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Pilonidal sinus — When hair is the culprit ! How to have strong bones WADDLING GAIT- the likely causes Health Notes
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Pilonidal sinus — When hair is the culprit! In this disease, a painful wound forms in the midline about 5-8 cms from the anus in the back region from which pus keeps oozing out. The wound doesn’t heal spontaneously because almost always there is a tuft of hair present at the base of the wound. This happens as the loose hair over the lower back are drilled, propelled, and sucked into the pilonidal sinus. This sucking is caused by friction and the movement of the buttocks whenever the patient stands or sits. The wound has the tendency to spread upwards or sidewards, thereby extending the disease to the new area. When pus keeps on forming and somehow is unable to drain, an abscess might form leading to an acute swelling and severe pain. Pilonidal disease is notorious for its recurrent nature after treatment. However, if properly managed its recurrence is not very common. The treatment of pilonidal disease is almost always surgical. Of the non-surgical techniques, injections of Phenol or Fibrin Glue may be tried but are usually not widely used. The goals of the ideal procedure for the treatment of this disease should be reliable wound healing with a low risk of recurrence, a short period of hospitalisation, minimal inconvenience to the patient, and minimum wound-management problems. Also, treatment should allow the patient to resume normal daily activities as quickly as possible.
Surgical therapy
1. Incision & drainage: This is done in acute cases when there is an abscess formation. A small cut is made and the pus collected is drained out. The cavity is thoroughly cleaned. The rest of the management of sinus is done at a later date. 2. Excision of the sinus and leaving the wound open: Excision of a pilonidal sinus means removing all the affected tissues with at least 5 mm margin of normal skin. All the tissue right up to the backbone (prescaral fascia) is removed. The wound is cleaned by rubbing with a blunt instrument to remove the hair, granulation tissue and skin debris. A bunch of hair is usually found at the base of the wound, which is responsible for non-healing of the wound. The resulting wound is left open which gets healed slowly over four-six weeks. 3. Excision with primary closure: In this method, the diseased part is totally removed as described above. However, the wound is closed so that it heals much faster. However, a small disadvantage of this method is that the recurrence could be potentially slightly higher. This is so because any infection left behind would not be known as the wound has been closed. Different methods have been used to close the wound. It can be a primary closure (simply closing the wound with stitches) or making a flap such as Z flap, rhomboid, limberg, bascom or karydakis flap. 4. Incision and marsupialisation: In this method, the pilonidal is incised (simply cut open and cleaned of all the pus, hair and debris) rather than excised (removing the sinus with a wide margin). The benefit is that the resulting wound is much smaller and healing time and pain is much less than when the wound is widely excised. In the majority of the cases, this procedure can even be done under local anaesthesia and, therefore, the person can resume work with-in two-three days. In spite of all these methods, there is always a small risk of recurrence of the disease after the operation. Therefore, certain precautions need to be taken so that the chances of recurrence are minimised. These are: a. Regular shaving/cleaning of hair 5 cms around the disease site. This shall be required for at least five years after the operation. b. Keep the area dry. Apply powder regularly in the buttock folds two-three times a day. c. In case the body weight is on the higher side, then keeping the weight in check helps. d. In case of any problem, immediately consult your surgeon. The writer is a senior surgeon, Fortis Hospital, Mohali. Email:
drgargpankaj@yahoo.com |
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How to have strong bones The basic structure of human body rests on the complex framework of about 206 bones. Keeping these bones healthy and strong is the key to preventing postural disability, damage of joints and other disabling conditions. Considered one among the seven types of body tissues by ayurvedic seers, bones are an active and changing physical constituent. In the normal course, we hardly come to notice the natural process of formation of new bones in place of the older ones. But with advancing age, the resorption or removal of the old bones starts to exceed the formation or replacement of the new bones. This condition in modern parlance is known as osteoporosis. Earlier it was believed that osteoporosis is associated with older women who are past their menopausal phase. But nowadays doctors are coming across a large number of patients, both males and females, who belong to a relatively younger age group suffering from weaker bones. Researches show that globally 80 per cent of those with osteoporosis are women and in India, one out of eight men and one out of three women are diagnosed with this condition. Osteoporosis makes the Though modern scientists attribute osteoporosis to the lack of certain hormones — oestrogen in women and androgen in men — ayurveda considers that it is the vitiation of vata which leads to the depletion and drying up of body tissues and fluids. Long-term immobility, excessive smoking and drinking and taking low levels of dietary calcium are strong reasons for bones becoming weak in old age. Many other conditions that affect the absorption of the necessary nutrients such as the inflammatory bowel disease and celiac disease, long-term use of steroids, thyroid disorder and autoimmune diseases like rheumatoid arthritis are notable causes of osteoporosis. Early signs of osteoporosis go unnoticed and the disease at this stage doesn’t cause any visible problem. Once bones have weakened beyond a point, symptoms like persistent backache, fatigue, a poor posture and occasional fracture start appearing. Osteoporosis doesn’t affect the whole skeleton at an equal degree. Fractures in the spine, the hip, the upper and lower limbs, including hands and feet, are quite common to the osteoportic bones, and sometimes minimal trauma or stress to the bones can lead to such a situation. Building strong and healthy bones requires an adequate dietary intake of calcium and other nutrients, and it is Vitamin D which helps absorb calcium and phosphorus through the intestines. Though this vitamin is present in milk, fish liver oil and egg yolk, its maximum gain is made through the skin in the course of its normal exposure to the sun. The present urban lifestyle of avoiding direct sunlight is largely responsible for the prevalent Vitamin D deficiency in a large number of people. Taking an adequate quantity of milk, green leafy vegetables, pulses and egg and fish in the case of non-vegetarian food promotes healthy building of body tissues, including bones. Regular exercise also prevents premature wear and tear of bones and joints. Ayurveda classifies certain herbs as “asthi-sandhaniya” which have been proven to give strength to the bones and prevent osteoporosis. There are various preparations made of herbs like Ashwagandha, Shatavari, Arjuna, Laksha, Giloy and Guggul which are rich in calcium and promote the formation of healthy bones. Classic medicines like Lakshadi Gugul, Abha Guggul, Praval Panchamrut Rasa and Godanti Bhasma have also an equal preventive and curative value in the case of osteoporosis and fractures. The writer is a Ludhiana-based senior ayurvedic consultant and Guru at the Rashtriya Ayurveda Vidyapeeth. Email - ayu@live.in |
