SPECIAL SUPPLEMENT THURSDAY 31 JANUARY 2019

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Al-Ahli’s Orthopedic Department provides a wide spectrum of services

Public HealthPM officially

opens new PHCC Qatar University

Health Centre

ACTING MANAGING EDITORMohammed Salim Mohamed

EDITORIAL CONTRIBUTOR Fazeena Saleem

EDITOR-IN-CHIEFDr. Khalid Mubarak Al-Shafi

SPONSORS

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FAZEENA SALEEM THE PENINSULA

Antibiotic resistance is one of the most urgent threats to public’s health, according to the World Health Organi-sation. Antibiotic resistant

bacteria can cause illnesses that were once easily treatable with antibiotics to become untreatable, leading to dangerous infections. Antibiotic-resistant bacteria are often more difficult to kill and more expensive to treat. In some cases, the anti-biotic-resistant infections can lead to serious disability or even death.

Antibiotics save lives, but any time antibiotics are used, they can cause side effects and lead to antibiotic resistance.

Antibiotic resistance occurs when bacteria develop the ability to resist the drugs designed to kill them. When bac-teria become resistant, antibiotics cannot fight them, and the bacteria multiply.

“Antibiotics are medicines used to prevent and treat bacterial infections. Antibiotic resistance occurs when bac-teria change in response to the use of these medicines,” said Dr Muna Al Maslamani, Medical Director, Communi-cable Disease Center (CDC) of the Hamad Medical Corporation (HMC).

Overuse and misuse of antibiotics allows the development of antibiotic-resistant bacteria. Every time a person takes antibiotics, sensitive bacteria (bac-teria that antibiotics can still attack) are killed, but resistant bacteria are left to grow and multiply. This is how repeated use of antibiotics can increase the number of drug-resistant bacteria.

“Antibiotic resistance is accelerated by the misuse and overuse of antibiotics. Bacteria, not humans or animals, become antibiotic-resistant. These bacteria may infect humans and animals, and the infec-tions they cause are harder to treat than those caused by non-resistant bacteria. Antibiotic resistance leads to higher medical costs, prolonged hospital stays, and death,” Al Maslamani told The Peninsula.

Antibiotics, also known as antibacte-rials, are medications that destroy or slow down the growth of bacteria. They include a range of powerful drugs and are used to treat diseases caused by bacteria. Most illnesses are caused by two kinds of germs: bacteria or viruses. Antibiotics can cure bacterial infections only – they cannot cure viral infections. Antibiotics

cannot treat viral infections, such as cold, flu, and most coughs.

“Smart use of antibiotics is key to con-trolling the spread of resistance. Right dose of antibiotics should be taken in a right duration,” said Dr Maslamani.

When infections can no longer be treated by first-line antibiotics, more expensive medicines must be used. A longer duration of illness and treatment, often in hospitals, increases health care costs as well as the economic burden on families and societies. Antibiotic resistance is putting the achievements of modern medicine at risk. Organ transplantations, chemotherapy and surgeries such as caesarean sections become much more dangerous without effective antibiotics for the prevention and treatment of infections.

According to WHO, the world urgently needs to change the way it prescribes and uses antibiotics. Antibiotic resistance is rising to dangerously high levels in all parts of the world. New resistance mechanisms are emerging and spreading globally, threatening the ability to treat common infectious diseases.

A growing list of infections such as pneumonia, tuberculosis, blood poisoning, gonorrhoea, and foodborne diseases, are becoming harder and sometimes impos-sible, to treat as antibiotics become less effective. Qatar has taken many steps ahead to keep people safe from Antibiotic resistance. The need to reduce antibiotic resistance is being addressed within the Enhanced Health Protection priority area of Qatar’s National Health Strategy 2018-2022.

“Selling antibiotics without prescription is illegal in Qatar. We have implemented this law long back. HMC updates its anti-microbial policy annually based on our local data. We create awareness among the public and health care providers often about correct use of antibiotics and risk of anti-biotic resistance,” said Dr Maslamani.

Antibiotic-resistant bacteria are

often more difficult to kill and more

expensive to treat. In some cases,

the antibiotic-resistant infections

can lead to serious disability or

even death.

Antibiotics: Handle

with care

THE PENINSULA GRAPHIC

SUPPLEMENT COORDINATORAhmed Eltigani Idris

DESIGNAbraham Augusthy

Dr Muna Al Maslamani

Public Health

THURSDAY 31 JANUARY 2019

2

NEED TO SEE A DOCTOR?

CALL MAKE AN APPOINTMENT

Primary Health Care Cor-poration (PHCC) has opened their latest health centre located at Qatar University (QU) in an official ceremony.

His Excellency Sheikh Abdullah bin Nasser bin Khalifa Al Thani, the Prime Minister and Minister of Interior, accom-panied by Her Excellency Dr. Hanan Mohamed Al Kuwari, the Minister for Public Health; and Dr. Mariam Abdul Malik, Managing Director of Primary Heath Care Corporation (PHCC), opened the new primary health care centre in a ribbon cutting ceremony held on January 15. This was followed by a tour

of the new facilities led by Managing Director of PHCC, Dr Mariam Abdul Malik. Special guests attending the opening also included Dr. Hassan Rashid Al Derham, President of Qatar Uni-versity, as well as representatives from Qatar University and PHCC.

The new state-of-the-art facilities — situated close to Qatar University — will support registered patients, bringing high quality, convenient care even closer to the community.

PHCC now has 27 clinics across Qatar and their newly opened health centre aims to provide a high standard of patient care with a medical team of 23 doctors and 44 nurses offering an

array of services including dermatology, dieticians, radiology, dental clinics and ophthalmology.

