Tuesday, December 9, 2014

child infant skin rash, is it allergy ot chiken pox or handfoot mouth disease or measles

Skin rash with fever in kids. Getting rational!@

Allergy does cause an itchy swollen rash... often without fever and at times may progress to respiratory discomfort.. and hence need to be promotly understood treated and prevented. Common allergies are related to diet protein nut/egg/oats/milk/fish etc
Around winter.. three types of viral rashes are often seen. Although any viral fever including dengue fever can rash; the viral rash is often strongly described and seen with measles and chicken pox and hand foot mouth disease.
Commonest of these 3 being hand foot mouth disease HFMD... is the mildest of all and often may not need any specific measures unless has bad oral sores or complications. Its easy to know that HFMD rash is small reddish mini fluid bumps and doesnt affect trunk or back and often has a mouth sore. Fever may be short and mild. All may disappear in two weeks though can spread very fast.
Chicken pox on other hand appears more dreadful and scary rash. It has high fever at onset with trunk lesions and takes three days to spread over rest of body. Different sizes and stages of small to large fluid bumps called vesicles in different stages at a time and each bump surely scarring in a week; and no new bumps beyond ten days since onset is most likely chicken pox. It can cause complications like acute pneumonia.
Rash of HFMD is discrete-small and in measles bumps are very small size and in 'chicken pox and measles' heavily spread all over body.
Measles rash is more common in kids who have skipped measles vaccine of 10 month age. Rash is fine sand like but red; starting in neck with high fever and spreading all over body in two days. Fever settles by three days and rash in a week without any scar. If u see WOUNDS or scar.. surely its not measles. Measles causes fall in immunity and has serious complications like pneumonia or TB to follow over a month.

Its important not to panic; but understand the disease course and visit a doctor earliest. Read danger signs and basic care in viral fever at kondekar.com

Remember if child refuses feed even twice or prefers to lie down more than six hours without sleep.. it may be a sign for hospital based observation.
There are tens of viruses and bacteria that cause a large variety of rashes. This is just an awareness basic.


from www.facebook.com/ChildSpecialistMumbai


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डॉं कोंडेकर संतोष वेंकटरमण@मुंबई Dr Santosh Kondekar is now also available at Shushrusha hospital Dadar West . Mumbai India. Monday to Friday at 7 to 9 PM. www.kondekar.com DR SK is a qualified pediatrician with MD and DNB qualification, from India who has specialised himself in counselling parents and children about the knowledge and various aspects of child health, illness, treament, diseases and their doctors. Dr SK is working as a pediatric intensivist and respiratory and infections specialist at Seth G S Medical College and KEM Hospital Mumbai India 400012. He has clinical expertise in guiding doctors, patients and also managing various illnesses and / or clinical situations concerning child health and its aspects like: Growth, Development Social and behavioural pediatrics including ADHD Respiratory illnesses including cold,cough, asthma Cardiac illnesses including congenital defects and rheumatic diseases Renal diseases Gastrointestinal diseases including diarrhea, vomiting, infections. hematological illnesses including anemias and hemorrhages. and various infections caused by various bugs like bacteria viruses and fungus. and many other clinical situations, illnesses, diseases. He has special interest in tuberculosis and other infections affecting various body organs and systems. The answers posted at above website are sole opinions of Dr SK with or without references and personal experience. These answers are just hypothetical and logical assesment of the limited information provided by the parent to the doctor in the form. The doctor being not able to examine the patiet and / or being not able to have access to reports, is practically not in a position to make diagnosis orprove it wrong... or suggest any treatment. Treatment suggested by this doctor at this site is just a hypothetical suggestion in agiven hypothetical limited situation which the parent may use for his basic understanding or discussion with his doctor, and for understanding and following basic health norms. Donot follow any prescription just because it was mentioned at this site. The consultation didnot take place, as the doctor has not examined the patient, legally its impossible to give any online prscription. What the doctor had written here is not a prescription for the given hypothetical case.
-->

Sunday, July 7, 2013

Fever Cough, cold, Flu? is it flu? will it need antibiotics?

Fever Cough, cold, Flu? is it flu? will it need antibiotics?
Viral fevers of respiratory system are called flu. Flu is something that comes with nose throat symptoms and fever may be optional. if it gets to chest, there is danger of pneumonias and also serious issues.
In typical viral flu, fever may be there for a day or two at beginning and later runny nose or stuffy nose for two days... as nose starts settling cough pics up and may last for a week. Child intake gets reduced adding another danger.
Often A dr will add a fever treating medicine in beginning with an antihistaminic combination for few days and as cough starts the medicines may be switched over  to cough syrups; which may be sedatives and if there is more night cough bronchodilator cough syrups may be needed.
Antibiotics may become essential if Dr thinks about a bacterial disease or complication.
Key to adequate response to therapy is a detailed history, close watch on danger symptoms, Doctor's clinical acumen on picking up signs , deciding appropriate therapy based on current flu strains in community added the experience. Doses matter a lot in kids and cough syrups come with caution of life threatening dangers. Doses of drugs and compliance of patient decidesthe response. click for ask/details. As there are different bacteria, differeent antibiotics likely depending on clinical impressiob by your doc.
Please visit a doctor.

