Constipation - How to relieve - Easy Tips

Constipation define as infrequent bowel moments (</= 3 time per week) or passing stools less often than the person's own normal habit, or with difficulty staining, or pain. Constipation is not an uncommon condition in population. It is two time common in female than male.

 

Causes of  Constipation

• Poor  diet
• Lack of exercise
• Old age
• Reduced water intake
• Fearsome, dirty toilets  

Although there are many benign causes, some disease condition and drugs also cause constipation.

• Intestinal obstruction
• Anal fissure
• Rectal prolapse
• Bowel strictures
• Hypothyroidism
• Drugs (opiates, iron, anticholinergics)

But constipation is unlikely to be the only feature of some serious illness. 

1. Drink plenty of water

You should drink ten or more glasses of water per day. It will moisten your stools and lubricate your intestine.  Drink plenty of water also a good health habit.

2. More fiber foods

You should eat 25g -40g of fibers per day. The next question 
is what are the foods which have lot of fibers.  Generally these are cereals, fruits and vegetables. The high fiber foods are wheat germ, barley, bran; mangoes, raspberries, pears, apples; green peas, beans, chickpeas. Fiber do not digested by intestinal enzymes so it cannot absorb. It increases the bulk of the stool and absorb fluids to moist the stool. Not only in constipation high fiber diet helpful in several disease conditions like diabetes mellitus and hyperlipidaemia.

3. Reduce the stress

Anxiety and depression can cause constipation. If you are in an upset mood or have some features of depression like loss of appetite, lose of energy and reduce sleep better to consult a doctor, because early treatment lead to better outcomes. Do not forget depression is common in normal population.

4. Do it regularly

The most important thing is you must go to the bathroom when you have urge. It is important to have a regular time (better in morning) in your time table. Do not forget to do it daily and regularly. If you allow stool to stay lot of time in your body, the water get absorbed and make stool more harder. 

5. Exercise daily

Better to do 4 to 5 times per week for 30 minutes. It will stimulate your intestinal muscles and increase food passage though intestine.    

 

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Snake Bite.....Prevention and First Aid

Most snakes avoid people if possible and bite only when threatened or surprised and most of snakes are not poisons.

To prevent snakebite

• Avoid places where snakes may live. (tall grass or brush, rocky areas, bluffs, marshes, and deep holes in the ground)
• When moving through places where snakes may live, poke at the ground in front of you with a long stick to scare away snakes. 
• Watch carefully your step and where you sit when outdoors.
• Wear long trousers, boots and gloves when necessarily. Snake fans does not directly contact with you. So chance of poisoning is less after a snake bite.
• Use a torch when walking outside at night.
• Do not touch a snake, even if you think it is dead.
• Reduce rubbish materials where a snake could shelter.

 

If a snake bites you 

• Note the Snake's Appearance. Do not try to catch them. It can cause further bites.
• Remain calm.
• Reassure the patient.
• Immobilize the bitten part and keep it below the heart. It will keep the poison from spreading through your body.
• Apply a splint to reduce movement of the affected area, but keep it loose enough and to see the toes.
• Remove rings and anklets before you start to swell.
• Wash the wound with a clean cloth soaked in water and covers it with a clean, dry dressing.
• Seek medical advice as soon as possible.  

Do not

•  use a tourniquet or apply ice after a snake bite.
•  cut the wound or attempt to suck out venom.
•  give alcohol, aspirin or caffeinated drinks.
•  clean wound with flushed water or condys.

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How to use a insulin pen.

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Childhood Obesity

Obesity is a common problem affecting children and adolescents. This is a result of both increased intake of energy-dense foods (high-fat diet, fast foods) and reduced exercise.

Energy expenditure has fallen as a result of an increase in sedentary behavior. Children spent lot of time in front of computers and television. They have less chance to play outdoor games due to competitive education and extra classes.

Other causes of obesity are hypothyroidism, Cushing's syndrome and some syndromes like Prader-Willi syndrome.

Emotional disturbance is seen in some affected children and unhappiness may lead to further excessive eating.

Complications of obesity are bone deformities (bow legs), headache, heart failure, polycystic ovaries, hyperinsulinaemia or non-insulin-dependent diabetes mellitus, hypertension, abnormal blood lipids, asthma and psychological problems like low self-esteem, depression.

To get rid of this problem child should reduce in television viewing and fat intake, increase physical activity (30 to 60 minutes of moderate or vigorous physical activity per day), increase fruit and vegetables intake. Of these, the most effective single factor is reduced television viewing. There is no evidence that any drug treatment is effective in treating obesity in children.

Important to notice

Obesity in children is becoming more common

Predispose children to a wide range of medical illness such as diabetes, high blood pressure and psychological distress in childhood and adult life.

An obese child tends to become an obese adult.

Most children are obese as a result of their lifestyle not due to an underlying medical problem.

Lifestyle changes are difficult to achieve and even harder to maintain.

Success is more likely if there is family support and participation. Therefore family support is necessary to get rid of this problem.

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HEAT test for URINARY PROTEIN....Method of doing and reading at HOME

To perform the heat test, two thirds of a test tube is filled with urine. It is held at a slant and the lower half of the tube is heated until boiling point.

If turbidity appears, two drops of 10% acetic acid (vinergar) are added to exclude the possible presence of phosphates. If this turbidity due to phosphate, turbidity will disappear after adding acid. The degree of turbidity is read against a background of black print. Proteinuria is graded according to the degree of turbidity.

Grading of proteinuria

Nil -          no turbidity

Trace -     slight turbidity with no difficulty in reading the print

+ -             clouding of the print but possible to read the print

++ -          cannot read the print but can notice black

+++ -        cannot notice black

++++ -      cannot notice black and with precipitate

The sulphosalicylic acid test also a recommended test to detect proteinuria.