The QU health centre will deliver women’s wellness clinics, maternity and well-baby clinics, vaccination clinics, smoking cessation clinics and a spe-cialised travel clinic providing vaccina-tions and health advice. Housing modern laboratories, pharmacies, physiotherapy services as well as dedicated health and wellness centres.

It will provide patients with access to a swimming pool, gym and health coaches and offer the support and guidance needed to help them improve their health.

PHCC now has 27 clinics across Qatar

and the newly opened health centre

aims to provide a high standard of

patient care with a medical team of

23 doctors and 44 nurses offering

an array of services including

dermatology, dieticians, radiology,

dental clinics and ophthalmology.

PM officially opens new PHCC Qatar University Health Centre

Public Health

THURSDAY 31 JANUARY 2019

3

DO YOU HAVE A DOCTOR’S APPOINTMENT?

KEEP IT! RESCHEDULE OR CANCEL IT

OR

Commenting on the opening of the new QU health centre, Dr Mariam Abdul Malik, Managing Director at PHCC, said: “High functioning Primary care is at the core of a strong health care system. This is yet another mile-stone in the journey of ensuring that we are supporting healthier lifestyles in Qatar, providing more flexibility, accessibility and timely care closer to people’s homes.

“The cutting edge wellness centres, family-focused pre-vention programs will aim to encourage people to live healthy independently, and to give them greater choice and control over their health.

“We want to bring care closer to the home whilst placing an emphasis on Prevention and effective management of long-term conditions through an array of advanced facilities and services. We believe that we are partners in care, our team of health care professionals will work closely with patients to provide that the most appro-priate care, ensuring that patients’ needs and health centres offerings are always headed in the same direction”

Dr. AlAnoud Saleh Al Fehaidi, PHCC QU Health Centre Manager, commented: “QU Health Centre provides health services to Qatari families, resi-dents of the local area and QU students. The centre provides family medicine and specialists clinics and walk-in services. Family medicine services include chronic disease management, child health, antenatal care, health education among others.

“Specialist’s clinics onsite are ophthalmology clinics, dental services, dermatology and ENT. The centre offers the services through appointments and walk-in systems and wel-comes resident’s registration. Our dedicated team will

providetreatments for minor ailments as well as specialist management of long term con-ditions and clinics covering a wide range of healthcare issues.”

The new health centre in QU complies with the Global Sus-tainability Assessment System Certification (GSAS), which is the first performance-based system

in the MENA region developed for rating green buildings and infrastructures.

The health centre was also designed and built to have adopted the latest sustainability standards which includes natural lighting through extended areas of core skylight, external windows, fresh air heat recovery units for energy saving

and higher efficiency, as well as a Building Management System that monitors and optimizes the operation of other individual systems and much more

The health centre has con-venient access and parking facil-ities for the disabled, it will operate between 7:00 am to 11:00 pm, and you can call 107 for further details.

The QU health centre complies

with the Global Sustainability

Assessment System

Certification (GSAS), which is

the first performance-based

system in the MENA region

developed for rating green

buildings and infrastructures.

Public Health4

Public Health5

THURSDAY 31 JANUARY 2019 THURSDAY 31 JANUARY 2019

Pic: Baher Amin/The Peninsula

A team of nine orthopedic consultants and special-ists provide enhanced services to pediatric and

adult patients at the Al-Ahli Hospital.

“We take care of all ortho-pedic problems from the neck to the feet,” said Dr Stanley Jones, Acting Head of Orthopedics Department, and have the capa-bility, resources and the staff to provide the best care possible and complete orthopedic service to the adults and children.

“With the use of modern equipment and up-to-date min-imally invasive surgical techniques we provide an exten-sive and fully inclusive service within the Orthopedic Depart-ment,” he added.

The Orthopedic Department has grown rapidly since its incep-tion in 2009, and at present it receives at least 2,000 guests each month. It provides services in collaboration with all other departments within the hospital and particularly Physiotherapy, Radiology, Rheumatology, Neu-rology, Chiropractor and the Emergency Department.

SERVICES

The Orthopedic Department runs a dedicated outpatient clinic from Saturday to Thursday. After the initial consultation the

Orthopedic doctor will arrange appropriate investigation ie Blood tests or radiology (X-rays, CT or MRI scan) to confirm the diagnosis and hence decide on treatment. It also provides inpatient care for all types of Orthopedic problems.

PEDIATRIC SERVICEThe Orthopedic service

assesses and manages all pediat-ric musculoskeletal conditions including gait abnormalities, deformities of limb and congen-ital talipes equino varus (club foot). The services also treats frac-tures and sports related injuries.

BACK PAIN MANAGE-MENT SERVICE:

The care and treatment pro-vided includes analgesics, physiotherapy, chiropractor and surgery including selective nerve block, facet joint and caudal epi-dural injection, radiofrequency ablation, micro-discectomy and spinal fusion.

JOINT REPLACEMENT SERVICE:

Total joint replacement of the hip or the knee, through a mini-mally invasive surgical technique is a hugely successful surgery for the treatment of degenerative joint disease (hip and knee arthri-tis). If the Orthopedic consultant recommends surgery, a minimally

invasive surgery technique will be used. This type of surgery has proven benefits including a shorter hospital stay, less trauma, less scarring and a quicker heal-ing time.

Joint replacement surgery brings a great improvement in function and relief of pain.

SPORTS INJURY SERVICE:

The management of sports related injuries, include the man-agement of acute and chronic conditions. Treatment packages might include analgesics, physi-otherapy, chiropractor or surgery.

TRAUMA SERVICE:The Orthopedic Department

in collaboration with the Emer-gency Department provides treatment to pediatric and adults with fractures of the extremities, back and soft tissue injuries. The Department boasts a dedicated and fully equipped plaster room for the application of both basic and specialized casts.

