Monday, December 7, 2009

Clubfoot (Clubfeet) in Infants

Parents know immediately if their newborn has a clubfoot. Some will even know before the child is born, if an ultrasound was done during the pregnancy. A clubfoot occurs in approximately one in every 1,000 births, with boys slightly outnumbering girls. One or both feet may be affected.


Doctors still aren't certain why it happens, though it can occur in some families with previous clubfeet. In fact, your baby's chance of having a clubfoot is twice as likely if you, your spouse or your other children also have it. Less severe infant foot problems are common and are often incorrectly called clubfoot.

The appearance is unmistakable: the foot is turned to the side and it may even appear that the top of the foot is where the bottom should be. The involved foot, calf, and leg are smaller and shorter than the normal side.
It is not a painful condition. But if it is not treated, clubfoot will lead to significant discomfort and disability by the teenage years.


Nonsurgical Treatment

Treatment should begin right away to have the best chance for a successful outcome without the need for surgery. Over the past 10 to 15 years, more and more success has been achieved in correcting clubfeet without the need for surgery. A particular method of stretching and casting, known as the Ponseti method, has been responsible for this. With this method, the doctor changes the cast every week for several weeks, always stretching the foot toward the correct position. The heel cord is then released followed by one more cast for three weeks.
Once the foot has been corrected, the infant must wear a brace at night for two years to maintain the correction. This has been extremely effective but requires the parents to actively participate in the daily care by applying the braces. Without the parents' participation, the clubfoot will almost certainly recur. That's because the muscles around the foot can pull it back into the abnormal position.

The goal of this, and any treatment program, is to make your newborn's clubfoot (or feet) functional, painless and stable by the time he or she is ready to walk. (Note: Anytime your baby wears a cast, watch for changes in skin color or temperature that may indicate problems with circulation.)

Surgical Treatment

On occasion, stretching, casting and bracing are not enough to correct your baby's clubfoot. Surgery may be needed to adjust the tendons, ligaments and joints in the foot/ankle. Usually done at 9 to12 months of age, surgery corrects all of your baby's clubfoot deformities at the same time. After surgery, a cast holds the clubfoot still while it heals. It's still possible for the muscles in your child's foot to try to return to the clubfoot position, and special shoes or braces will likely be used for up to a year or more after surgery. Surgery will likely result in a stiffer foot than nonsurgical treatment, particularly as the years pass by.
Without any treatment, your child's clubfoot will result in severe functional disability. With treatment, your child should have a nearly normal foot. He or she can run and play without pain and wear normal shoes. The corrected clubfoot will still not be perfect, however. You should expect it to stay 1 to 1 1/2 sizes smaller and somewhat less mobile than the normal foot. The calf muscles in your child's clubfoot leg will also stay smaller.

Image Before and After

Friday, December 4, 2009

Caring for Infants & Children with OI "Osteogenesis Imperfecta"

What is Osteogenesis Imperfecta?
Osteogenesis imperfecta (OI) can literally be translated as imperfectly formed bones. Most forms of OI are caused by imperfectly formed bone collagen that results from a genetic defect.
Collagen is the major protein of the body's connective tissue and is the framework upon which bone and tissue are built. It can be likened to the framework around which a building is constructed. If the collagen framework is defective, the bones fracture easily, the skin is loose and transparent, and the muscles lack tone. People with OI either have less collagen than normal, or a poorer quality of collagen.

There are at least four types of OI, called types I, II, III and IV.  It is believed that there are between 20,000 and 50,000 people with OI in the United States. The disorder also affects people in other countries throughout the world.

Characteristic Features
OI varies significantly according to type, and it is very difficult to predict what symptoms or complications your child will have. Please keep in mind that very few people with OI exhibit all of the following symptoms, and that the severity of each symptom can vary tremendously between individuals. Common features include:
·    Bones that fracture easily
·    Short stature
·    Hearing loss
·    Discolored, brittle teeth
·    Blue sclera (blue color in the whites of the eyes)
·    Skeletal deformities of limbs, chest, and skull
·    Scoliosis (curvature of the spine)
·    Respiratory difficulties
·    Weak muscles
·    Excessive sweating
·    Constipation
·    Tendency to bruise easily
·    Loose joints and ligaments
·    High-pitched voice
It is important for you to understand that nothing you or your spouse did during conception or pregnancy caused this condition in your child. OI has been prevalent for thousands of years. Genetic counseling, which is available at most hospitals, may help you understand the type of OI your child has. If you are thinking about having more children, you should consider contacting a geneticist, who can help determine the probability of recurrence of OI in your family.