What is nebulisation?
its a form of cold mist with or without medicines used to sooth the airways by inhalation through nose and mouth, Nothing scary or addictive. If the child cries, may be better will be the effect.
advantage small doses, less system side effects than medicines taken by mouth. May help. Discuss with your doctor..


डॉं कोंडेकर संतोष वेंकटरमण@मुंबई Dr Santosh Kondekar is now also available at Shushrusha hospital Dadar West . Mumbai India. Monday to Friday at 7 to 9 PM. www.kondekar.com DR SK is a qualified pediatrician with MD and DNB qualification, from India who has specialised himself in counselling parents and children about the knowledge and various aspects of child health, illness, treament, diseases and their doctors. Dr SK is working as a pediatric intensivist and respiratory and infections specialist at Seth G S Medical College and KEM Hospital Mumbai India 400012. He has clinical expertise in guiding doctors, patients and also managing various illnesses and / or clinical situations concerning child health and its aspects like: Growth, Development Social and behavioural pediatrics including ADHD Respiratory illnesses including cold,cough, asthma Cardiac illnesses including congenital defects and rheumatic diseases Renal diseases Gastrointestinal diseases including diarrhea, vomiting, infections. hematological illnesses including anemias and hemorrhages. and various infections caused by various bugs like bacteria viruses and fungus. and many other clinical situations, illnesses, diseases. He has special interest in tuberculosis and other infections affecting various body organs and systems. The answers posted at above website are sole opinions of Dr SK with or without references and personal experience. These answers are just hypothetical and logical assesment of the limited information provided by the parent to the doctor in the form. The doctor being not able to examine the patiet and / or being not able to have access to reports, is practically not in a position to make diagnosis orprove it wrong... or suggest any treatment. Treatment suggested by this doctor at this site is just a hypothetical suggestion in agiven hypothetical limited situation which the parent may use for his basic understanding or discussion with his doctor, and for understanding and following basic health norms. Donot follow any prescription just because it was mentioned at this site. The consultation didnot take place, as the doctor has not examined the patient, legally its impossible to give any online prscription. What the doctor had written here is not a prescription for the given hypothetical case. -->

Tuesday, April 16, 2013

tonsil adenoids in children, is it asthma or infection?


What are tonsils and adenoids?
They are the protective pillars at the entry point of infection that is throat and nose respectively. Dominant in children below 5 years age as they are weak, By age 10 yr age, most children have very small tonsils and adenoids and practically not serving any purpose.

What age children get affected? adults?
Usual age is 2 to 7 years. Those kids who have chronic symptoms may have it persistent in adults.

How do tonsils and adenoids get infected?
As they are the first pass gaurds, any infection entering from food or breath/aerosol can affect them respectively.

Is it infection or allergy?
Not allergy for sure. tonsils infections are easy to confuse with asthma while adenoid infections are easy to confuse with allergic rhinitis. As symptoms are overlapping to large extent.

How does a doctor make out a child having tonsils and adenoids?
from their symptom profile. In case of adenoids, the kids have nose block on throat side.. and kids often present with runny nose lasting 2 weeks or more.As the nose is almost blocked , these kids may have mouth breathing. fever, growth failure and reduced diet can be off and on. often there is bad breath, snoring and speech issues. rising pressure in ears may also cause ear pain and discharge as adenoids are close to ear openings in throat.
Tonsils often present with fever throat pain or fever cough or fever vomiting episodes. Often get cured with symptomatic therapy. there may be bad breath, hot potato speech or reduced solid intake. Children often look thin short and active. there are often nodes seen just around angle of jaw. Tonsils and house of tonsils often looks inflammed red in acute infections and may get sticky to uvula or other tonsils.
Reduced diet and growth failure is very common and may necessitate surgery.

Any investigations needed?
Adenoid examination by IDL test, Xray nasopharynx (digital) often shows adenoids blocking nose from throat side. Often it may block Eustachian tube.. the openings of ear inside throat.
For tonsils, a throat examination is enough. A blood count or strept test for throat may decide the course of antiniotic therapy.... but if there is any suspicion of TB, one may need node biopsy.

Does it cause growth failure?
As both these cases cause reduced intake, and frequent symptoms poor weight and eventually porr height gain is not uncommon.

Do all kids need surgery for tonsils?
No, unless growth failure or 7-8 episodes in a year affecting quality of life.

Does it cause bad breath, disfigurement of face or teeth?
possible.

Is it due to bottle feeding?
possible

Does it cause leaky ear or ear infection?
possible.

Is there any permanent cure?
yes.. surgery but not needed in all cases. Even natural cure at times.

Are there any medicines?
yes. often symptomatic. Intermittent antibiotic courses and decongestants.

When and how to take these medicines?
Please visit a doctor for prescription.

Is this viral?
possible, but not all cases are viral.

