabetes is a chronic health condition where the body is unable to produce enough insulin to control the level of glucose (sugar) in the blood. Diabetes affects about 5% of the population. The cause of diabetes is unknown, but the tendency toward having it is partly inherited. Other factors include obesity, physical and emotional stress, pregnancy, and certain medications. The diagnosis is based on elevated blood sugar levels. Diabetes may cause no symptoms at all if the sugar is not too high; if the sugar levels are very high, it can cause weight loss, severe dehydration or shock. Diabetes increases your risk of developing infections. The long-term effects can result in damage to the nervous system, eyes, kidneys, heart and blood vessels. Proper treatment and control of the blood glucose help reduce the risk of complications. In Type I diabetes, insulin injections are necessary to control the blood glucose; in Type II diabetes, which is more common in older patients, diet, weight loss, and oral hypoglycemic medicines are usually prescribed. Most diabetics will benefit from education programs to teach them how to measure, mix, and inject insulin and how to monitor their blood sugar level. Your actual blood sugar level is a result of the balance between several factors. These include what kind of food and how much you eat, how much exercise you get and the amount of insulin available in your body. Stresses to the body such as infections can cause high blood sugar. Taking too much of your diabetes medicine or not eating regular meals can lead to dangerously low blood sugar.
Diaper rash is an irritation of the skin caused by excessive heat and moisture. When the skin is in contact with urine or stool for extended periods of time, the skin develops irritation and can begin to break down. Irritation can also be caused by the laundry soap and bleach used to wash your child’s cloth diapers or clothes. Diarrhea and skin infections may make the skin irritation worse. Keeping the skin clean and dry is the most important part of treatment. Depending on the cause of the rash, a medication may be prescribed. A yeast infection call Candidiasis can sometimes cause diaper rash due to the moisture and complicate the condition. A diaper rash caused by yeast is not serious, but may need antifungal medication to heal it.
DIARRHEA IN CHILDREN
Most diarrheas in children are due to viral enteritis, commonly known as the “stomach flu”. This may last from 2 to 7 days. The main danger from repeated diarrhea is dehydration, which is the loss of excess water and minerals from the body. When this occurs, body fluids must be replaced with an oral rehydration solution such as Pedialyte, Infalyte or Rehydralyte. These are available at drug stores and most grocery stores without a prescription. Antibiotics are usually not indicated. Most cases resolve on their own
Some people develop pouches along the wall of the colon; they are called diverticuli and usually cause no symptoms. If the diverticuli become blocked and inflamed an infection (diverticulitis) may develop resulting in lower abdominal pain, diarrhea (sometimes bloody), and possibly fever. Diverticulitis will sometimes resolve with symptomatic treatment but may progress to perforation and/or abscess formation which may require emergency surgery. When treatment is started, early oral antibiotics alone may be enough to cure this condition; if you do not improve or if your condition worsens, it may be necessary to admit you to the hospital for IV antibiotics or surgical treatment.
EXTERNAL EAR INFECTION
An infection of the external ear is often called “swimmer’s ear”, and is caused by either trauma from a Q tip, chemical irritants such as swimming pool water, wax plugs, bacteria or fungus. Sometimes hair spray and hair dyes that get into the ear can also cause this problem. Symptoms include itching, redness, drainage, or swelling of the ear canal, as well as temporary loss of hearing. Treatment usually includes antibacterial and steroid eardrops. Symptoms usually improve within a day or two. If symptoms don’t improve, a visit to an ENT (ears, nose and throat) specialist is indicated.
GASTROESOPHAGEAL REFLUX IN BABIES
Gastroesophageal reflux, sometimes referred to as “spitting up”. This condition occurs when the muscle at the end of the esophagus (food pipe) is weak. When a baby with reflux is fed, some formula in the baby’s stomach returns to the esophagus. Most babies will “spit up” occasionally, and all babies will spit up if they are overfed; however, this is not reflux. Spitting up improves with age. By 7 months of age, most reflux has decreased or resolved. Give your baby smaller amounts (at least 1 ounce less than you have been giving) of food. Your baby doesn’t have to finish a bottle. Wait at least 2 hours between feedings, because it takes that long for the stomach to empty itself. Avoid tight diapers, for they put pressure on the stomach. Don’t double your child up during diaper changes. Don’t allow people to hug your child or play vigorously with him or her right after meals. Burp your baby 2 or 3 times during each feeding. Do it when he or she pauses and looks around. Do not interrupt the feeding rhythm to burp the baby. Keep in mind that burping is less important than giving smaller feedings and avoiding tight diapers. After meals, try to hold your baby in an upright position using a front pack, backpack, or swing for 30 minutes.