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WADDLING GAIT- the likely causes Scores of people can be seen walking with a limp in parks, shopping malls, offices, etc. Causes of the waddling gait could be as varied as obesity, knee arthritis, leg length inequality and flat feet. This also happens during later stages in pregnancy. Feet are held wide apart and the individual walks somewhat like a duck. Waddling is, in fact, a distinctive duck-like walk that also appears in childhood or later in life. Usually it starts when one reaches 65 years of age and increases by the age of 85. Flat feet: Unfortunately, this so-called minor problem is not dealt with at an appropriate age due to the lack of awareness. Causative factors are heredity, flattening of the arch due to obesity and lack of elasticity of ligaments, muscles and tendons. Normally, a child till the age of two years has flat feet due to the presence of a pad of fat and incomplete union of bones. With age, the fat pad decreases and 90 per cent children develop a perfect arch by the age of 10 years. Parents generally fail in detecting flat feet. The usual complaint is child falling frequently while running. Flat feet in the normal course may not cause any problem but can lead to heel, knee and ankle pain in instances where physical activity is accelerated. An examination of an individual’s shoes with flat feet reveals the worn-out inner side. Arthritis patients: To avoid pain (which usually occurs on the inner side of the knee joint) try transferring weight on the outer side of the leg and foot causing a waddling gait. Walking thus for prolonged periods of time leads to their lower leg bones becoming bow-shaped. Prevention and treatment of gait disturbances depend on the cause. Once the cause is treated, the disturbance will often go away. Reduction in the body weight is a very critical component in treating and alleviating pain/discomfort in cases of knee arthritis. Knee braces/supports can help provide stability to the knee joint. Shoe modifications are done by inserting a medial arch in flat feet patients. Medial/ lateral wedge raises could be given to lessen the waddling gait. As the muscles and ligaments hold the knee together, it is critical that they are strong. Mandatory stretching and strengthening of muscles on the front and back of thighs (quadriceps and hamstring) are indeed crucial. To achieve these the following exercises help considerably:
The following exercises are beneficial for flat feet, especially in the case of children below 12 years. Stand on a towel and grab it with your toes. Return to the original position and repeat it 10 times. Pick up marbles with the toes. Do duck walking. Waddling gait could be lessened/ treated if the cause could be detected and treated at the earliest. Otherwise the gait disturbance can even lead to back pain or knee pain, causing greater agony. The writer was associated with the Indian cricket team as a doctor and physiotherapist. Email:
chadha_r2003@yahoo.co.in
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Now, a dish that ‘talks’ to fight obesity London: The National Health Service (NHS) has introduced a talking plate in the UK, which warns fat families about their eating habits and tells people not to wolf their food. The Mandometer, which is available for 1,500 pounds, monitors the amount of food leaving the plate and tells users who gobble to “please eat more slowly.” The Swedish device is to be used in an NHS initiative to help hundreds of obese families lose weight. The device comes in two parts, a scale placed under the plate and a small computer screen showing a graphic of the food that gradually disappears as the user eats. A red line on the screen shows the user’s speed of eating while a blue line shows a healthy rate. If the user guzzles, the red line angles away from the blue one, warning them to ease off, and if the lines deviate too much, the computer voice tells them to slow down.
— ANI Gene behind muscle disease discovered London: An international team of researchers has discovered a genetic defect that contributes to a muscle disease using next-generation DNA sequencing techniques. The research co-led by the University of Leeds’ School of Medicine and the Charite, Berlin, investigated several families whose children suffered from a progressive muscle disease. The children developed severe weakness of the body’s muscles and the diaphragm — the main breathing muscle — making them dependent on a wheelchair and continuous mechanical ventilation. The children also had to be tube-fed because the esophagus — a muscular tube that transports food from the mouth down into the stomach — did not work properly. Using state-of the-art, next generation DNA sequencing technology, the scientists initially found a defect in the MEGF10 gene for a large family living in the UK. — ANI How our brains help us make sense of the world London: Have you ever wondered how we make accurate perception of the environment out of smell, taste, hear, view and touch. Now, a team of scientists at the University of Rochester, Washington University in St. Louis, and Baylor College of Medicine has solved the mystery. The human brain is bombarded with a cacophony of information from the eyes, ears, nose, mouth and skin. But the team has discovered how the brain manages to process those complex, rapidly changing, and often conflicting sensory signals to make sense of our world. — ANI |
Pilonidal disease is an ailment that occurs in the lower part of the back region. It usually affects young, hairy, plumpy (overweight) males who sweat a lot and have to sit for long hours. It is most common in the 15-30 age group and rarely has the onset after 40. About 1 per cent of the population is affected by this disease and males are afflicted about 3 times more than females.