Is this asthma?
It can cause asthma like symptoms so much so that sometimes these cases do need asthma like medicines,

Why do some children worsen?
due to neglect... due to large tonsils, frequent symptoms, inadequate therapy, and in some cases parents refusal to give antibiotics despite need.


And many more questions on tonsil adenoid infections,answers will soon be posted at www.kondekar.com
If you have any query regarding tonsil or adenoid issues about your child, do write back at www.kondekar.com





















डॉं कोंडेकर संतोष वेंकटरमण@मुंबई Dr Santosh Kondekar is now also available at Shushrusha hospital Dadar West . Mumbai India. Monday to Friday at 7 to 9 PM. www.kondekar.com DR SK is a qualified pediatrician with MD and DNB qualification, from India who has specialised himself in counselling parents and children about the knowledge and various aspects of child health, illness, treament, diseases and their doctors. Dr SK is working as a pediatric intensivist and respiratory and infections specialist at Seth G S Medical College and KEM Hospital Mumbai India 400012. He has clinical expertise in guiding doctors, patients and also managing various illnesses and / or clinical situations concerning child health and its aspects like: Growth, Development Social and behavioural pediatrics including ADHD Respiratory illnesses including cold,cough, asthma Cardiac illnesses including congenital defects and rheumatic diseases Renal diseases Gastrointestinal diseases including diarrhea, vomiting, infections. hematological illnesses including anemias and hemorrhages. and various infections caused by various bugs like bacteria viruses and fungus. and many other clinical situations, illnesses, diseases. He has special interest in tuberculosis and other infections affecting various body organs and systems. The answers posted at above website are sole opinions of Dr SK with or without references and personal experience. These answers are just hypothetical and logical assesment of the limited information provided by the parent to the doctor in the form. The doctor being not able to examine the patiet and / or being not able to have access to reports, is practically not in a position to make diagnosis orprove it wrong... or suggest any treatment. Treatment suggested by this doctor at this site is just a hypothetical suggestion in agiven hypothetical limited situation which the parent may use for his basic understanding or discussion with his doctor, and for understanding and following basic health norms. Donot follow any prescription just because it was mentioned at this site. The consultation didnot take place, as the doctor has not examined the patient, legally its impossible to give any online prscription. What the doctor had written here is not a prescription for the given hypothetical case. -->

Tuesday, December 11, 2012

Loose motions "acute gastroenteritis" dehydration dysentery

For COUGH related queries, please read my article  
for clinic address in Mumbai, India please visit www.doctorchild.com

Acute DIARRHEAS... WATER LOSS.. DEHYDRATION... DYSENTERY,., QUERIES

All diarrheas are not same…
They are caused by infections and many times without infections.
Causes of diarrhea are different at different ages too.
Apart from causes-- pattern of diarrhea is also important. Some are watery and some with less water. Some are sticky and some with blood. Some do have serious reason under it. Some do cause serious complications.
in summary a common medicine or formula can not be applied to a case of diarrhea without knowing above details.
Often there is a confusion that teething causes diarrhea, winter causes diarrhea.. monsoon causes diarrhea...etc there is scientific logic which needs to modify these beliefs.
Teething Diarrhea
Often parents come with various tonics for dentition available in market...practically teething per say does not cause diarrhea. during teething the important milestone of hand to mouth and biting starts developing. at this phase kids even start chewing clothes, fingers and toys. the germs that get carried along with this; often end up causing gut or throat infections. Both may cause diarrhea.. simple hygeinic measures and controlling cloth/toy chewing may settle this. If there is serious pica associated may need an attention.
Cold/ cough related diarrhea
in nose, throat, ear infections the mucus secretions or pus gets swallowed in small infants and passes through gut undigested and may look like mucus in stools.. but may smell same as nose secretions.
monsoon diarrhea
Often this is due to water/ feed or hand contamination. Though usually rotavirus related in first year of life; there are many other viruses and bacteria that may cause such monsoon diarrheas. bacterial diarrheas and dysenteries predominate in summer and in areas and seasons of water scarcity too. Often such diarrheas are more watery compared to dyentry.
watery diarrheas
diarrhea is often watery. how much water content per stool may decide the level of infection. Infections from small inetstine often cause large watery diarrheas (enteritis). As the infection spreads from small to large intestine; the water content gets lesser and pain or cramps .. and mucus/blood may come in stools.(enterocolitis).when this happens.. the diarrhea is no longer just diarrhea, but is called dysentery. All diarrheas may not go through this phase. There are some viruses that causes redominant gastritis.. some do cause gastroenteritis; some cause only enteritis and some cause entrocolitis; while soem cause colitis.
dysentery
whenever water content of stool is not enough to make the bed "wet", lets call these diarrheas as nonwatery or may be dysentry. dysentery is presence of mucus or blood in stool/poop. dysentery may be associated with spurts of water.. which is often due to inflammation of rectum ( proctocolitis).
Dysentery may be due to amebiasis, bacteria or antibiotic induced.
Viruses often do not cause dysentery.