SCOLIOSIS SERVICE: As a specialized part of the

Orthopedic Department, the Sco-liosis Service provides care for the different types of spinal deform-ity, whether congenital or acquired.

Al-Ahli Hospital's Orthopedic Departmentprovides a wide spectrum of services

SPINE

→ Selective Nerve Block.→ Facet Joint and Caudal Epi-

dural Injection→ Radiofrequency ablation→ Discectomy→ Dynamic stabilization or

spinal fusion→ Spinal decompression

SHOULDER

→ Torn cartilage→ Rotator cuff tears and

rotator cuff tendinitis→ Impingement syndrome→ Stiff and frozen shoulder→ Loose bodies within the

joint (either of bone or cartilage)

HAND & ELBOW

→ Tennis elbow→ Golfer's elbow→ Cubital tunnel syndrome→ Carpal tunnel syndrome→ De-Quervain's disease→ Dupuytren's contracture→ Trigger finger→ Ganglion

HIP

→ Hip replacement surgery

KNEE

→ Meniscal tears (a tear of the cartilage)

→ Anterior cruciate ligament tear

→ Chondromalacia (a degen-eration of cartilage cushion due to poor alignment of the kneecap)

→ Loose bodies within the joint (either of bone or cartilage)

→ Arthritis and degeneration the joint

→ Knee replacement surgery.

FOOT & ANKLE

→ Bunionectomy/hallux val-gus correction

→ Achilles tendonitis→ Morton's neuroma→ Plantar fasciitis

ARTHROSCOPIC PROCEDURES

FOR SHOULDER AND KNEE

Injury and degenerative disease of the knee or shoul-der can damage the bones, muscles, tendons, ligaments and cartilage. Arthroscopy is used to diagnose injury or dis-ease within these joints.

A small camera (pen sized) is inserted to view the joint ie knee. The Orthopedic consult-ant can then see the condition of the joint, cartilage and liga-ments. Damage within the joint can then be repaired as necessary.

A full range of treatment is provided for all such condi-tions at the Al-Ahli Hospital.

The highly experienced team of Orthopedic consultants perform an extensive range of surgical procedures.Al-Ahli Hospital's Orthopedic Department provides

a wide spectrum of services and treats all types of

conditions from everyday sprains and strains due

to sports-related injuries and all musculoskeletal

conditions.

EXTRACORPOREAL SHOCK WAVE THERAPY (ESWT):

ESWT is routinely carried out within the Orthopedic Department. ESWT treat-ment is a great option for sufferers of chronic pain. The benefits of ESWT include a significant reduction in pain for a high percentage of patients receiving this treatment with many becoming com-pletely free of pain.

It is a procedure that directs shock waves to the area of pain and is a non-invasive treatment that requires no anesthesia, medication or surgery. It is thought to stimulate healing of the con-dition it is being used to treat.

Many conditions can be treated with ESWT including, plantar fasciitis, achil-les tendinitis, capsulitis and calcific tendinitis of the shoulders, tennis elbow and golfer's elbow,

Dr Stanley Jones,

Acting Head of Orthopedics Department

With the use of modern equipment

and up-to-date minimally invasive

surgical techniques we provide

an extensive and fully inclusive

service within the Orthopedic

Department

We lose our bonesWe are born with about 300 but end up just 206. Many bones,

like those in your skull, fuse together as we grow

What makes us growAs long as growth plates (at the end of long bones in our arms legs) stay open, we grow. The plates close in the late teens for

boys and within two yours of starting periods for girls.

How to keep our bones happyOur bones gain in density until we turn 30. Then density declines

unless we get enough exercise, calcium and vitamin D. Exercise maintains healthy bones.

How broken bones healThe damaged surfaces knit together to form new bone.

Sometimes the new bone is stronger.

Skeleton has many jobsIt moves us. It protects our brain, heart and lungs.

It manufactures blood cells. And it stores and regulates minerals to help our entire system function.

Longest and short bones.Femur, or thigh bone, is the longest. The stirrup-shaped stapes in

your middle ear (measuring only 0.11 inches) is the shortest.

Where we have the most bones.The 54 bones in our hand, fingers and wrists allow us to write,

use a smartphone and play piano.

Bone is living tissueThe collagen in bone constantly replenishes itself. So about every

seven years, we have a new skeleton.

Teeth are part of skeletonThey contain calcium and minerals like bones. But they lack

collagen, which gives bones flexibility and strength.

How women are different.Men and women’s skeletons look surprisingly alike. But the

shape, size and angle of a woman’s pelvis are specially geared for childbirth.

Some joints don’t moveOur bones come together at the joints. Some (like our knee joint)

move a lot. Others (like the joints in our cranium) don’t move at all.

Why joints start to creak.Muscles and ligaments support our joints and cartilage helps to

cushion them. When cartilage wears out, arthritis occurs.

Where is that ‘funny bone’It is not even a bone, It is our ulnar nerve, which runs inside our

elbow. Hitting it triggers a surprisingly tingling, prickly pain.

BONE FACTS

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Bones make up the skeleton of the body. They allow us the ability to interact with our environment and lift out body up against gravity. Bones are attachment points for muscles which allows us to run, jump, sit, kneel, grasp,

and lift. Bones also protect organs from potential damage, and the bone marrow (tissue inside of bones) is responsible for blood cell production.

Bones are the body’s storage area for calcium. On a cellular level, calcium is always entering and exiting bone under the influence of the body’s hor-mones. Parathyroid hormone increases calcium levels in the bloodstream, meaning, that it regu-lates it’s release by bone and decreasing bone density. Calcitonin decreases blood calcium levels and helps restore calcium to bone. Calcium is needed in the blood stream to help muscle cells including the heart to function. Hormone levels will sacrifice calcium in bone to maintain blood calcium levels in a normal range. For that reason, calcium and Vitamin D are important to maintain calcium stores in the body.

