Health Tips - Acute Conditions

A(H1N1) Swine Flu - The Emergency Committee of the World Health Organization recently confirmed the outbreak of Swine Influenza (also known as swine flu). The strain (A/H1N1) responsible for this outbreak is believed to have recently mutated.

The human symptoms are flu like in nature with the infected persons reporting fever, headaches, sore throat, general aches and pains, loss of appetite, cough and lethargy. Some patients have also report vomiting and diarrhea.

It must be emphasized that such symptoms are not specific for swine flu and other strains of flu may present with similar symptoms. However, there should be a high index of suspicion that swine flu can be responsible for such symptoms if the ill person has recently been in a country with confirmed swine flu or the person has been in contact with someone with suspected or confirmed swine flu during the seven days preceding the onset of their illness.

Spread from human-to-human occurs when the infected person sneezes, coughs, exhales or inadvertently contaminates a surface (e.g. doorknobs, toys, tables, mats, another hand, telephones, pens, etc.) with their hands. The exposed person can become infected by inhaling the infected droplets/ particles or when their hands come into contact with a contaminated surface and then transfer the virus to themselves by touching their eyes, nose or mouth. Swine flu cannot be spread by pork products.

In order to reduce the spread of swine flu the frequent washing of your hands with soap and water or with alcohol-based hand sanitizers is highly recommended, especially after you have been out in public. You should avoid touching your mouth, nose or eyes with your hands unless you've washed your hands. If you do cough, you should cough into a tissue and throw it in the garbage immediately or if you cough into your hand, you should wash your hands immediately.

The Centre for Disease Control recommends the use of Tamiflu (oseltamivir) or Relenza (zanamivir) for the treatment and/or prevention of infection. If a person gets sick, these antiviral drugs can make the illness milder and make the patient recover faster. These medicines may also prevent serious flu complications (e.g. pneumonia). Antiviral drugs work best if started within the first 2 days of symptoms.

<< Back to Health Tips index

A(H1N1) More Contagious Than Seasonal Flu - The WHO reported the A(H1N1) virus causing the outbreak is a new virus strain that has not been seen previously in either humans or animals. Scientists are predicting that pre-existing immunity to the virus will be low or non-existent especially in the young. A(H1N1) appears to be more contagious than seasonal influenza.

The secondary attack rate of H1N1 is double the seasonal influenza ranges. Outside Mexico, nearly all cases of illness, and all deaths, have been detected in people with underlying chronic conditions. Generally the A(H1N1) virus tends to cause very mild illness in healthy people.

<< Back to Health Tips index

Alcohol - A Few Facts - Alcohol is absorbed into your bloodstream within a few minutes after drinking and is carried to all parts of your body including the brain.

The concentration of alcohol in the body, known as the ‘blood alcohol concentration’, depends on many factors, but principally, how much you have drunk, how long you have been drinking, whether you have eaten, and your size and weight. It is difficult to know exactly how much alcohol is in your bloodstream or what effect it may have.

It takes a healthy liver about 1 hour to break down and remove 1 unit of alcohol. A unit is equivalent to 8 gm or 10 ml of pure alcohol. The following all contain one unit of alcohol:

• a half pint of ordinary strength beer, lager and cider
• a single 25 ml measure of spirits
• a small glass of wine

If someone drinks heavily in the evening they may still be over the recommended drink drive limit the following morning.

Black coffee, cold showers and fresh air won’t sober someone up. Only time can remove alcohol from the bloodstream.

<< Back to Health Tips index

Alcohol & Sensible Drinking - Alcohol consumption increases during the Holiday season and is an integral part of many activities at this time of year. Most of the time drinking alcohol doesn’t cause any major problems but drinking too much or at the wrong time can be harmful.

In general, the higher the alcohol intake, the more harmful alcohol is potentially likely to be. This is true whether or not the alcohol intake is high on a very regular basis or in less frequent periods called binge drinking. In the short term, alcohol consumption impairs co-ordination and judgement and significantly increases the risk of accidents. Complex skills such as driving are particularly affected.

There are also health implications and long term consequences of heavy drinking.