Commonest cause of loose stools in developing countries liek India are giardiasis (a form of protozoa); and in elderly kids may eb amebiasis.
Commonest cause of watery diarrheas.. in infants in rotavirus related, in seasons. otherwise can be toxin producing e coli bacteria or salmonella bacteria.. Cholera is a serious cause of severe watery diarrhea... and needs specific therapy. In cholera 1 or 2 motions can make a child very sick. The stool has fishy smell and looks like rice water.
Common causes of diarrhea without too much of water loss, are non rotavirus viruses and bacteria..Most bacteria produce a toxin or they may also attack the intestinal skin (epithelium) and may cause infection, bleed or holes in mucosa that may take days to heal.
each bacterial diarrhea my not need antibiotic too, but most need it.
When to stop breast milk in diarrheas ?
Breast milk is best and should not be stopped in diarrheas. feeding is essential component in maintaining feeds and tackling dehydrations.In soem cases, when diarrhea lasts for longer than 4-5 days, the gut epithelium loses its factors required to digest lactose, a domonant sugar in milk. When lactose not digested, it carries water with it in stools and may harm and motions persist. In such cases breast milk or any milk that contains lactose should be promptly stopped for a week and the same phase should be replaced by lactose free formula or feeds for the same duration. Doctor diagnose this condition by looking at stool Ph and reducing substances in stools.

danger signs in diarrhea: any of  these signs if there may  risk life by dehydration or sepsis..they are as below:
1.reducing urine frequency and quantity
2.sleepy child, lethargic
3.child refusing feeds, voomiting not getting controlled
4.cranky or irrtable child , very thirsty child.. but fails to drink or digest
5.perianal rash..nappy rash, diaper rash or skin sores ulcers or redness.. easy to secondarily infected to complicate matters
6.fever not settling despite 72 hours

If any of these danger signs.. prefer the doctor sees the child very often or the child remains under hospital supervision and therapy. Parents cannot feel or assess the severity of diarrhea related issues which child may be going through. A child of 10 kg often needs 1 litre liquid daily to maintain circulation.A motion of hundred ml will compromise it by 10 % aqnd a 5 motions can compromise it by 50%.
be liberal with fluids with children suffering from gastroenteritis.

Leave the judgement of medicines to doctors.. as all diarrheas are not same in presentation, severity and treatment response. Commonly a diarrhea starts responding to medicines in 72 hours.. but may last 7 to 10 days.
डॉ कोंडेकर संतोष ,एम .डी,.डी.एन .बी.,डी.सी.एच.,एफ.सी.पी.एस.
विशेष बाल रोग निदान व उपचार केंद्र, ओपिडी नं ११
सायं ७ ते ९, सोम ते शुक्र ; शुश्रुषा हॉस्पिटल 
appt: 9869405747 रानडे रोड दादर (प). मुंबई ४०००२८

 post your free queries at www.kondekar.com 
Part II: managing diarrheas.. awaited..
डॉ कोंडेकर संतोष ,एम .डी,.डी.एन .बी.,डी.सी.एच.,एफ.सी.पी.एस.
सहप्राध्यापक बालरोग विभाग , बाल दमा विभाग 
टोपीवाला राष्ट्रीय वैद्यकीय महाविद्यालय 
बा.य ल नायर धर्मार्थ रुग्णालय मुंबई सेन्ट्रल 

child specialist on call..

DR SK is a qualified pediatrician with MD and DNB qualification, from India who has specialised himself in counselling parents and children about the knowledge and various aspects of child health, illness, treament, diseases and their doctors. Dr SK is working as a pediatric intensivist and respiratory and infections specialist at Seth G S Medical College and KEM Hospital Mumbai India 400012. 
He has clinical expertise in guiding doctors, patients and also managing various illnesses and / or clinical situations concerning child health and its aspects like: Growth, Development Social and behavioural pediatrics including ADHD Respiratory illnesses including cold,cough, asthma Cardiac illnesses including congenital defects and rheumatic diseases Renal diseases Gastrointestinal diseases including diarrhea, vomiting, infections. hematological illnesses including anemias and hemorrhages. and various infections caused by various bugs like bacteria viruses and fungus. and many other clinical situations, illnesses, diseases. He has special interest in tuberculosis and other infections affecting various body organs and systems. 

The answers posted at above website are sole opinions of Dr SK with or without references and personal experience. These answers are just hypothetical and logical assesment of the limited information provided by the parent to the doctor in the form. 
The doctor being not able to examine the patiet and / or being not able to have access to reports, is practically not in a position to make diagnosis orprove it wrong... or suggest any treatment. Treatment suggested by this doctor at this site is just a hypothetical suggestion in agiven hypothetical limited situation which the parent may use for his basic understanding or discussion with his doctor, and for understanding and following basic health norms.
 Donot follow any prescription just because it was mentioned at this site. The consultation didnot take place, as the doctor has not examined the patient, legally its impossible to give any online prscription. What the doctor had written here is not a prescription for the given hypothetical case.



Thursday, February 2, 2012

WHAT IS EPILEPSY?

Child health specialist pediatrician Mumbai presents epilepsy FAQs:
Following is not a medical prescription, but just for information. No medicines should be taken or changed without direct clinical consultation and prescription issued by your doctor.
.paid queries at this site click here 
Visit My Message Board for public or open queries.Fill the form at this site for private queries.