GASTROESOPHAGEAL REFLUX (GERD)-ADULT
Gastroesophageal reflux the backup of the stomach contents into the esophagus, which may also be accompanied by inflammation of the esophagus. Symptoms of GERD include abdominal pain, indigestion, nausea, vomiting, chronic coughing, and sometimes bleeding. Besides medications, alcohol, caffeine, nicotine, spicy or acidic foods, and emotional distress can bring on this condition. Other risk factors include foods that can increase reflux and inflammation like high-fat foods, yellow onions, chocolate, peppermint, and citrus foods. If untreated, this condition can lead to esophageal cancer. Treatment includes antacids (Mylanta or Maalox) help neutralize stomach acid. 1 to 2 tablespoons or tablets should be taken one hour after meals and at bedtime. If cimetidine (Tagamet), ranitidine (Zantac), or sucralfate (Carafate) has also been prescribed, allow 1 hour between taking this medicine and taking the antacids. Avoid factors that will increase stomach acid. These include cigarettes, caffeine (coffee, soft drinks, teas) and emotional stress. Avoid substances that irritate your stomach. These include aspirin-containing products and alcohol.
GOUT AND PSEUDOGOUT
Gout and pseudogout are caused by a build-up of gout crystals in the joint fluid. Gout occurs in people with excess uric acid in their system. Pseudogout, an acute arthritis that causes joint pain, swelling, and heat is due to the presence of calcium pyrophosphate crystals in the joint fluid. Pseudogout often follows minor injuries. It may also be associated with a history of gout or high calcium levels in the blood. The knee is the most frequently involved joint. Gout also causes a hot, red, swollen, and painful joint. If you have had one episode of gout, you are likely to have another. If these attacks become frequent, it may be necessary to take a daily medicine to correct this. Gout occurs most commonly in men, and appears to be an inherited condition. Diuretics (water pills) tend to elevate blood uric acid levels, and can cause similar joint problems. The big toe, foot, ankle, and knee are the joints most often effected. Use ice packs for 20 minutes every 2 to 4 hours to reduce pain and swelling. Drink extra fluid to help flush the gout crystals through your kidneys. Rest and elevate the painful joints. Use a frame to keep the sheets off your leg as needed. If gout affects the joints of your foot or leg, you may want to use crutches for the first few days to keep from bearing weight on the foot or leg. Anti-inflammatory medicine is used for this condition such as indomethacin (Indocin), ibuprofen (Advil, Motrin), or naproxen (Naprosyn or Aleve). Tylenol will not be effective. If narcotic pain medicines have been prescribed, they should be used in addition to the anti-inflammatory drugs, and only for severe pain. Avoid aspirin, since this may slow down the flushing of the gout crystals through your kidneys.
Please follow these instructions to prevent future attacks:
– Foods high in purine form uric acid in the body, and increase your risk for a gout attack: therefore, avoid the following foods: certain seafood (anchovies, sardines, shrimp, scallops, herring, mackerel); wild game, meat extracts and meat gravies, and organ foods (kidney, liver, calf brain, sweetbreads). – Limit the following foods to one serving a day: red meat and pork, fish, poultry, dried beans and peas, asparagus, mushrooms, cauliflower, and spinach. – If you are overweight, this is a risk factor, and you should talk to your doctor about a weight reduction plan; however, avoid fasting or extreme low calorie diets (less than 900 cal/day). which will increase uric acid levels in the body. – Minimize or avoid alcohol use. Excess alcohol intake can cause a gout attack. – Avoid injury to the involved joint, since this can lead to a gout attack.