Guidance on sensible drinking, suggests the following as examples of specific situations when the best advice is not to drink at all:

• before or during driving;
• before using machinery, electrical equipment or ladders;
• in the workplace where appropriate functioning would be adversely affected by alcohol.

The message this Christmas is moderation and the appointment of a designated driver.

<< Back to Health Tips index

Asthma - Asthma is a disease of the lungs that involves constriction of the muscles around the small airways as well as an inflammatory response within these airways. These reactions occur in response to environmental agents like dust, smoke etc or exercise. This constriction and inflammation greatly reduces the passage through which air flows and may cause a high pitched sound known as wheezing. This gives the characteristic symptoms of chest tightness, shortness of breath and cough.

Management is aimed at dilating the airway and reducing the inflammation. This is achieved by use of inhalers or nebulisations. In addition the inflammatory aspect is treated by using a steroid medication. The steroid may be administered in an inhaled, liquid or tablet formulation. In people who have frequent attacks the steroid inhaler is used twice daily and this prevents inflammation from building up in the airways. However, if an attack occurs, then the rescue inhaler (Ventolin/Barotec) or nebulisations are used to treat the sudden onset of symptoms.

There is no cure for asthma.

<< Back to Health Tips index

Brain Haemorrhage - It’s assumed that a “brain haemorrhage” always begins as a sudden onset severe (clap of thunder) headache that is worse than any headache previously experienced. The latest studies show this is only the case in less than 40 % of brain haemorrhages.

Cerebral aneurysms are the most common cause of spontaneous brain haemorrhages, but only 10% to 20% of them are diagnosed before rupture. 60% of those with brain haemorrhages experience a number of warning symptoms that predate the brain haemorrhage by 1 to 6 days. Such headaches are often diagnosed as migraine, sinusitis, tension headache, or cervical spine disorder. Symptoms and risk factors of a brain haemorrhage include:

• 1. New onset pulsatile headache
• The most severe headache ever experienced by the patient
• Most frequently the headaches were frontal or fronto-temporal
• Some experience neck stiffness associated with severe headaches
• Up to 25% had an abnormal gait
• Other less frequent symptoms include:
  • Seizure
  • Reduced power in a limb
  • Abnormal eye movements
  • Transient loss of consciousness
  • Hypertension

<< Back to Health Tips index

Chickenpox - Caused by a virus: varicella-zoster It is extremely contagious, and can be spread by direct contact, droplet transmission, and airborne transmission.

When someone becomes infected, the pox usually appear 10 to 21 days later. People become contagious 1 to 2 days before outbreak. They remain contagious while uncrusted blisters are present.

Associated symptoms include fever, headache, tummy ache, or loss of appetite, for a day or two before breaking out in the rash. These symptoms last 2 to 4 days after breaking out. The blisters often appear first on the face, trunk, or scalp and spread from there. In most cases, it is enough to keep children comfortable while their own bodies fight the illness.

Oatmeal baths in lukewarm water provide a crusty, comforting coating on the skin. An oral antihistamine can help to ease the itching, as can topical lotions. Safe antiviral medicines have been developed and are most effective when started within the first 24 hours of the rash.

The outcome is generally excellent in uncomplicated cases. Encephalitis, pneumonia, and other invasive bacterial infections are serious, but are rare, complications of chickenpox.

A chickenpox vaccine is about 100% effective in preventing moderate or severe illness.

<< Back to Health Tips index

Childhood Emergencies - How would you handle it if your child was unconscious, choking, or having a seizure?

This is a list of some potential childhood medical emergencies:

• Difficulty breathing
• Choking on food, drink or object
• Uncontrolled bleeding
• Unresponsiveness or unconsciousness
• Blue or grey skin or lips
• Severe or persistent vomiting and diarrhea
• A seizure
• A very high fever especially if accompanied by a skin rash or neck stiffness
• Firearm wound
• Near drowning
• Suffocating
• Severe injury from a car or bike crash
• Eating or drinking something poisonous

It must be noted that preventable injuries/ emergencies are the leading cause of death and permanent disability in children. Child safety seats, bicycle helmets, poison prevention, safety caps on medicines, placing all medicines out of the reach of children, window guards and sports safety equipment are only some of the ways of preventing injuries/ emergencies.