WHAT IS EPILEPSY?
A repetitive seizure disorder due to abnormal cortical excitation, manifesting as local or generalized paroxysmal stereotypical movements with or without loss of consciousness, with or without frothing at mouth, with or without passage of urine and stools , with or without visible, tonic/clonic manifestations of a seizure.

WHAT IS NOT EPILEPSY?
Single seizure with normal EEG is not an epilepsy. Movement disorders like tremors, chorea may be confused as epilepsy. Epilepsy may mimick syncope, migraine or vertigo

. WHAT ARE THE DIFFERENT PATTERNS OF EPILEPSY?
Epilepsy can be presenting as focal or generalized seizures without any aetiology as idiopathic epilepsy. When some reason is there, it may be called as pathological or syndromic epilepsy. Clinical patterns may vary from just twitching to tonic clonic movements and from syncope like events to unconsciousness.

HOW DO WE DIAGNOSE THEM
Diagnosis is often clinical. Investigations help in understanding prognosis and aetiology. EEG and MRI brain is often asked for in most epileptics.


DO’S AND DONTS WHEN A PATIENT GETS A SEIZURE
When a patient gets a seizure, let the seizure pass, turn the patient on one side to prevent aspiration of secretions. If available you may give oxygen and nasal midazolam or injectable or per rectal diazepam. Even if seizure is settled, giving medicine will delay next seizure. Discourage the myths about pouring water and applying strong smells or onion to nose , as it will harm the patient.

WHAT ARE THE EMERGENCY DRUGS FOR SEIZURE CONTROL?
Emergency seizure control can be achieved by any of the following drugs depending on availability: Intranasal midazolam spray, per rectal diazepam, intramuscular diazepam,intravenous diazepam or lorazepam or phenytoin or phenobarbitone. These drugs may have life threatening side effects if proper precautions not taken by the doctor.

WHATS ANTICONVULSTANTS TO BE USED FOR WHAT TYPE OF SEIZURES?
This is better left to the experts as type and pattern of seizure and availability of drugs and knowledge of dosages and side effects does matter.The drugs used in past for generalized and focal epilepsies in past that is phenobarbitone and phenytoin respectively, may not be recommendable in view of their side effects, as better drugs are available. Focal and temporal lobe seizures, complex partial seizures, respond better with carbamazepine and oxycarbazepine. Most generalized seizures are well controlled with valproic acid which is a relatively safe drug as the dosages with it can be easily titrated to double without side effects.Newer anticonvulsants shouldnot be used without specialists consultations.

WHAT ARE THE DOSAGES OF SEIZURE CONTROLLING MEDICINES?
Most common drugs like phenytoin, phenobarbitone have narrow therapeutic window and are used in dosages of 5mg/kg body weight per day. Valproic acid having a wider therapeutic window is used in doses of 15 to 40 mg/kg/day. Carbamazepine is used in doses of 10-20mg/kg/day. Should always be started by and confirmed with treating doctor.

HOW LONG THE SEIZURE THERAPY SHOULD BE CONTINUED?
Single seizures with normal EEG and also febrile seizures, often do not need long term seizure therapy. Once started for valid reasons, seizure therapy is usually continued to observe at least 2 years seizure free. Then afterwards there may be a chance of tapering and stopping the therapy, though not in all patients.

WHAT ARE THE SIDE EFFECTS OF SEIZURE THERAPY?
They differ with different drugs, from intellectual dysfunction to anemia, rickets, gynecomastia , obesity etc. Overdoses may cause sleepiness, ataxia, diplopia, headaches and convulsions with different drugs.

WHEN WILL IT GET CURED?
Once the patient is seizure free fro more than 2 years, and there is no other reason to continue the same medicines and on with drawl of medicines if seizures donot recur in 6 months, the disease may be taken as cured for that time.

CAN THE PATIENT SWIM OR DRIVE?
Should preferably be avoided till medicines are on, though many countries promote these activities once 2 years seizure free.

IS THERE ANY SURGERY?
Selective refractory cases with focal manifestations on clinical evaluation or EEG or MRI may be subjected to surgery.


CAN THEY GO TO SCHOOL?
Schooling and office work can be permitted as long as it is stress free and doesn’t involve being on empty stomach for longer hours.

ARE ALL OF THESE ARE MENTALLY RETARDED?
Some seizure patients have mental retardation as comorbidity or may be associated with developmental delay, more so in pediatric patients say of birth asphyxia. In fact, some of the epileptics are superintellectuals.




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Friday, October 14, 2011

recurrent cough and cold, are you worried of asthma or allergy?

ask Child health specialist pediatrician Mumbai....
what is cough, cold and wheeze?
Many parents and people have wierd ideas about cough, cold and wheeze.These interpretation are based on their knowledge, info, myths and perceptions. its better to be clean on these terms when we proceed to discuss further.