Head lice is a common insect parasite that affects the scalp and pubic area (“crabs”). Lice or “crabs” are tiny insects the size of a pinhead. Head lice infect the scalp only, causing scalp itching. Lice lay eggs called “nits” that look like tiny white specs stuck to the hair, though do not brush away or wash off like dandruff. Lice are easily spread by close contact with an infected person, or by sharing personal items such as hats, combs, brushes, towels, and bedding. Treatment includes NIX Cream Rinse is an over-the-counter medicine that is often used to treat head lice. To remove the nits from your hair, apply a mixture of one-cup vinegar and one cup water after the medicine has been washed from your hair. Rinse after one hour. For a stronger effect, put a shower cap on and leave the vinegar in your hair overnight. Rinse your hair in the morning. Use a fine-toothed comb made for removing nits (you can get it from the drugstore). Stroke from your scalp to the end of the hair shaft. Repeat this once a day until all nits are gone. All personal headwear, scarves, coats, bed linens and towels should be treated by machine-washing them in hot water. Dry on the hot cycle of the dryer for 20 minutes. Any clothing that cannot be washed this way should be dry-cleaned or sealed in a plastic bag for two weeks. Lice will die during this time. Combs, brushes, and curlers may be treated in Lysol or rubbing alcohol for 2 hours, or boiling in water for 5 to 10 minutes. If possible, vacuum all rugs, carpets, and mattresses that were used while you were infected. Sex partners should be treated at the same time. Avoid sexual contact until rechecked by your doctor to confirm that all lice are gone. Unless another medicine has been prescribed, you may take Benadryl (available at drug and grocery stores) for itching. Use lower doses during the daytime and higher doses at night, since it may make you sleepy.
Symptoms of heat illness include exhaustion, dizziness, fainting, muscle cramps, nausea, vomiting, chills, and goose bumps. Heat exhaustion occurs when the body loses too much water through sweating. This can lead to heat stroke, which is a medical emergency. People who work in hot environments, athletes, and older people are at a greater risk for suffering from heat illness. You must drink increased amounts of water or other clear liquids during hot weather to prevent heat illness. If vomiting, IV fluids may be necessary. This is especially true if you work or do vigorous exercise in the heat (up to a gallon of sweat can be lost every hour under the right conditions). You will stay cooler by reducing your effort, and by frequently dousing yourself with water. Certain drugs increase the risk of heat illness because they reduce sweating: these include antidepressants and antihistamines. Be more cautious during hot weather by drinking several glasses of water before, during, and after vigorous activity, and see your doctor if you have any heat-related problems.
HYPERTENSION (HIGH BLOOD PRESSURE)
The normal blood pressure for adults is up to 140/90, and for the elderly it may be as high as 160/90. One high blood pressure reading doesn’t necessarily mean you have hypertension. Injury, illness, emotional stress, caffeine, and some medicines, such as decongestants, may elevate the blood pressure temporarily. A blood pressure consistently above normal means that further medical evaluation and treatment may be needed. Remember, high blood pressure usually has no symptoms; the only way you know you have hypertension is to have your blood pressure checked. Treatment for hypertension may include weight control, reducing dietary salt, proper exercise, quitting smoking, and possibly drug therapy. There are many different types of medicine used to treat high blood pressure. If not treated, high blood pressure increases your risk for heart disease, strokes, and kidney failure.
IMPETIGO IN CHILDREN
Impetigo is an infection of the skin. The rash starts as a small blister, and when the blister breaks, the liquid dries and forms yellow crusty scabs. The germs, which cause the infection, grow under the scabs, and when the child scratches, the infection can be spread to other body parts or to other people. It may start as an infected insect bite. It is contagious and can be given to other children by touching. Impetigo requires treatment with an antibiotic. Trim fingernails to prevent scratching. Wash your hands and your child’s often. This will avoid spreading it to other parts of the body, and to other children. The crusty sores should be washed 2 to 3 times a day with soap and water. Apply an antibacterial cream (such as Neosporin or Bacitracin). If an antibiotic was prescribed, it must be taken until completely gone even, if your child begins to feel better before. Take all medication exactly as prescribed. Keep your child’s washcloth and towels away from other family members, so the infection will not spread. Wash towels and clothes after each use. Carefully wash the tub with soap and water after bathing the child who has impetigo.
INFECTED INGROWN TOENAIL
An ingrown toenail happens when the nail edge grows into the skin and bacteria invade the area. Poorly fitted shoes, minor injuries, and improper cutting of the toenail may also contribute to the problem. You should cut your toenails squarely instead of rounding the edges, and do not cut them too short. Treatment for infected ingrown toenails includes soaking the toe for 20-30 minutes in warm water 3 times daily, and most often, oral antibiotics. Sometimes the ingrown portion of the nail must be removed. Keep your foot up and reduce your physical activity until the infection gets better.