Learning That Your Child Has OI
If there was a previous history of OI in either the mother's or the father's family, you probably have some idea what to expect and how to manage the disease. You should be aware, however, that a child's symptoms and severity may differ from those of the parent with OI; that is, the child may not necessarily be affected in the same way that the father or mother was.
 When you are not expecting your child to be born with a disability, it can be a terrible shock and may be very upsetting. Having a child with a disability such as OI can be very trying, and is not something that you had ever thought could happen. Don't be ashamed to cry and express your disappointment to friends and loved ones. As with any grieving process, you will most likely find yourself repeatedly going through stages such as refusal to believe there is a problem, anger and/or looking for someone to blame, depression and, finally, acceptance. There are many excellent books available that deal with the birth of a child with a disability that you may find helpful.

Most psychiatrists agree that parents of children with disabilities will benefit from joining with other parents whose children have similar problems. Our hope at the Osteogenesis Imperfecta Foundation is to provide you not only with information, but with a support network of others who are grappling with, or have solved, some of the same issues that you will be facing.
If you have not already done so, you will need to contact a pediatrician and an orthopedic surgeon. It will be worthwhile to find doctors whom you trust and with whom you will be able to work closely, preferably those with experience treating patients with OI. The OI Foundation's physician referral list is available to assist you in locating a doctor. Many OI families find that their doctors become like members of the family. Eventually, you may find it necessary to take your child to a physiatrist (a habilitation and rehabilitation specialist). Physical and occupational therapists can help your child develop muscle tone, strength, and cognitive skills. Social workers who work with children with disabilities may also be helpful with family and marital difficulties should they arise.
It would be wise to evaluate your health insurance coverage. OI can become very expensive, and the financial strain can often become as burdensome to a family as the health problems. There are many organizations and clinics that help with some of the costs associated with birth defects. One organization is the Shriners Hospitals for Children, which provides free medical services to those who qualify. Medical services vary greatly from state to state; check with your local and state governments to determine what is available in your area.

One note of caution: Because awareness about child abuse is rising, it is not uncommon for parents of children with OI to be mistakenly suspected of this crime. When you find it necessary to seek medical help away from your regular doctor, be prepared to answer questions about your child's condition calmly and with understanding. A physician's primary concern is usually the overall welfare of the child, and knowledge of OI is not as widespread as we all would like it to be. It is a good idea to carry a letter from your doctor with you at all times, stating that your child has a diagnosis of OI and explaining what that means. Many parents also carry a copy of this letter in the glove compartment of the car. When you travel, carrying copies of your child's medical records can alleviate many potential problems.

Taking Care of a Child with OI
In most ways, caring for the child with OI is just like caring for any child. There are, however, a few precautions and tips unique to handling babies with OI that we would like to share with you.

Car Seats and Strollers
You will need a car seat to take your baby home from the hospital. Look for an infant seat that reclines as much as possible, with careful consideration of how easily the child can be placed into or removed from the seat. You may want to pad the seat with egg crate foam, available from medical supply stores, or one-inch foam, available from fabric stores. In addition to lining the bottom of the seat, place a layer of foam between the harnesses and the child for extra protection.

As with any child, it is important that the child with OI be safely confined in an approved car seat placed in the back seat. For maximum safety, never place an infant or child car seat in the front passenger seat--airbags can be dangerous, especially for children with OI.
For when the child is able to sit up, Snug Seat manufactures an excellent car seat for toddlers with OI. The seat is adjustable to accommodate the child when he or she is in a spica cast (a cast that goes up over the child's hip).
As with your car seat, you will need a stroller that reclines considerably and is wide enough to accommodate casts. Fisher Price manufactures a three-wheeled stroller that many parents have used very successfully. Sling or umbrella-type strollers are unsuitable because they lack leg support and provide poor positioning of the spine and head.

Common sense is the best guide when handling a child with OI. Remember that the bones are very fragile and can break with little or no pressure. Be especially careful of the long bones in the body, i.e., the arms, legs, and ribs. You should not lift your baby under the armpits or pull on his/her arms or legs. When you change diapers, lift the baby by the buttocks and not by the ankles, as is customarily done. Spread your fingers apart as far as possible, and put your hand under the buttocks, with your forearm under the baby's legs to prevent them from dangling. To lift the baby onto your shoulder, or carry the baby, use the same technique, but with one hand behind the head and the other behind the buttocks, again with fingers spread as far as possible. When lifting or moving your child, be careful that little fingers and toes do not get caught on clothing you are wearing, such as shirts or blouses that button down the front. Many parents find it helpful to insert a piece of egg crate foam rubber or a thick piece of foam rubber into a pillowcase and use this to transport the baby. Some parents use a pillow. This type of support can also be used as a base when holding the baby.