Cough: is an explosive sound when air comes out of mouth with a force. noises from nose, chest, throat during breathing is not cough. "Kaff" (in ayurveda) means a lot different than the word "cough". Cough is of different types and varieties, that may help a doctor assess its severity and origin and accordingly plan a therapy.

Cold: Ice is cold, when fever settles hands and feet may go cold. so cold is a very common word used for many issues. When meeting a doctor regarding respiratory issues, we will consider cold as "common cold". The word "common Cold" is used for symptoms of nose and throat with or without fever. Literally its  synonymous with flu.But describing this doesnt help a doctor much to understand the problem. So for all practical purposes we will call cold as runny nose/running nose/stuffy nose/sneezing/watering nose etc. Describing specifically will help doctor plan a specific therapy. cold often may be followed by cough and may be associated with noisy breathing and at times mouth breathing. Read  and understand each word carefully.

Wheezing: its a musical like sound, little longer and high pitch (softer), may be felt by hand on chest or heard aloud at times with child visibly distressed. It is different from noisy breathing which is mainly a sound like snorring or stridor which is louder, and low pitch. Doctor's precision may be needed to separate them. often wheeze is a late sign in asthma , though it has many reasons not related to asthma.

Recurrent cough/ cold/wheeze?
Many parents often feel that their child gets repeated cough cold wheeze etc. Often this may be biased if both parents are working. For example if a child coughs every night and if the parent comes home only at night, while informing the doctor parent may tell he is coughing all the time. This may affect diagnosis and therapy in a great way. Children below 3 year age in India and developing countries, get exposed to a number of respiratory viruses and pollution too. its normal for a child to have 4-8 episodes/year of respiratory issues in infants upto 2 years age. If it is more than 8 per year in first 2 years or more than 3 per year after 2 year age, its likely that this will be called "recurrent".
Recurrent doesnt always mean serious. Serious ones are those that last longer than 7 days, recurr within a gap of 2 weeks and may be life threatening ( see danger symptoms) and may affect weight gain and growth. Serious respiratory symptoms when recurrent (3 per year at any age) may need to be evaluated for associated congenital heart defects.

All these symptoms may be individual or together, with or without fever. Infections often come with fever, allergy / asthma like diseases often come without fever. Occasionally there may be overlap.Allergy / Asthma is difficult to define below 2 years age, its difficult to prove till 6 years age.
Therapy in both groups is primarily symptomatic.Fever medicines for fever, decongestants for runny nose, bronchodilators for wheezers, cough syrups (bronchodilator or suppressive) for cough.
Evaluations / investigations are supportive. Infections may need antibiotics at times, while Allergy / Asthma may need steroids at times.
lets discuss one by one in details. Treatment of runny nose is already discusssed.





 part 2... continued .. please await next posting or put a query in the form on top if you want further details in advance.for free.

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Sunday, July 31, 2011

Danger symptoms: when not to ask for online help from a doctor?

following situations will be difficult or impossible to manage through email, how ever you may just discuss with the doctor later once the acute condition settles down.
while asking a query to Child health specialist pediatrician Mumbai...
You shouldnot post your query on any online medical advice forms in the following way.

1. should i go to a doctor?
== legally when you feel like going to a doctor for consultation of emergency or appointment, there is no second thought. Online doctors cant refuse your wish as the seriousness you describe or the doctor feels cant be assessed online without a video-call.

2. if the child has trauma , medicolegal issue, abuse, addiction, psychological element of the caretaker, its very important and binding that the emergency issues be tackled first. legal elements and psychological issues require a great follow up and cant be answered by email forms.

3. when child has any danger signs:
=== when a child has any danger signs or danger symptoms, its not wise to sit at home or expect a doctor to give remedy on phone or email. you may discuss hypothetical emergencies with doctor to get a general udnerstanding.

4. danger symptoms/life threatening issues
==== these issues should require earliest medical attention preferably at emergency room or casualty. common danger symptoms in child are: trauma, bleeding, fall, convulsion, unconscious, breathlessness, blueness, high fever, not feeding/drinking  well in 12 hours, not passing urine since 12 hours, non responsive child, lethargic child, persistent vomits, many loose motions, rsspiratory discomfort, choking , sudden weakness on any part of body etc such cases need preferably ER visit to rule out life threatening condition. once that is taken care of you may consult to discuss such issues and preparedness to face them in part at home.

5. when you feel like hiding some reports or details when some or any past history is there, please do not ask for advice if the transparancy is not there.

6. If you are a medico/doctor/nurse, please mention in your query to avoid advice to a nonmedico. if you dont wnat to mention , please dont ask a query.

7. IF YOU FEEL, YOU DONOT KNOW ANY DETAILS ABOUT A CASE, AVOID ASKING QUERY ABOUT SUCH A CASE WITH THIRD PARTY. LET THEM ASK THE QUERY DIRECTLY

ASK ANY QUERY WITH ANY HYPOTHETICAL OR VIRTUAL \NAME AND VIRTUAL SITUATION, ANSWERS TO SUCH QUERIES WILL ALWAYS BE ONE OF MANY POSSIBILITIES IN THAT SITUATIONS.