WHAT CAUSES A BROKEN BONE?

When a bone has an outside force exerted upon it, like a blow or a fall, there is potential that it cannot withstand the amount of force and it breaks. That loss of integrity results in a fracture. It is important to remember that a fracture, break, or crack all describe the same situation, an injury to the bone where it has been damaged. One term is not more serious than another. Fracture, break, and crack all mean the same thing. Depending upon the situation, the amount of force required may not be very great. People with osteoporosis, the bones lack calcium and are brittle, a minor injury or even gravity may create enough of a force to cause a vertebral compression fracture of the back or a hip fracture. Fractures are usually described by their location, how the bones are aligned, whether there are associated complications with blood and nerve function, and whether the skin is intact at the injury site. The terms and definitions used in medicine to describe fractures allow health care professionals to describe exactly where in the bone the fracture is located.

COMMON ANATOMIC TERMS USED TO DESCRIBE FRACTURES INCLUDE:

Proximal (closer to the center of the body) and Distal (further from the center): The elbow is proximal to the wrist and the wrist is distal to the elbow.

Anterior (toward the front of the body) and Posterior (toward the back): The chest is anterior to the back and the back is posterior to the chest.

Medial (toward the middle of the body) and Lateral (to the outer edge of the body): The ears are lateral to the nose and the nose is medial to the ears.

By thinking of the body in the anatomic position, fractures can be described by their location in the bone and how the parts are aligned and related to each other. Fractures are either dis-placed or non-displaced, meaning that they are adequately aligned or not. Some physicians suggest that all fractures have some displacement and prefer the term “minimally displaced”.

The description of the fracture also includes the direction it takes within the bones.

Transverse: The fracture travels across the boneOblique: The fracture occurs at an angleSpiral: The fracture spirals or extends down

the length of the boneComminuted: The fracture has more than two

parts, multiple fragments are present.

SPECIAL TERMS

Greenstick: In young children, the bones are not yet solid and when force is applied, it tends to bow and not break completely through. The term comes from a similar situation when trying to break a young branch off a tree.

Torus: In children, when only one part of a bone buckles it is called a torus or incomplete fracture.

Open fracture: An open fracture describes the situation where the bone penetrates through the skin. The skin is very important in protecting the inside of the body from infection. If the skin over-lying a broken bone is damaged, whether it is cut, torn or scraped, there is potential for bacteria from the outside world to invade the broken bone and cause an infection.

Fractures are classified as open (if the skin is damaged) or closed (if the skin is intact). An open fracture may require an orthopedic surgeon to wash out the fracture site to prevent osteomyelitis (bone infection). Depending upon circumstances, the type of fracture, the amount of contamination to the skin and wound, and the person’s condition, this procedure may take place in the operating room.

COMPRESSION FRACTURE: The spine is comprised of 7 cervical, 12 thoracic, and 5 lumbar vertebrae. The spine holds the body erect against gravity and to protect the spinal cord. Com-pression fractures can be caused by osteoporosis, injury, or trauma. People with osteoporosis lose calcium from the bones, and the vertebrae may become weak and unable to hold up against the forces of gravity, so they gradually compress over time.

A compression fracture due to an injury may or may not have spinal cord or nerve root irritation

because of the fracture. A compression fracture due to trauma most likely occurs from a motor vehicle crash or fall from height.

SKULL FRACTURE: The purpose of the skull is to protect the brain. It is a flat bone and it takes a significant direct blow to cause a fracture. Because the main concern is an injury to the brain and not the skull injury, plain X-rays are not routinely per-formed to look for a skull fracture. Instead CT scan of the brain is recommended if there is concern about a brain injury. Skull fractures are often asso-ciated with localized swelling and bleeding at the site of injury.

Basilar skull fractures describe damage to bone at the base of the brain. Physical findings may include bloody drainage from the ear or nose, bruising behind the ear (Battle’s sign), and bruising around the eyes (Raccoon eyes).

With a depressed skull fracture, the bone is broken and fragments are pushed inward. Depending upon depth of the bony depression and whether there is brain tissue involvement, surgery may be required.

With an open skull fracture, the scalp is lac-erated and the wound may connect with the fibrous coverings of the brain (meninges). Surgery is often performed to help prevent infection.

STRESS FRACTURE: Stress fractures are the result of multiple microtraumas where the bone cannot tolerate and absorb repeated stresses placed upon it. It is an overuse injury and is often seen in the lower leg especially with runners and other athletes. If untreated, and if the person continues to participate in offending activity, the stress fracture may progress to a completed fracture. These are most often seen in athletes who partic-ipate in running, tennis, basketball, and other sports that involve running and jumping on hard surfaces. March fracture is the name given to a stress fracture of the metatarsal bone of the foot. They are described in soldiers who are forced to walk or “march” for prolonged distances.

WHAT ARE THE MOST COMMON BONES THAT ARE BROKEN?

The most common fractures involve the clavicle (collarbone), the forearm (radius and ulna), the wrist, the ankle and the hip. Closed frac-tures are more common than open fractures (the skin overlying the injury is intact and not damaged). In children, a fracture of the distal radius is most common. The break occurs in the radius near the wrist but usually does not involve the joint itself.

Broken hand or fingers: Injuries to the hands and fingers are very common because they are exposed in daily activities. In addition to the bones, the health care professional will be interested in making certain there are no tendon or nerve injuries associated with any broken bone(s). Because the anatomy of the hand is so complex, complicated fractures may be referred to an ortho-pedic or plastic hand specialist. Many of them will only require splinting or casting, but occasionally surgery will be necessary.