It is important that those entrusted with looking after children (including parents) become familiar with basic CPR and other life saving techniques – e.g. Heimlich manoeuvre.

<< Back to Health Tips index

Dengue - Flu- like viral disease spread by the bite of an infected (Aedes) mosquito. Dengue fever usually starts suddenly with a high fever, severe headache, pain behind the eyes, and muscle and joint pain. The severity of the joint pain has given dengue the name "breakbone fever." Nausea, vomiting, and loss of appetite are common. A rash may appear 3 to 4 days after the start of the fever.

The illness can last up to 10 days, but complete recovery can take as long as a month. Most dengue infections result in relatively mild illness, but rarely, some can progress to dengue hemorrhagic fever. Seek medical attention if initial flu- like symptoms worsen, or if any blood is noticed from the mouth, gums or nose or there are any signs of bruising.

There is no specific treatment for dengue. Drink lots of fluids, rest and simple paracetamol containing analgesia may help with the symptoms. Prevention centers around avoiding mosquito bites and eliminating mosquito breeding sites such as discarded tires, flower pots, old oil drums, water storage containers, etc.

<< Back to Health Tips index

Eclampsia/Preeclampsia - Preeclampsia occurs when blood pressure exceeds 140/90 after the 20th week of pregnancy, accompanied by protein in urine. When severe, blood pressure exceeds 160/110 and urinary protein is present. This condition occurs in approximately 5% of pregnancies. Other symptoms may include headaches, blurred vision, abdominal pain, swelling of face, hands and lower extremities, reduced urine output and metal disturbances.

Eclampsia, is where seizures occur in women who meets the criteria for having preeclampsia, and does not normally have a seizure disorder.

Complications can include: (a)maternal and foetal death, (b) severe swelling (oedema) of extremities/ face, (c) significant weight gain, (d) retinal detachment, (e) kidney failure, (f) pulmonary oedema (fluid in the lungs), (g) HELLP syndrome (Hemolysis, Elevated Liver enzyme levels and a Low Platelet count Leaky vessels in the liver), (h) low birth weight, (i) brain swelling resulting in seizures and coma, (j) brain damage to the mother caused by brain swelling and oxygen loss during seizures, (k) Blindness in the mother, liver rupture, kidney failure and placental abruption (a life-threatening condition to both mother and baby that occurs when there is a disruption of blood flow to the placenta).

Ectopic Pregnancy - An ectopic pregnancy is a pregnancy where the developing baby is found outside of the area (i.e. uterine cavity) where it is normally found. The majority of ectopic pregnancies occur in the “tubes” – i.e. the Fallopian tube.

Approximately 1 in every 100 pregnancies is ectopic. The cause of such is generally unknown. However, it is found that some of the following conditions predisposes some to ectopic pregnancies; these include previous ectopic pregnancies, endometriosis and previous pelvic infections.

For the most part symptoms initially are absent or subtle. On average clinical symptoms are only apparent 7 and ½ weeks after the last normal menstrual period. Early symptoms/signs include:

• Pelvic pain and discomfort
• Abnormal period – i.e. late, lighter than normal
• Pain with a bowel movement

Those with a late ectopic pregnancy may experience:

• Vaginal bleeding
• Moderate to severe pelvic/abdominal/back pain – especially on one side
• Shoulder tip pain
• Lightheadedness/Dizziness

If you suspect that you or someone you know is experiencing an ectopic pregnancy or you experience any of the aforementioned you are encouraged to seek urgent medical attention.

<< Back to Health Tips index

Fever in children - Fever is a response produced by the brain and in children it is quite often a reaction to either viral or bacterial illness. The increased body temperature aids the immune system to fight infection. Therefore it is the body’s natural defense mechanism in the effort to eradicate infection. Fever is defined as an oral temperature greater than 37.7°C. After your child is found to have a fever he or she may become irritable or uncomfortable and medication can be given to reduce the fever. The most common and readily available medications are Paracetamol (Aramol, Calpol) and Ibuprofen (Advil). Remember to check medication labels for dosing instructions. The child’s appetite is usually decreased, so do not force solid food but ensure that he or she is adequately hydrated, by giving extra oral fluids.