Sunday, March 6, 2011

Re: Feedback via the Online Free advice by Dr SK


format of an online question answer
Name:
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Post or paste your query here:Dr. Kondekar,
I have a question about my nephew. I did try to consult with you last year.|
My nephew was admitted to the hospital in Thane c/o cough and fever in 2010 Feb; diagnosed with strep pneumoniae and discharged on augmentin. Three days after the discharge, he was readmitted due to persistent 101-102 F fever. The doc could not figure out; baby had seizures due to hypocalcemia; dehydration ( no feeding) ; baby was in ICU; transferred to Wadia and diagnosed with klebsiella and mild GERD; admitted for almost 15 days and discharged with instructions to elevate head; thick formula and anacids; however, the cough; intermittent cough and fever is not resolved yet; he is on steroid inhaler; currently has cold, cough and wheezing.
My question: why he has persistently intermittent fever; almost 102F?
Why he still has cough?
Will steroids affect his height?
Is th is related to GERD or ashtma as an atypical presentation of GERD? or something else is going on with underlying inflamatory condition?

The baby is active and cognitively well fucntioning.
I read that you are also specialized in respiratory medicine. I am eager to receive feedback and insights from you.
Thanks and have a great day.
Best Regards,
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answer:My question:
why he has persistently intermittent fever; almost 102F?
====== i clearly could not get from your info that how often how many days.. the efver used to come. i would say, intermittent cant be continuous. we call fever more than 15 days at a stretch as persistant, and fever coming not more than one or 2 times a day as continuous. please provide details with dates,duration,frequency and also the fever free intervals in a month

Why he still has cough?
=== considering he is 1 year age now (please provide exact age), and considering that cough is every day since a year (details not provided), she should have some weight loss if theer is any major problem. the reasosn for cough related to day, night, allergen feeds, diet, vomit , breathless etc have different reasons and therapy. please detail.
Will steroids affect his height?
=== not the inhalational ones.

Is this related to GERD or ashtma as an atypical presentation of GERD?
=== possible but the baby will ned a repeat GER test at this age.
or something else is going on with underlying inflamatory condition?
== please post me xray images(pics) that may help me assess if any underlying issue.
as you had not provided email address, the answer is posted at site.





Sunday, January 9, 2011

My daughter having asthma attack in the hospital


Please go to our dedicated website for asthma in children, teaching parents home based classification, therapy and management of asthma.. www.breathingdiary.com



Dr kondekar is available for private consultations at 
 Shushrusha Hospital Dadar West Mumbai from Monday to Friday 7 to 9 pmPlease confirm appointment 91-9869405747 by call or sms.
a very important cinical sign for parenst to watch at homw for severity of asthma/wheezing

Sunday, January 2, 2011

Pediatrician interview for student project on child sepcialist experience, as a career challenge

1. Why did you choose this career?
by choice as it is challenging!

2. Where (what school) did you get your education for this career?

Seth G S Medical College and King Edward Memorial Hospital Mumbai INDIA
3. How long did your education take?
from 1992-2002

4. How much did your education cost and how did you pay for it?
On an Average 1 million INR

5. Do you like your job? Why or why not?
Yes, as it is challenging to my expectations too.
6. What is the best part of your job?
I interact with people.

7. What is the worst part of your job?
I am an emergency doctor, so taking vacation is real painful.
8. What do you like to do in your free time?
Play with my kids.

9. Do you feel that your job gives you enough free time? (to be with your family and/or traveland/or participate in leisure activities?
Not enough time, I can barely manage family, travel is difficult too.

10. What advice can you give me, as a high school student who is interested in this career?
Plan to revise your decision at every step of your life before deciding on it, as what one may fall fro as a child/adolescent, may not be as one expects.





Employer: Municipal corporation of Mumbai
Job Title: Pediatrician and Associate Professor
Phone #: 91-9869405747
Email; 9869405747@in.com
physical address: Department Pediatrics, Topiwala National Medical College Mumbai Central, INDIA




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Friday, September 17, 2010

child had a fall from bed or height. what to do? when is head injury serious? any to worry?

often there are no issues if the child didnt fall from more than 2 feet or on sharps or was not dropped with force.
if there are no issues for 48 hours usually all is ok.
but very rarely some issues creep if some internal damage like say chronic subdural hemorhage has set in.
commonly kids with mild form of head trauma may develop some irritability or vomiting for few hours. if it lasts longer or if the child develops any neurological symptom like say sleepiness , lethargy, irritability or persistant vomit, it warrants a brain scan and further action.

head injury in child is significant if its a fall from more than 3 feet or its showing some symptoms.
Symptoms may be of local injury at the site of trauma,like abrasion, bruise, lacration, cuts, fracture or bleeding. can be at head, body, spine or back.

It can also cause some internal complications like internal bleeding in brain, chest or abdomen or at times thigh or muscle hematomas/fractures.

Head injury is problematic if it causes some internal problem like internal bleed, hematoma or increased pressure with or without concussions/ contusions and other shake injuries.