Broken wrist: Falling on an outstretched hand is the most common reason for a wrist fracture. It is often the distal radius that is damaged, and the fracture may involve more than one bone. Aside from the radius, wrist fractures may also include fractures of the carpal bones of the wrist (carpus), those that connect the radius to the long bones of the hand (metacarpals).

Doctors often look for fractures of the scaphoid bone (the bone between the bottom of the thumb

and the top of the radius), and dislocations of the lunate (the bone next to the scaphoid bone) that may be difficult to see on plain X-ray. In some cases, the wrist is splinted even if X-rays are normal because upon physical examination the doctor may be concerned about a potential occult or hidden fracture (the fracture is so small that it does not show up on an X-ray).

Depending upon the bone that is injured and it’s alignment, surgery may or may not be required. Regardless of the treatment, the goal is to have a normally aligned wrist, especially if the fracture involves the joint surface. Poor alignment may lead to arthritis in the future.

Broken hip: Hip fractures are perhaps the most common fracture seen in people 75 years of age or older. While falls and trauma may be the obvious cause, many times, people are more susceptible to hip fracture because of osteoporosis and some-times the hip will break spontaneously. The hip joint is made up of the interconnection of two bones in a ball and socket: 1) the socket in the pelvis (acetabulum), and 2) the ball (femoral head). Hip fractures refer to the femur fracture. Almost all hip fractures require surgery and the type of surgery depends upon where in the femur that the fracture is located.

Broken leg: Each of the many bones of the lower extremity is at risk for fracture. Leg fractures also may involve the knee joint, and treatment depends upon the type of fracture. Similarly, frac-tures of the lower leg (tibia and fibula) and talus (the most proximal bone in the foot) may involve the ankle joint. Fractures and dislocations of the foot may be as complex as the hand. Because of the anatomy, they may also be more difficult to diagnosis on plain X-rays.

Broken toe: Broken toes are a common fracture and may be diagnosed by history and physical examination. X-rays may or may not be needed depending upon the clinical situation.

Broken shoulder: The clavicle (collarbone) fracture is one of the most commonly seen broken bones, fracture of the humeral head (the ball) is quite common an older person who falls. Depending upon the amount of comminution (into how many pieces the humeral head breaks) surgery may or may not be required. Initial treatment usually begins with a sling. The scapula or shoulder blade is a flat bone and very difficult to break. The mechanism is usually a direct blow. Any scapula fracture needs to be evaluated for related injuries.

WHAT ARE THE SIGNS AND SYMPTOMS OF A BROKEN BONE?

Broken bones hurt. The lining of the bone (peri-osteum) is rich with nerve endings that can cause pain when inflamed; and the muscles surrounding the fracture go into spasm to prevent movement of the fracture site, and this spasm may intensify the pain. Bones have a rich blood supply and will bleed when injured. This will cause swelling and the blood that seeps into the surrounding tissue will also cause further pain. The discoloration due to the blood can show up as dark red or purple bruise in the area of the fracture site.

Because muscles and tendons may not be damaged, the person may be able to move the injured extremity. For that reason, just because you can move the injured area, doesn’t mean it’s not broken. If there is damage to a nearby artery, the injury may be cool and pale (distal to the injury), and if there is nerve damage, there may be numbness (distally).

HOW IS A BROKEN BONE DIAGNOSED?

The doctor will take a history of the patient’s injury, examine the injury, and look for potential other injuries that may have occurred. The skin surrounding the injured area is inspected to look for a laceration, scrape, or skin tear. The area of tenderness and swelling will be evaluated to identify the injured bone. The type of X-ray that is ordered depends on the specific injury. Some-times plain X-rays do not identify the injury. If the doctor is still concerned, CT scan or MRI might be ordered.

Fractures in children: Fractures may be difficult to diagnose in children because bones have not com-pletely formed. Many parts of developing bone are com-prised mostly of cartilage and have yet to have calcium deposited in them. Growing bone also has growth plates that may mimic or hide fractures. On occasion, the diag-nosis of a fracture is made clinically based upon physical exam, even if the X-rays do not show an injury.

WHAT IS THE TREATMENT FOR A BROKEN BONE?

The initial treatment of a fracture begins with sta-bilization and immobilization. In the field RICE (rest, ice, compression and elevation) may help make the patient more comfortable and prevent the fractured bones from moving.

Bone heals in three stages.Reactive stage: The blood clot that forms at the

fracture site begins to organize and the body’s building blocks start to bridge the gap between the two ends of the broken bone.

Repair stage: Specialized cells located in the outer lining of the bone (periosteum), begin to form a lattice work or grids of cartilage and bone, called a callus, which spans the fracture. More bone is laid down to provide strength to the area.

Remodeling phase: Over the next few years, the body will attempt to resculpt this mass of bone into it’s original size and shape.

HOW CAN FRACTURES BE PREVENTED?

Many broken bones occur because of accidents in the home, at work or at play, and not all may be preventable. Using proper safety equipment and precautions may minimize the risk of injury, but it cannot be completely eliminated.

As we age, there is an increased risk for falls at homes and some preventive steps may help reduce fall risks. These include:

� Make certain that lighting is adequate� Shoes should not be slippery� Loose rugs or uneven floors should be

repaired� High traffic areas like from the bed to the

bath or from the kitchen to the living area need to be clear from hazards like excess furniture, extension cords, or boxes

� Bathrooms should have nonslip mats on the floor and in the bathtub or shower

� Install handrails for stairs and grab bars in the bathroom

Bones also get old as we age and the man-agement of osteoporosis is a life-long commitment. Increasing calcium content in bone will decrease the risk of spontaneous fracture, and also may make bone strong enough to potentially withstand an injury that otherwise would result in a fracture. Ways to prevent osteoporosis include:

� Increase weight bearing exercise� Make sure you are getting the right amount

of calcium and Vitamin D in the diet. Take supple-ments if necessary.