Seek medical attention is any of the following is observed:

• The fever is constant for more that 2 days
• The child appears very sleepy or floppy
• Has neck stiffness
• Is not tolerating oral fluids
• Has a seizure (fit)

<< Back to Health Tips index

Gastroenteritis in Children - Gastroenteritis is a term used to describe an illness in which there is a combination of nausea, vomiting, diarrhea and abdominal pain. The majority of cases are of viral origin however bacteria and parasites may also be causative agents.

In managing these cases the level of dehydration must be determined as the child may easily be dehydrated due to fluid loss through the vomiting and diarrhea. Therefore the aim is to maintain adequate hydration and avoid dehydration. This is usually achieved by allowing the child to continue to take oral fluids but given in smaller volumes and more frequently. There are specifically formulated rehydration solutions like Pedialyte or Oral Rehydration Salts that are commercially available to replace these fluids and electrolytes.

In some cases the child may need intravenous fluids but then may either be discharged home to continue oral rehydration or be admitted to hospital if the vomiting persists and oral fluids are not tolerated. In addition medication may be prescribed to help with vomiting and abdominal pain.

<< Back to Health Tips index

Meningitis - This is the inflammation of the membranes and fluid surrounding the brain and spinal cord; it is usually as a result of an infection. Most cases are caused by a virus, but some are caused by bacteria and fungi. Some cases can be a life-threatening emergency. Early treatment can prevent complications.

The early signs and symptoms of meningitis can be mistaken for the flu. Classically the symptoms develop over a 48 hour period.

Common symptoms include:

• Fever
• Severe headache
• Confusion
• Stiff neck
• Seizures
• Drowsiness
• Anorexia
• Skin rash in some cases

If meningitis is suspected seek medical attention immediately. There are certain factors that can predispose one to meningitis, such as:

• Not completing the childhood vaccine schedule
• Children less than 5
• Community living e.g. College campus dormitories
• Compromised immune system e.g. HIV
• Working closely with animals

Complications can include hearing loss, blindness, speech loss, learning disabilities and paralysis. In order to diagnose such a lumbar puncture (spinal tap) will be performed. Treatment will be tailored based on the cause. Specific immunization may prevent meningitis.

<< Back to Health Tips index

Migraine - Recent studies have proven that a combination drugs taken within an hour after the start of a migraine is effective in relieving symptoms. This combination includes the drugs sumatriptan and naproxen sodium.

It is well known that most migraine suffers put off treatment. This lost window of opportunity can essentially turn the initially treatable migraine into a refractive headache. The recent study unequivocally proves that treating a migraine at the first sign of pain increases the likelihood of relief.

The study involved well over 1,000 patients who frequently suffered with migraine headaches. Half of the participants (of the study) were given the sumatriptan/naproxen drug within an hour after migraine pain started and while the pain was still mild. The other half was given a placebo (false drug). Neither group were aware of what they actually received.

The study showed that the migraine suffers who received the combination of sumatriptan/ naproxen were more likely to be relieved of their headaches, nausea, light and noise sensitivity, or other symptoms when compared to those who received the placebo.

<< Back to Health Tips index

Near-Drowning - Near-drowning is the term for survival after suffocation caused by submersion in water or another fluid. A reduced concentration of oxygen in the blood is common to all near-drownings.

The signs and symptoms of near-drowning can differ from person to person. Breathing may have stopped, or the victim may be gasping for breath. Bluish skin/ lips (cyanosis), coughing, and frothy pink sputum are often observed. Rapid breathing, a rapid heart rate and a low-grade fever are common. Conscious victims may appear confused, lethargic, or irritable.

Treatment begins with removing the victim from the water and performing cardiopulmonary resuscitation (CPR). Have someone call an ambulance. Once emergency medical help has arrived on the scene, oxygen is administered. If the victim's breathing has stopped or is otherwise impaired, a tube is inserted into the windpipe to maintain the airway. The victim is also checked for head, neck, and other injuries, and fluids are given intravenously. The victim is then transported to an emergency department. Hospital admission for further observation and treatment is a must for patients who do not appear to recover fully in the emergency department.