The sulphosalicylic acid test is performed by adding 2 drops of 30% sulphosalicylic acid to 5 ml of urine in a test tube and observing the resulting turbidity. Grading of proteinuria is similar to the heat test. 

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Patient and Parent Education about NEPHROTIC SYNDROME

What you should know about Nephrotic syndrome......

In nephrotic syndrome lot of protein pass through kidneys result in a low plasma protein (albumin) and oedema (body swelling).

Prognosis

One third of children resolve directly, another one third continue with infrequent attacks and other one third become Steroid dependent (two consecutive relapses occurring during corticosteroid therapy or within fourteen days after its cessation). 10%- 15% of children become steroid resistant.Reassurance that progression to end stage renal failure is extremely rare is important.

Parental motivation and involvement is essential in the management of a child with nephrotic syndrome. Patients and parents who have a clear understanding of the disease comply better with treatment. 

Prior to discharge following treatment of the initial episode – the following aspects of management must be emphasized.

• Urine examination for protein at home. Parent/patient should have a clear understanding of grading proteinuria. How to do....(click here)
• Examination should be done every morning during a relapse, during intercurrent infection or if the child has even mild periorbital oedema.
• Urine is examined twice / thrice a week during remission.
• The dipstick test is carried out by dipping the marked end of the strip in urine for 3 seconds and comparing the colour change with the code given in the pack

• Maintain a diary showing proteinuria, medications received and intercurrent infections. 

• Ensure normal activity and school attendance. It is important that the child participates in all activities and sports.

• Bed rest.     This is not required and could be harmful. (Predisposes to thrombosis)

• Fluid restriction.   This is usually not recommended.

• Infections are an important cause of morbidity and mortality and parents need to understand the measures needed for preventing frequent infections (avoid crowded place…..) and the importance of seeking early treatment for infections (fever, cough, excessive crying, abdominal pain).

• Diet.      It is important to give clear instructions as most parents have their own views and beliefs regarding dietary restrictions in kidney diseases. A balanced diet adequate in protein and calories with a protein intake of 1.5-2 g/kg/day is recommended. A high protein diet had not been shown to improve serum albumin concentration. (The average Sri Lankan diet contains approx. 0.8g/kg/day of proteins) Not more than 30% calories should be derived from fat and saturated fats should be avoided. Carbohydrates are best given in complex forms. A modest reduction in salt is advised in the presence of oedema. Snacks containing high salt are best avoided during this period. Fruits and fruit juices can be given without restrictions. Corticosteroids stimulate the appetite, and advice should be given about ensuring physical activity and preventing excessive weight gain.

• All killed vaccines included in EPI programme should be offered to these children preferably while receiving alternate day prednisolone. Parents must be made aware that live vaccines are contraindicated while on treatment with steroids.

Live vaccines are contraindicated in children receiving high dose systemic steroids (prednisolone 2mg/kg/day or 20mg/day in children >10kg body weight ) until the steroids have been discontinued for 3 months. (BNF;2006, SLMA guidelines on vaccines:2004)

Hepatitis B vaccine should be given to all the children who were not vaccinated previously.

• Educate about prednisilone. 
• Admit the child if there is oedema and +2protein for more than two days at home.

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Fever - What you should know...

What is a fever ?

A fever is when the body’s temperature is higher than normal. Humans usually have a body temperature within a very narrow range. Normally a child has a fever when their temperature is over 37.5ºC (when taken by a thermometer under the arm). A child with a fever often has a hot, flushed face. The forehead may feel hot. The child may feel hot, or sometimes even shivery. A child’s hands and feet may feel cold, even when the rest of the child is hot. Children with fever

are often miserable or tired.

Is fever good or bad ?

Fever is the body’s natural response to infection. Raising the body temperature helps the body to fight off the infection, so it is not always necessary to treat the fever. However, children with fever often feel uncomfortable and unwell. Using measures to bring down their temperature can help. Fevers, especially if they are rapidly increasing, may occasionally bring about convulsions (fits)in children under five years old. These are not dangerous but they can be frightening.

Keeping a child’s temperature from getting too high may prevent fits.

What causes fever ?

The most common cause of a fever is infection. Infections of the upper respiratory tract, such as colds and flu, are very common, especially in preschool children. These infections are caused by a virus and get better on their own without antibiotics. Some infections, like ear infections and some throat infections, may be caused by bacteria. If your child has a bacterial infection, he or she will get better much quicker if antibiotics are prescribed by a doctor. Fever may also be caused by other factors, such as prolonged exposure to the sun on a hot day.

When do you need to see a doctor ?

You need to see a doctor if your child has a fever and:

• Your child is very young (six months or younger)
• Your child seems very sick.

You also need to see a doctor if your child: 

• has an earache 
• has difficulty swallowing 
• has fast breathing 
• has a rash 
• has vomiting 
• has neck stiffness 
• has bulging of the fontanelle (the soft spot on the head in babies) 
• is very sleepy or drowsy 
• you are concerned.

Older children who have a cold, but are not very sick, generally do not need to see a doctor with every fever.

Managing a fever

Since a fever is the body’s natural response to infection it is not always necessary to reduce a fever. However, if your child is very hot and uncomfortable, you can try these simple steps:

• Take off your child’s clothes.
• Give medications to reduce fever, eg paracetamol . This medication should be given at the correct dose, so ask your doctor or refer the instructions on the bottle for the correct dose.
• Give your child plenty to drink as children with a fever need more fluids.
• Consult a doctor if the fever does not settle or your child is still sick.

Impotent to Remember 

• Most fevers are caused by viral infections.
• Make sure your child drinks plenty of fluids.
• Babies under six months with a high temperature should be seen by a doctor.
• See a doctor if your child seems very sick.

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