� Do not smoke� Avoid excess beverage intake.

Broken bone: Diagnosis and prevention

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THURSDAY 31 JANUARY 2019

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A boil is caused by a bacterial skin infection. This skin abscess forms deep inside a hair follicle or oil gland. A boil generally starts as a reddened, tender area. Over time, the area becomes firm and hard.

The infection damages your skin cells, hollowing the tissue out. Your immune system responds with white blood cells, which fill the center of the infection and make it soft. Your body makes these cells to destroy the infection. Together with bac-teria and proteins, these white blood cells are known as pus. This pus may eventually form a central head near the surface of your skin. This head may drain on its own, spilling out of the surface of your skin. If not, it can be surgically opened.

WHAT SYMPTOMS ARE RELATED TO BOILS?

A boil starts as a hard, red, painful, pea-sized lump. It is usually less than an inch big. Over the next few days, the lump becomes softer, larger, and more painful. Soon a pocket of pus forms on the top of the boil. Here are some symptoms related to a severe boil infection:

� the skin around the boil becomes red, painful, and swollen;

� several boils may cluster around the original one (a carbuncle);

� a fever develops;� the lymph nodes in the area become swollen� The common places for boils to appear are

on your neck, armpits, shoulders, and buttocks.� When one of these occur on the eyelid, it is

called a sty (stye).

WHY DO BOILS FORM?

Boils are caused by bacteria, and usually the infectious bacterium is Staphylococcus aureus. Many staph infections develop into abscesses and can become serious very quickly. This germ can be present on normal skin and enters the body through tiny breaks in the skin or by traveling down a hair to the follicle.

Some boils can be caused by an ingrown hair. Others can form as the result of a splinter or other foreign material that has become lodged in the skin that causes the infection to develop.

The skin is an essential part of our immune defense against materials and microbes that are foreign to our body. Any break in the skin, such as a cut or scrape, can develop into an abscess (boil) should it then become infected with bac-teria; consequently, not all boils originate in hair follicles.

Folliculitis is an inflammation or infection of the hair follicles. This condition can develop into a boil and appears as numerous small red or pink little bumps at the hair follicles.

Infection of the hair follicles can occur when the skin is disrupted or inflamed due to a number of conditions, including acne, skin wounds or injuries, friction from clothing, excessive sweating, or exposure to toxins.

CAN BOILS BECOME CONTAGIOUS?

Boils themselves are not contagious, but S. aureus is. Until it drains and heals, an active skin boil can spread staph infection. The infection can

spread to other parts of the person’s body or to other people through skin-to-skin contact or the sharing of personal items, such as towels or wash-clothes. There are several different types of boils. Another name for a boil is “furuncle”. Among these are carbuncle; hidradenitis suppurativa (seen in the armpit or groin); pilonidal cyst (area on the back where the buttocks merge); cystic acne and sty (stye).

CARBUNCLE VS FURUNCLES: A carbuncle is an abscess in the skin caused by the bacterium Staphylococcus aureus. It usually involves a group of hair follicles and is therefore larger than a typical furuncle, or boil. A carbuncle can have one or more openings onto the skin and may be asso-ciated with fever or chills. Carbuncles are con-sidered more serious skin conditions. When you have multiple carbuncles, the condition is known as carbunculosis. This skin condition may not respond to home remedies, and is more likely to need expert treatment from a health care professional.

CYSTIC ACNE: Cystic acne is a type of abscess that is formed when oil ducts become clogged and inflamed. Cystic acne affects deeper skin tissue than the more superficial inflammation from

common acne. Cystic acne is most common on the face and typically occurs in the teenage years.

HIDRADENITIS SUPPURATIVA: It is a con-dition in which there are multiple abscesses that form under the armpits and often in the groin area. These areas are a result of local inflammation of the hair follicles. This form of skin inflammation is difficult to treat with antibiotics alone and typ-ically requires a surgical procedure to remove the involved hair follicles in order to stop the skin inflammation.

PILONIDAL CYST: A pilonidal cyst is a unique kind of abscess that occurs in or above the crease of the buttocks. Pilonidal cysts often begin as tiny areas of inflammation in the base of the area of skin from which hair grows (the hair follicle). With irritation from direct pressure, over time the inflamed area enlarges to become a firm, painful, tender nodule making it difficult to sit without discomfort. These frequently form after long trips that involve prolonged sitting.

EYELID STY: A sty (also spelled stye) is a tender, painful red bump located at the base of an eyelash or under or inside the eyelid. A sty results from a localized inflammation of the glands or a hair follicle of the eyelid. A sty is sometimes confused with a chalazion, a lump on the inner portion of the upper or lower eyelid, but a chalazion is usually painless and caused by obstruction and inflammation of an oil gland, not an infection.

WHO IS MOST LIKELY TO DEVELOP A BOIL?

Anyone can develop a boil. However, people with certain illnesses or medications that impair the body’s immune system are more likely to develop boils. Among the illnesses that can be

associated with impaired immune systems are diabetes and kidney failure. Diseases, such as hypogammaglobulinemia, that are associated with deficiencies in the normal immune system, can increase the tendency to develop boils. Many med-ications can suppress the normal immune system and increase the risk of developing boils.

WHAT IS THE TREATMENT FOR A BOIL?

Most simple boils can be treated at home. Ideally, the treatment should begin as soon as a boil is noticed since early treatment may prevent later complications. The primary treatment for most boils is heat application, usually with hot soaks or hot packs. Heat application increases the circulation to the area and allows the body to better fight off the infection by bringing antibodies and white blood cells to the site of infection. Do not pop the boil with a needle. This usually results in making the infection worse.