<< Back to Health Tips index

Puncture Wounds - These are generally caused by sharp narrow objects. On the day of injury seek medical attention if: Bleeding does not stop after you have put pressure on it for 10 minutes.

• The wound is deep, large, or jagged or it gapes open.
• The wound is on the face and you are concerned about scarring.
• Around the wound feels numb.
• The wound is from an animal or human bite.
• There is any possibility that a foreign body remains in the wound.
• The object went through your shoe or was dirty.
• It’s more than 5 years since your last tetanus shot.
• You are DIABETIC or otherwise immunocompromised.

First Aid includes washing the wound thoroughly with warm water and soap. Put pressure on the wound with a bandage or clean cloth until the bleeding stops.

After initial treatment keep the wound covered with a clean bandage and change it each day or whenever it becomes wet or dirty, until the skin has healed. This usually takes about a week for minor injuries.

<< Back to Health Tips index

Recognizing Medical Emergencies - Severe pain that is not going away is one of the more common emergency symptoms, especially if the pain is in the abdomen, chest or head. Severe abdominal pain may mean appendicitis or an ectopic pregnancy. A severe headache, worse than anything you have ever felt, could mean a ruptured artery in the head. Severe chest or upper back pain could signal a heart attack. Another warning sign of a medical emergency is shortness of breath, difficulty breathing or choking.

Sudden mental changes should be taken seriously. Anyone who suddenly loses their memory or thinking abilities could be suffering a stroke, serious infection or complications of diabetes.

Changes in speech or suddenly not being able to see clearly are two other reasons to seek emergency care.

Uncontrolled bleeding from any wound also calls for urgent attention. Coughing or the vomiting blood should be expediently assessed.

If you or someone that you know has indicated that they are having suicidal thoughts they must see a doctor right away.

Other emergencies include near drowning, ingestion of a poisonous substance, head injury, spinal injury, eye injury or someone suddenly becoming dizzy and weak.

<< Back to Health Tips index

Transient Ischemic Attack (TIA) - A TIA is often referred to as a ‘warning stroke’ or ‘mini-stroke’ that last only a few minutes. Stroke-like symptoms may last for up to 24 hours. Persons who experience a TIA are more likely to have a ‘full blown’ stroke than persons who have not, and are of the same age and sex. Treating the underlying cause of a TIA can often reduce the chances of a ‘full blown’ stroke.

A TIA occurs when a blood clot temporarily clogs an artery to a part of the brain. Unlike a stroke, when a TIA is over, there is no permanent damage to the brain. It is very important to recognize the warning signs of a TIA or stroke, which can occur suddenly; these may include:

• Numbness or weakness of the face, arm or leg on one side of the body
• Confusion, trouble speaking or understanding
• Trouble seeing out of one eye
• Difficulty walking, dizziness, loss of balance or coordination
• Severe headache with no known cause

Don't ignore these symptoms if they appear, GET MEDICAL HELP IMMEDIATELY.

<< Back to Health Tips index

Urticaria/ Hives - Hives present as raised wheals on the skin and often burn and itch. They may appear in isolation or in clusters. Up to 20% of persons will have an episode in their lifetime. In most instances the hives disappear within a few weeks and in the rare case the person may have for months to years.

Their size varies from a pencil point to a very large area. Histamine, released from “mast cells” as a consequence of an allergic reaction, results in leaky blood vessels in the skin which allow the escape of blood plasma resulting in the hive. When hives causes difficulty in breathing or swallowing medical help should be sought immediately.

Foods most often linked to hives are: nuts, shellfish, eggs, chocolate, tomatoes, berries and milk. Almost any medication, prescription or over-the-counter, can cause hives. Viral upper-respiratory tract infections (colds) are a common cause. Hives may be caused by physical agents – e.g. sunlight, heat, cold, water, pressure, vibration or exercise. The best treatment is to identify and eliminate the cause. Antihistamines are often prescribed. No one antihistamine works for everyone. In severe cases, an injection of adrenalin and or cortisone may be administered.