 It is usually best to avoid lifting or moving a child with a painful fracture as much as possible. After some degree of healing occurs, the fracture will be less painful and moving your child will be easier. Unfortunately, leaving your child in one position for a long time can cause skin rashes and sores. Putting a child in different positions not only prevents these problems, but helps the child develop different sets of muscles, which is important for later mobility. Some parents have found the following method for shifting a baby from their stomach to their back, or vice versa, to be very useful when conventional methods cause discomfort:
 This procedure is best accomplished by two people. Position the baby on his/her back on a pillow or a covered piece of foam rubber. Turn the baby's head to one side. Then place a second pillow or piece of foam on top of the baby, sandwiching the child. With one person at the baby's head and the other person at the feet, each person places one hand under the bottom pillow and the other hand on top of the upper pillow and, at the count of three, the child is flipped onto his/her tummy. Be sure both participants agree beforehand on the direction that the baby will be turned. This method, although a little awkward, provides you with a way to change the baby's position without causing unnecessary discomfort.
When lifting your child, remember to use good body mechanics to prevent back injury to yourself. Always have the child as close to you as possible before beginning to lift. Flex your knees slightly and lift with the legs instead of the back.
Do not be afraid to show affection to your child by cuddling, rocking, touching, and talking to him or her. Frequent stimulation is necessary for sound emotional and social development.

Children with OI are frequently affected by warm temperatures and are often bothered by excessive sweating. Lightweight, cotton clothing seems to be the most comfortable. Look for clothes with buttons or snaps down the front and at the crotch. Many parents fashion cast underwear by placing snaps or Velcro at the crotch of their child's underwear to simplify toileting. 
Since children with OI generally do not outgrow their clothes as quickly as other children, many parents feel that it helps to increase the child's self esteem to invest in current styles and fashions. A positive self-image for a child with OI is sufficiently difficult without having the child feeling self-conscious about his or her clothes.

Tuesday, December 1, 2009

Pancreatic Carcinoma

Pancreatic carcinoma
Pancreatic carcinoma is cancer of the pancreas.
  • Abdominal pain
  • Back pain
  • Clay-colored stools
  • Depression
  • Diarrhea
  • Fatigue
  • Indigestion
  • Jaundice
  • Loss of appetite
  • Nausea and vomiting
  • Paleness
  • Weakness
  • Weight loss
At the time of diagnosis, only about 20% of pancreatic tumors can be removed by surgery. The standard procedure is called a pancreaticoduodenectomy (Whipple procedure).
This surgery should be done at centers that perform the procedure frequently. Some studies suggest that surgery is best performed at hospitals that do at least nine of these surgeries per year.
When the tumor is confined to the pancreas but cannot be removed, a combination of radiation therapy and chemotherapy may be recommended.
When the tumor has spread (metastasized) to other organs such as the liver, chemotherapy alone is usually used. The standard chemotherapy drug is gemcitabine, but other drugs may be used. Gemcitabine can help approximately 25% of patients.
For patients who have a blockage of the tubes that transport bile (biliary obstruction) and the tumor cannot be totally removed, the blockage must be relieved. There are generally two approaches to this:
  • Surgery
  • Placement of a tiny metal tube (biliary stent) that is similar to stents placed in the arteries of the heart, to relieve blockages during ERCP
Management of pain and other symptoms is an important part of treating advanced pancreatic cancer. Hospice can help with pain and symptom management, and provide psychological support for patients and their families during the illness.
Pancreatic cancer is slightly more common in men than in women. The risk increases with age.
The cause is unknown, but it is more common in smokers and in people who are obese. Almost a third of cases of pancreatic cancer are due to cigarette smoking.
There is controversy as to whether type 2 diabetes is a risk factor for pancreatic cancer. A small number of cases are known to be related to syndromes that are passed down through families.
  • Abdominal CT scan
  • Abdominal MRI
  • Abdominal ultrasound
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Endoscopic ultrasound
  • Pancreatic biopsy
This disease may also affect the results of the following tests:
  • Liver function tests
  • Serum bilirubin
Some patients with pancreatic cancer that can be surgically removed are cured. However, in more than 80% of patients the tumor has already spread and cannot be completely removed at the time of diagnosis.
Chemotherapy and radiation are often given after surgery to increase the cure rate. For pancreatic cancer that cannot be removed completely with surgery, or cancer that has spread beyond the pancreas, a cure is not possible and the average survival is usually less than 1 year. Such patients might consider enrolling in a clinical trial (a medical research study to determine the best treatment).
This cancer has a 5-year survival rate of less than 5%, meaning 95% of the people diagnosed with it will not be alive 5 years later.
  • If you smoke, stop smoking.
  • Eat a diet high in fruits, vegetables, and whole grains.
  • Exercise regularly.
  • Blood clots
  • Depression
  • Infections
  • Liver problems
  • Pain
  • Weight loss
Call for an appointment with your health care provider if you have:
  • Back pain
  • Fatigue
  • Loss of appetite
  • Persistent abdominal pain
  • Other symptoms of this disorder