A laceration is a cut through the skin. This can be treated with either stiches, staples, surgical tape closures (“Steri-Strips”) or skin adhesive, depending upon the depth of the wound or the tension on the wound. Most skin wounds heal within 10 days; however, an infection may sometimes occur despite proper treatment. Therefore, check the wound daily for the warning signs listed below. Stitches should be removed within 7 to 14 days. If a tape closure (“Steri-Strips”) was used, remove them after 7 days, unless told otherwise. If skin glue was used, the film will fall off by itself in 5 to 10 days.
MENSTRUAL CRAMPS (DYSMENORRHEA)
Menstrual cramp pain may begin 1 to 2 days before bleeding appears and may last for the first few days of the period. Cramping is related to the contraction of the uterus. When dysmenorrhea (the name given for painful menstrual periods) occurs, it usually starts during the first few menstrual cycles at puberty and gets gradually better as you get older. A hormone called prostaglandin causes menstrual cramps, and about 50% of women have symptoms. If painful periods begin in your late teens or as an adult, this may be a sign of other problems. These include endometriosis or chronic pelvic infection. If you get cramps with your periods often, do not wait for them to start before taking the medicine. You can prevent or decrease severe cramps by starting ibuprofen or naproxen the day before your period. Stronger medicine is rarely needed. Most women with this problem can remain active. You may even find that exercise reduces the pain. For severe cramping pain, you should rest in bed with a heating pad on the lower abdomen. A hot bath may also give some relief.
MIDDLE EAR INFECTION – CHILDREN
The space behind the eardrum is called the “middle ear” or the “otitis media.” This often occurs during a common cold when congestion blocks off the internal passage (Eustachian Tube) that drains fluid from the middle ear. When this passage is blocked, the middle ear fills with fluid and bacteria grow there, causing an infection. While antibiotics are often prescribed, a 3-day period of “watchful waiting” for children over two years old can be safe, and thus avoid the risk of antibiotics. Pain is often improved with acetaminophen or ibuprofen.
NAIL INJURIES AND INFECTIONS
A nail avulsion is an injury to the tip of your finger or toe. This will cause the loss of the nail. Sometimes, there is a cut of the nail bed, or a fracture of the bone under the nail. In almost all cases, the nail will grow back from under the cuticle. This takes a few weeks to start, and will complete in about 3 months for a fingernail and 6 months for a toenail. Sometimes a painful blood collection under the nail called a subungual hematoma will require drainage. Cuticle infections on the edge of the nailbed are called paronychia and often require drainage. Herpetic whitlow is a viral infection of the finger that should not be drained.
NAUSEA, VOMITING AND DIARRHEA
Nausea, vomiting and diarrhea can be caused by many different medical problems (stomach trouble, nervous system problems, alcohol and drug toxicity, infections). Whatever the cause, repeated vomiting and diarrhea can lead to dehydration and severe weakness. The treatment for vomiting includes rest and keeping the stomach empty for at least 1 hour, or until the stomach settles. Diarrhea often resolves on its own but can be treated by both prescription and over-the-counter medications. Medications for vomiting called anti-emetics may be given by injection, rectal suppository, or orally, as needed. After vomiting stops, first clear liquids then other light foods (gelatin, soup, bread) can be started. Avoid alcohol, dairy products, and richer foods for several days until you are completely better.
Please call your doctor right away if your condition is not better in 1-2 days. Call right away or go to the emergency room if you cannot take any oral fluids, if you vomit blood, if you have increased pain, fainting, fever, or other serious symptoms.
NECK & BACK PAIN
Both neck and back pain are usually caused by injury to the muscles or ligaments of the spine. Sometimes, the disks that separate each bone of the spine may cause pain by putting pressure on a nearby nerve. Back and neck pain may appear after a sudden twisting/bending force (such as in a car accident), or sometimes after a simple awkward movement. In either case, muscle spasm is often present and adds to the pain. Local measures such as ice or heat can be used to relieve spasm. Anti-inflammatory medication is the first choice for pain. Muscle relaxants may be prescribed to reduce spasm as well. X-rays are usually not needed unless significant trauma occurred.