As long as the boil is small and firm, opening the area and draining the boil is not helpful, even if the area is painful. However, once the boil becomes soft or “forms a head” (that is, a small pustule is noted in the boil), it can be ready to drain. Once drained, pain relief can be dramatic.

Most small boils, such as those that form around hairs, drain on their own with soaking and/or heat application. On occasion, and especially with larger boils, the larger boil will need to be drained or “lanced” by a health-care practitioner. Frequently, these larger boils contain several pockets of pus that must be opened and drained.

Once boils appear once, they may return. About 10% of people who develop a boil will develop another one within a year. Some people suffer from recurring boils (“recurrent furuncu-losis”). Home remedies and over-the-counter medicines may not be enough for this skin problem. Prescription antibiotics may be used to eliminate the responsible staph bacteria.

Especially if the skin surrounding your boil is infected, your doctor will often prescribe antibi-otics. However, antibiotics are not always helpful. Antibiotics have difficulty penetrating the outer wall of a boil. They often will not cure a boil without additional surgical drainage. In most cases, incising and draining the boil is sufficient to cure the infection.

You should call your doctor and seek medical attention if: the boil is located on your face, near your spine, or near your anus; a boil is getting larger; the pain is severe; you have a fever; the skin around the boil turns red or red streaks appear; you have a heart murmur, diabetes, any problem with your immune system, or use immune-suppressing drugs (for example, corti-costeroids or chemotherapy) and you develop a boil; the boil has not improved after five to seven days of home treatment; you get many boils over several months.

WHAT CAN BE DONE TO PREVENT BOILS?

Good hygiene and the regular use of antibac-terial soaps can help to prevent bacteria from building up on the skin. This can reduce the chance for hair follicles to become infected and prevent the formation of boils. Your health-care practi-tioner may recommend special cleansers to further reduce the bacteria on the skin.

Pilonidal cysts can be prevented by avoiding continuous direct pressure or irritation of the buttock area when a local hair follicle becomes inflamed. Regular soap and hot water cleaning and drying can be helpful.

For acne and hidradenitis suppurativa, anti-biotics are used and anti-inflammatory agents may be required on a long-term basis to prevent recurrent abscess formation.

Finally, surgery may occasionally be needed, especially for hidradenitis suppurativa or pilo-nidal cysts that recur. For pilonidal cysts, surgi-cally removing the outer shell of the cyst is important to clear the boil. For hidradenitis sup-purativa, extensive involvement can require plastic surgery.

www.medicinenet.com

Boils are caused by bacteria, and

usually the infectious bacterium is

Staphylococcus aureus. Many staph

infections develop into abscesses

and can become serious very

quickly. This germ can be present

on normal skin and enters the body

through tiny breaks in the skin or

by traveling down a hair to the

follicle.

Most simple boils can be treated at

home. Ideally, the treatment should

begin as soon as a boil is noticed

since early treatment may prevent

later complications. The primary

treatment for most boils is heat

application, usually with hot soaks

or hot packs. Heat application

increases the circulation to the

area and allows the body to better

fight off the infection by bringing

antibodies and white blood cells to

the site of infection.

Boils: Causes, symptoms and treatment

Public Health

THURSDAY 31 JANUARY 2019

8

You may not look forward to your annual doc-tor’s visit, but the yearly exam can play a crucial part in your ongoing health. Your doctor knows this, and uses that time to check for any symptoms or signs of health problems — and catch them while there’s still time to

do something about them.Yearly physical examinations can help spot high blood

pressure and high cholesterol, among others. They’re good ways to remember your immunization schedule, too. But perhaps the most important job of the yearly doctor’s visit is to screen for a variety of cancers, many of which are more easily treated — with better survival odds — if they are found early.

PRESS YOUR TUMMY

Your abdomen is important to your health. It’s where your liver, stomach, intestines and other vital organs live. So your doctor will prod a bit, testing to make sure every-thing is healthy. This is to make sure nothing is too tender, too big, or too firm. Along with the tummy-touching, a doctor will want to examine your skin, the shape of your abdomen, and how it moves as you breathe in and out. The doctor will probably also listen to the abdomen, as some bowel problems can be heard with a stethoscope.

POKE SOMETHING INTO YOUR EAR

Doctors use a device called an otoscope (or auriscope) to peer into your ears. If your hearing is troubled or you have an ear ache, this handy device can literally shed light on the problem. Remember — ear canals are dark places! That’s why doctors cast light on them and magnify them in this way.

Some of the problems a doctor may spy with an oto-scope include too much ear wax, swollen ear canals, irri-tated eardrums, and fluid that may signal infection. Beyond helping your doctor see, many otoscopes live a dual life as air-puffers. A doctor can puff a little air into your ear to find out if you’ve been having troubles with pressure differ-ences between the middle ear and the atmosphere.

PRESS YOUR TONGUE DOWN LIKE THAT

A mouth can say a lot about your health without even speaking. Doctors know this, so looking into your mouth with a tongue depressor and a flashlight or head lamp is typical during physical examination. So what can looking into your mouth tell your doctor? Well, if your tongue has a growth or a white spot, it may lead to cancer.

Your throat and the back of your mouth can suggest how healthy your teeth are too. Your tonsils could be inflamed, which happens when you have acute tonsillitis. Abscesses may be spotted as well. Dental problems like periodontal disease or cracked, broken or missing teeth can be addressed. Whitish coatings of oral surfaces or the presence of other lesions may indicate signs of infection or other underlying health problems.

LIGHT UP YOUR EYES

We usually don’t want bright lights flashed into our eyes. During a doctor’s visit, though, this can save you from huge problems down the road. By shining a light in your eye, a doctor can watch to see how much your pupil gets smaller (constricts). Your doctor is looking to make sure those tiny black spots in the center of your eye stay round, and that each eye reacts to the light in the same way. By doing this test, a doctor can check for high blood pressure, glaucoma, diabetes, or certain eye problems.