A major problem is expected if there is persistant vomiting, drowsiness, sleepiness, irritability,convulsion/fit altered sensorium or unconsciousness with or without weakness, headache, hypertension and bradycardia, which a doctor is keen on looking for.

The child may require some investigations including CT scan to check for major ailments asmentioned above.

Saturday, February 13, 2010

how to treat fever in children? tips and tricks

Child health specialist pediatrician Mumbai says:
Any rise in temperature is a discomfort.. and above 101F it becomes intolerable... and hence requires treatment.

'Highest level of tolerable temp' has no clinical significance as some children show symptoms of hyperpyrexia even at 103 F. and it varies from person to person.

Dr kondekar is available for private consultations at Shushrusha Hospital Dadar(w) Mumbai, monday to friday 7 to 9 pm appointment by sms 9869405747 
 
The question is whether do we need to treat the fever?

fever upto 101F should be watched.. as it may get cured spontaneusly and it can cure the disease at times.
High fever in children, can at times turn lethal; so observing without treatment is no wise.

How do we manage:

1.Switch on Fan /AC, not directed towards pt, air in room should be free flow.

2.take clothes off.. no blankets... a common question always asked is what to do if child is shivering...? The answer is child may shiver.. we may give blanket for 1o min only.. as shivering doesnt last longer and fever starts rising after shiver if a blanket is given. Also shivering is protective while fever may be harmful. SO do take the vlanket off by 10 min... can repeat same.

3. Give an oral antipyretic. In viral infections and malarial fever , the myalgia plays a significant role... so its better to use a combination with ibuprofen or only ibuprofen.. more symptomatic relief. wait for 10 min.

4. Fever coming down : observe. keep opne, turn to side, increase area of heat loss by radiation. ...Fever not coming down: start sponging. continuous or intermittent.

5. Sponging tricks : Keep fan on. dont get scared of shivering. Dont use ice or cold water (why? : its not required ! and it has a risk of ppting hypothermia in children.. children are scared of cold when febrile) use a wet hanky /turkish towel, make it wet.. remove excess water.. spread it over the trunk and tummy... cover maximum surface area, faster relief; till it dries off or becomes hot.. then change the towel, repeat same till temp comes down. Forehead sponging: Most of the times not reqd.. as it carries undue emphasis from movies.. and covers small area. Please dont restrict sponging only to forehead.

TricK: make scalp wet, let the forehead towel cover eyes.. that avoids pricking sensation in eyes.

6. wait another 10 minutes.. temp same or falling... observer and continue. If temperature rising.. try injectable paracetamol... by this we are just increasing the dose of PCM, changing route is only bcos child wont be in a position to take oral; one may try rectal.. equally effective.
There are different fever medicines tylenol, motrin, combiflam,inbugesic, meftal are few trade names, some are combination medicines. some doctors discourage combination medicines. They are available but should not be taken without a prescription by a doctor as some do have side effects in some individuals. 

7. Treat the cause of fever !!

Why prompt relief of fever reqd?

Annoying symptom, discomfort, feb seizure... hyperpyrexic brain damage.

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Tuesday, January 12, 2010

constipation in newborn or infant

Constipation in newborn or infant although more common in formula fed babies, it may also be seen in exlusively breastfed babies. It may be related to high phosphate and protein content of feeds by baby or mother diet.
A simple way to help in addition is avoid cow or buffalo milk or goat milk if any given to child or baby. If the baby is formula fed, add intermittent water sips between feeds, or replace one feed with water for a week. stools get hard when water content of feeds or stools get lesser or the phosphate content rises.

if the child is growing well along growth charts, then this may be a concern at times if it is asociated with bulging abdomen and in addition if the child makes faces, or appears irritable during feeds or cries at times with abdominal distension, child may be given small amount glycerine suppository (1gm Hallens)  by his doctor, alternate day for a week or teo to evacuate colon of the hard stuff, simultaneously working towards making the feeds with enough volume by maing one complete feed full liquid/thin for 10 days. sometimes manual removal of feces may be done by your doctor.

constipation at times is a surgical problem due to soem congenital gut anomalies which may require prompt surgical consultation or a sonography of abdomen.
Dr kondekar is available for private consultations at Shushrusha Hospital Dadar(w) Mumbai, monday to friday 7 to 9 pm appointment by sms 9869405747 

constipation is a chronic problem in school children, formula feds and who have rich milk intake and low calcium intake.
easiest way to improve is
1. wash of stacked piles of stools by repeated bowel wash/ enema not more than 3 a week under medical supervision till tummy distenstion goes off.
2. improve water intake not to dilute stools but more to prevent bowel tendency to retain water sensing some lack of water in body. water intake may be increased to 1.5 times of prior intake, again under medical supervision.
3. avoid constipating diet like milk, pomegrande and like others, and thos e containing high proteins
4.add softening diet like ripe bananas, rice, stool softenere
5. rest all medicines dont do much help in chronic constipations.
6. its always prudent to rule out any bowel obstruction by performing a sonography or barium meal as your doctor may suggest.

Above management is true for dietary constipation, improving activity and exercises add to the good mobility of bowel.

Dr Santosh Kondekar Mumbai