Both viruses and bacteria cause sore throats. Both viral and strep infection can cause throat pain that is worse when swallowing, aching all over, headache, and fever. Both types of infections are contagious and may be spread by coughing, kissing, or touching others after touching your mouth or nose. The most accurate way to diagnose a strep infection is by a throat culture or rapid strep test. Strep scores can be used to determine the likelihood of strep without a culture, but are less accurate. The IDSA does not recommend routine antibiotics for all cases of sore throat without strep testing.
Pneumonia is an infection deep within the lung. It may be due to a virus or bacteria. Severe cases require treatment in the hospital. Milder cases can be treated at home. Symptoms usually start to improve during the first two days of treatment. Treatment often includes antibiotics, bronchodilators, cough medication, and rest for the first 2 to 3 days, or until you feel stronger. When resuming activity, don’t let yourself become overly tired. Avoid exposure to cigarette smoke (yours or others). Use aspirin or acetaminophen (Tylenol) for fever, and ibuprofen (Advil, Motrin) for chest pains caused by breathing or coughing. Your appetite may be poor, so a light diet is fine. Avoid dehydration by drinking 6 to 8 glasses of fluids per day (water, soft drinks, juices, tea, soup, etc.). Extra fluid will help loosen secretions in the lung, making it easier for you to cough up the phlegm (sputum).
POISON IVY/POISON OAK
Poison Ivy and poison oak cause an itchy, red and blistered rash to the skin or susceptible people. They are treated with topical or oral steroids, antihistamines, and lotions such as calamine.
A puncture wound is a hole through the skin. Bacteria, dirt, and debris can be dragged into this wound, increasing the risk of infection; however, antibiotics are usually not prescribed for this injury unless the puncture went through the bottom of a sneaker (which can harbor a dangerous bacteria called pseudomonas) or signs of infection are already present; therefore, it is important to observe the wound closely for the signs of infection listed below.
Many conditions can cause a rash. Allergies, insects, infections, environmental irritants, certain foods, exposure to cold, sunlight or exercise, stress, medication and sometimes the cause is unknown. The general rule of thumb is to use antihistamines, pain medication when appropriate and steroids (either oral or topical) to control symptoms. If a bacterial cause is identified, antibiotic cream or pills are indicated.
Ringworm is not due to a worm, but is caused by a fungus. It is passed from animals or other persons infected with the fungus. The infection starts on the skin as a small, red, and itchy sore that grows larger in the shape of a round 1-2-inch ring, with clear skin in the center. When the fungus infects the scalp, it causes round, bald patches that are itchy and flaky. This infection is treated with creams that are applied to the skin, or oral medicine. Ringworm of the skin is not very contagious, and your child may return to school while being treated. Ringworm of the scalp is highly contagious and spreads easily to other children. Treatment is with an antifungal oral suspension. Do not share hats or combs while infected. Any child with ringworm of the scalp should stay out of school or daycare until cleared by your doctor.
Sciatica (“Lumbar Radiculopathy”) causes a pain that spreads from the lower back down into the buttock or hip, and part or all the way down the leg to the toes. Sometimes, leg pain can occur without any back pain. Sciatica is due to irritation or pressure on a spinal nerve as it comes out of the spinal canal. This may be caused by an injury to the nearby muscles or ligaments of the spine, or it may occur when an injured spinal disk (the cartilage cushion between each spinal bone) bulges and pinches a nearby nerve. Sciatica may begin after a sudden twisting/bending force (such as in a car accident), or could present after a simple awkward movement. In either case, muscle spasm is commonly present and contributes to the pain. Treatment includes anti-inflammatory medication, muscle relaxants, physical therapy and occasionally steroids.
Shingles (also called “Herpes Zoster”) is a very contagious illness. The same virus that causes Chicken Pox causes it. This usually occurs in adults over the age of 50 or those with lowered immunity. It starts as a tingling patch of skin on one side of the body. During the first several days, small, painful blisters appear in this area; however, unlike chicken pox, the rash does not spread to the rest of the body. The blister fluid is contagious to anyone who has not already had chicken pox. The contagious period ends when all blisters have crusted over (usually about 2 weeks after the illness begins). Scarring may occur where the blisters appear. Occasionally, there is continued sensitivity and pain in that patch of skin for months after the infection. Use acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for fever or pain, unless another pain medicine has been prescribed. Make a solution of cool water and cornstarch, baking soda, Aveeno Oatmeal, or Domeboro powder (available without a prescription). Apply the solution as a compress to the area. This will soothe the skin. Wash skin with soap and water to keep rash free of infection. Stay home from work or school until all blisters have formed a crust, and you are no longer contagious. Take any medicines prescribed exactly as directed until they are gone.