<< Back to Health Tips index

Vertigo: Quick and Easy Treatment - Benign paroxysmal positional vertigo (BPPV) is a relatively common condition of the inner ear that can result in mild, moderate or severe dizziness. The American Academy of Neurology (AAN) found that the best treatment for vertigo is the easiest and quickest one.

BPPV is believed to be caused by loose calcium carbonate crystals that move in the sensing tubes of the inner ear. The treatment involves manoeuvres that move the calcium crystals out of the sensing tube and into another inner chamber of the ear, from which they can be absorbed.

In many cases BPPV can be treated with simple manoeuvres, such as a series of head and body movements performed by a doctor or therapist while the patient sits on a bed or table. There are several manoeuvres currently in use for vertigo. The guideline found that canalith repositioning procedure, also called the Epley manoeuvre, is safe and effective for people of all ages. The Semont manoeuvre may be an effective treatment as well.

The American Academy of Neurology (AAN) web site has an updated Guideline on the management of Vertigo.

<< Back to Health Tips index

Treating and Preventing Viral Red Eye The leading cause of a red, inflamed eye is an adenoviral infection. There is usually an associated watery discharge. The eyelids may be swollen. Sometimes looking at bright lights is painful. Those affected should see a doctor. Viral red eye usually resolves in 7 to 10 days. Treatment of conjunctivitis includes:

• Cold compresses and lubricants (e.g. artificial tears)
• Protecting eyes from dirt and other irritating substances
• Avoiding makeup
• Removing contact lenses
• Topical astringents or antibiotic drops/ointments may be used to prevent bacterial superinfection

Preventing spread of conjunctivitis includes:

• Avoiding touching infected eye(s)
• Washing hands often with soap and warm water
• Washing discharge from eyes twice a day using a fresh tissue
• Washing bed linens, pillowcases, and towels in hot water and detergent
• Wearing shades
• Avoiding sharing of towels
• Washing hands after applying the eye drops or ointment to the infected eye
• Do not use eye drops in a non-infected eye that were used for an infected one
• Keeping child home from school or day care until no longer contagious

<< Back to Health Tips index

Warning signs of a heart attack

• Chest discomfort: Most persons experience central chest discomfort that lasts for more than a few minutes, in some instances the discomfort may go away and subsequently return. The discomfort can feel like a pressure, squeezing, fullness or pain.
• Discomfort and pain in other areas of the upper body: Such can be experienced in one or both arms, the back, neck, jaw, or stomach
• Shortness of breath: Shortness of breath often accompanies chest discomfort. In some instances it can occur before the chest discomfort.
• Other symptoms: These may include cold sweats, nausea and or light-headedness.
• Women: For women their most common heart attack symptom is chest pain or discomfort. However, women are more likely than men to experience shortness of breath, nausea/vomiting and back or jaw pain
• Diabetics: Diabetes can affect your nerves and, therefore, make heart attacks painless or “silent.” A silent heart attack means that you may not have many of the warning signs

Once you suspect that it may be a heart attack, you should still have it checked out immediately. Fast action saves lives.

<< Back to Health Tips index

What to do in a case of a Medical Emergency

• Remain calm.  
• Start CPR or rescue breathing if necessary and make sure you know the proper technique.
• Know the location and quickest route to the nearest emergency facility.
• Keep emergency phone numbers posted by the phone and or on the fridge. Everyone in your household, including children, should know when and how to call these numbers. These numbers include police, fire and ambulance services as well as your doctors' numbers and contact numbers for work and neighbour or nearby friend or relative.
• Upon arriving at an emergency facility, the person should be immediately evaluated. Life- or limb-threatening conditions will be treated first. People with conditions that are not life or limb-threatening may have to wait.
• Wear a medical identification tag if you have a chronic condition or look for one on a person.
• Place a semiconscious or unconscious person in the recovery position (please visit www.wikipedia.org for information on the recovery position) until the ambulance arrives. DO NOT move the person, however, if there has been or may have been a neck injury.

<< Back to Health Tips index