LISTEN TO YOUR HEART, LUNGS, AND NECK

A doctor’s stethoscope is so important that these handy hearing devices are immediately recognized by most people. A stethoscope magnifies sounds like your heart beat. Making sure your heart is in good working order is perhaps the primary job of a stethoscope. It is also used to listen to your lungs and neck.

HEART: By listening carefully to your heartbeat, a doctor can know right away if you have a heart murmur, which is another word for an unusual wooshing or swishing sound in your heart. Most murmurs are normal, but some can indicate problems such as a fever, anemia, high blood pressure, or an overactive thyroid. Murmurs can also indicate a variety of problems with heart valves. The steth-oscope can let the doctor know immediately if the heart is not beating normally.

LUNGS: The stethosope can let your doctor hear sounds like crackles, rales (sounds like rattling or crumpling cel-lophane) or detect no sounds in the lungs where some should be present. The various sounds can help your doctor screen for and/or diagnose lung problems.

NECK: By listening to the sides of the neck with a steth-oscope, your doctor can screen for carotid narrowing by detecting a carotid bruit, an abnormal swooshing sound in the carotid artery.

SQUEEZE THAT CUFF AROUND YOUR ARM

It’s important to get your blood pressure checked reg-ularly. To do that, a doctor or nurse cuffs your upper arm and tightens it. This is to measure how much force your veins are using to pumping your blood. This is the only convenient, reliable way to watch out for high blood pressure, because the condition is known for showing few symptoms. That’s how it earned the nickname “the silent killer”. High blood pressure can raise your risk of stroke, heart failure, and heart attacks, but it is manageable with medication and lifestyle changes. If you have been assessed as having high blood pressure, you will want to check your own blood pressure at home regularly between doctor visits.

Physical exam: Why does your doctor do that?

TELLING YOU TO TURN YOUR HEAD AND COUGH

When your doctor asks you to cough, it means you’re being checked for a hernia. Coughing tightens your stomach muscles, and when that happens someone with an inguinal hernia may find that a part of their intestines or abdominal fat starts bulging through the lower abdomen. Your doctor can feel this by placing a hand on your scrotum while you cough.

This condition can be present at birth, or it may be caused by straining, such as when you lift a heavy object. It can cause pain and dis-comfort by itself, and it can also lead to more serious problems. Your doctor will probably encourage you to undergo surgery, the only effective treatment for this issue. That explains the coughing part. But why turn your head? That’s actually pretty simple. Your doctor doesn’t want to be coughed on!

TRACK YOUR HEIGHT AND WEIGHT

Tracking your height and weight helps your doctor assess your body mass index (BMI). This is an estimate of your total body fat, and can tell your doctor if you’re at a heightened risk for high blood pressure, heart disease, gallstones, type 2 diabetes and other ailments. This is also a good way to track your weight from year to year. Your doctor can see whether you’ve been losing weight or gaining it, and recommend helpful medical advice either way.

DRAW BLOOD

Sometimes our bodies don’t show many symptoms when they’re sick. The blood can tell the story that may not be obvious from any other

source. Signs of liver disease, thyroid disease, and kidney disease can be picked up from bloodwork, as can high cholesterol and other medical problems.

It’s never enjoyable to learn that your body isn’t functioning the way it should, but blood tests can tell you early, which can save you from much more serious health complications down the road. Discovering what ails you early can also save you money in the long run.

TAP YOUR KNEECAP

You’ve probably seen your doctor pull out that funny, triangular, rubber hammer before. And you know what comes next — a firm tap below the kneecap and (usually) your leg jerks up. But not always. Sometimes this reflex test finds a problem with your reflexes rooted in your nerves. The nerves to your legs are carried through your lower back, and sometimes com-pression will hamper or slow your reflexes. So even though your doctor isn’t anywhere near your back when tapping that tendon, this exercise may actually unearth a lower back problem. This test can also detect thyroid problems, as delayed relaxation after testing is found in about 75% of patients with hypothyroidism.

TAP YOUR BACK

You may wonder why your doctor is thumping your back like a ripe melon. That tapping action has a name: “percussion”. And just like a drum, your lungs have air that carries sound. That sound can let your doctor know if there is liquid inside your lungs, which can happen if you are sick. Fluid in your lungs can signify emphysema, heart failure, or cancer.

TRACK YOUR HEART RATEHow fast your heart beats can reveal a lot

about your health. And tracking it over time can help your doctor anticipate future problems. A normal resting heart rate is 60 to 100 beats per minute (BPM). This can vary depending on a lot of things, like how much caffeine you’ve had recently, how active you’ve been in the last two hours, and whether or not you’re anxious or stressed.

Usually a low resting heart rate suggests good physical fitness. But that’s not always the case. A heart rate that is at the very low end of the range or below can signify something is wrong with the way your heart is transmitting electrical signals. This is more likely if you also notice fatigue and occasional dizziness. All those heart-beats take their toll. Exercise helps reduce your resting heart rate, though, as does maintaining a healthy cholesterol level.

TAKE URINE SAMPLES

Peeing in a cup is a routine part of an annual physical examination. Your doctor knows that urine can reveal a lot about your body. Everything from the colour to the odour can give off clues about your health, but lab results of the chemical composition of urine offer even more information.

If your urine is very dark, you may be dehy-drated. If it is flaky or cloudy, that may be a sign of a urinary tract infection. And if protein is dis-covered in the urine, that can be a sign of kidney inflammation. Diabetics may be tipped off to high blood pressure if ketones are found in the urine. Nitrite and white blood cells (leukocytes) can be signs of bacterial infection. Bladder problems and kidney stones can also be spotted through this test.