The sinuses are air-filled spaces within the bones of the face. They connect to the inside of the nose and can become congested during or after a common cold, or severe attack of hay fever. Sinusitis causes facial pain, headache, green or yellow drainage flowing from the nose or flowing into the back of the throat, and an occasional fever. Antibiotics are rarely needed or helpful except in more severe cases. Nasal washes with saline or “Neti pots” can be very helpful. Sometimes nasal steroids will be prescribed along with decongestants.
SKIN INFECTIONS (CELLULITIS)
Skin infections, also known as cellulitis can starts with a scrape, cut, insect bite, blister or other opening in the skin, which becomes infected. This can be a serious condition, particularly in people with diabetes or other immune compromising diseases. It must be watched closely to be sure the infection is not spreading. With antibiotic treatment, the size of the red area will gradually shrink in size until the skin returns to normal. This will take 7 to 10 days. The red area should never increase in size once the antibiotic medicine has been started. Occasionally, an infection will be resistant to one antibiotic and another one must be used.
SPRAINS AND STRAINS
A sprain is an injury to a ligament-a stretching or a tearing. One or more ligaments can be injured during a sprain. The severity of the injury will depend on the extent of injury to a single ligament (whether the tear is partial or complete) and the number of ligaments involved. A strain is an injury to either a muscle or a tendon. Depending on the severity of the injury, a strain may be a simple overstretch of the muscle or tendon, or it can result in a partial or complete tear. Apply an ice pack to the injured area for 20 minutes at a time, 4 to 8 times a day for 24 to 48 hours. This will lessen the swelling and keep the injury from hurting as much. A cold pack, ice bag, or plastic bag filled with crushed ice and wrapped in a towel can be used. To avoid cold injury and frostbite, do not apply the ice directly on the skin, but wrap it in a towel. Acetaminophen or ibuprofen can be helpful in reducing pain. X-rays are usually not needed for sprains and strains.
Sunburn is an injury to the skin caused by over-exposure to ultraviolet light from the sun. This will take 1 to 3 days to heal. Very severe sunburns may cause blistering and fluid draining from the skin. This is at risk for becoming infected. On the first day, apply ice packs or take cool baths to relieve severe pain. Over the counter First-Aid creams and sprays (Solarcaine, etc.) contain an anesthetic, which also relieves pain. If a dressing was applied, change it once a day. If the bandage sticks, soak it off in warm water or with a solution of hydrogen peroxide. Wash the burned area daily with soap and water. Pat the burn area dry with a clean towel. You may take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for pain, unless another pain medicine was prescribed. Avoid sun exposure for the next two weeks to allow time to heal. Use sunscreen lotions in the future to prevent a recurrence.
UPPER RESPIRATORY INFECTIONS (COLD)
A viral respiratory infection is also known as a cold. The symptoms can include runny or stuffy nose, fever, sore throat, cough and occasionally wheezing. There are many different viruses that can cause colds. Antibiotics are not helpful in colds unless there is a secondary bacterial infection such as ear infection, sinusitis, or bronchitis. Treatment to relieve cold symptoms includes bed rest, increasing fluid intake, and using a vaporizer. Oral decongestants, antihistamines, throat lozenges, and cough medicine may help symptoms. Nose spray decongestants should not be used for more than 3 days. Bronchodilators and atrovent nasal spray may be prescribed to reduce wheezing and runny nose. Take acetaminophen (Tylenol) or ibuprofen for pain and fever. Most colds are better within one week. Fever usually lasts less than 3 days. Runny nose and sore throat are usually gone in a week. Coughs can last 2-3 weeks. If you have a fever lasting more than 3 days, colored nasal discharge, headache, or cough that lasts for more than 10 days, please call your doctor
URINARY TRACT INFECTION
1. A bladder infection (“cystitis” or “UTI”) usually causes a constant urge to urinate and a burning when passing urine. Urine may be cloudy, smelly, or dark, and there may be pain in the lower abdomen. This infection occurs when bacteria is forced from the vaginal area in women or through the penis in men into the bladder opening (urethra). This can occur during sexual intercourse or with tight clothing. Other factors can also cause this problem. Antibiotics are indicated for treatment. You may also be given Pyridium (generic – Phenazopyradine) to reduce burning with urination. Antibiotic resistance is common in those with frequent UTI’s. Drink lots of fluids (at least 6 to 8 glasses a day). This will force the medicine into your urinary system and flush the bacteria out of your body. Avoid sexual intercourse until your symptoms are gone. Avoid caffeine, alcohol and spicy foods since these irritate the bladder. Cranberry juice was recently found to be unhelpful in treating this disease. Left untreated, UTI’s can move into the kidneys and cause serious illness.
Vertigo is a sensation of a whirling, spinning movement, even though your body is perfectly still. It causes loss of balance when trying to walk, and there may be nausea or vomiting. Head movement from side to side, or changing position from lying to sitting or standing may make symptoms much worse. There are many causes for this condition, such as a viral infection, degenerative changes of the inner ear, or poor blood circulation to the part of the brain that controls balance. It may be triggered by a movement of the head into uncommon positions (tilting upward to look at the ceiling). There may also be hearing loss or ringing in one or both ears. An episode of vertigo may last seconds, minutes or hours. Once you are over the first episode of vertigo, it may never return; however, sometimes symptoms recur off and on over several weeks or longer, depending on the cause. Treatment may include medication to reduce the sense of spinning. If symptoms are severe, rest quietly in bed. Change positions slowly. There is usually one position that will feel best, such as lying on one side or the other, or lying on your back with your head slightly raised on pillows.
Typical symptoms of virus infections include: fever, muscle aches, headache, fatigue, stomach upsets, sore throat, and dry cough. Antibiotic drugs are not effective in viral illnesses; they are only given when there is a secondary bacterial infection. General treatment includes bed rest, increasing oral fluid intake of clear, non-caffeinated drinks like ginger ale, fruit juices, water, or sports (electrolyte) drinks, and medicine to relieve specific symptoms such as cough, pain, or diarrhea. Acetaminophen (Tylenol) or ibuprofen may be used to help control fever and pain.
VOMITING OF PREGNANCY (HYPEREMESIS GRAVIDARUM)
This is a condition that is described by persistent vomiting in a pregnant woman that can affect fluid and nutritional balance. It is usually associated with the first 8 to 20 weeks of pregnancy. Some of the symptoms you may experience will be hypersensitivity to smell, alteration in taste, persistent nausea, or tiredness. Treatment includes resting and avoiding drinking or eating anything for at least 1 hour, or until the stomach settles. Start drinking small amounts of clear liquids (water, sodas, Gatorade, etc.) as tolerated. Medication to stop vomiting (anti-emetic drugs) may be given by injection, rectal suppository, or orally, as needed. After you can keep down clear liquids, other light foods (gelatin, soup, bread) can be started. Avoid dairy products and richer foods for several days until you are completely better. Once the vomiting and nausea subside, your diet should consist of foods rich in carbohydrates and protein, such as fruit, cheese, cottage cheese, eggs, beef, poultry, vegetables, toast, crackers, and rice. You should limit foods that are spicy or high in fat.
Warts are caused by a virus, and occur mostly on the hands and feet. Usually warts will disappear in 2 to 3 years without any treatment, but you can often get rid of them in 2 to 3 months with treatment. Warts can be spread to other parts of your body by direct contact if you scratch or chew them, but they are not very contagious to other people. Treatment may include relaxation and meditation techniques, which have been shown to succeed in getting rid of warts. Warts can be treated in a doctor’s office with electro-surgery or liquid nitrogen applications. A prescription cream called Aldara has been shown to be effective as well. If you treat the warts with salicylic acid liquid and patches (Compound W. and others) at home, apply daily for 5 to 7 days. Apply the acid to the wart and then cover it with adhesive tape. This acid should not be used near the eyes or mouth. After about a week, the dead tissue on top of the wart can be removed with scissors or a razor blade. Soaking the wart in warm water before trimming makes it easier to remove the top. In children with many warts, topical cortisone cream applied nightly and then covering the area with a clear plastic wrap may be very effective also. To keep from spreading warts, don’t scratch them. Warts spread readily to small cuts and scratches.