- Bed Sores
Bed sore are pressure point ulcers develop in the bed ridden patients. Many patients unable to move and even change the sides become the victim of pressure sores. Unconscious, paralytic, old ages, fracture of hip or neurological deficit patients remaining bed ridden are prone to it. These bed sores refuse to heal and go worse from day to day. Best way is to prevent it than to treat it.
Some points are to be kept in mind while managing bed ridden patients;
- Bed should be soft and without any folds.
- A water bed is always better if can be affordable.
- Bed sheets should not be of rough type and there should not be any creases.
- Change of sides of patient at frequent intervals.
- The bed should not be soiled with water, urine or feces
- The patients should be cleaned daily and body sprayed with talc powder. Surgical spirit can be applied all over body; especially over the pressure points like; hip, gluteal region, shoulder blades, heels and back etc. two to three times a week.
All of the above will prevent development of bed sore.
But if develops, all of the above steps must be followed rigorously. A dressing is to be applied over the wound after cleaning with a mild antiseptic lotion. Diabetic status is to be checked and if present will be controlled. Oral protein supplementation should be continued if otherwise not contraindicated e.g. patients suffering from hepatic coma; but can be given through intravenous route. A short course of antibiotic coverage keeping an eye on anaerobic bacteria coverage is to be given; but a culture and sensitivity test to choose an antibiotic is better than empirical choice. Vitamin B can be given to assist in healing. Sometimes blood and blood fractions may be required if there is anemia.
The gold standard is “Prevention is better than cure”.
There have been several calls from hospital emergency staff in the recent past to alleviate retention of urine in elderly male and the associated pain. The urethral opening is completely closed by phimosed prepuce, the fore skin of penis. The common cause of retention of urine in elderly male is a prostatic enlargement. And in a situation where there is such type of phimosis remains associated, it gives rise to problem in introducing a silicon pipe through urethra to relieve the acute retention. Such type of peculiar situation probably is best encountered in India; where the people do not give attention to the phimosis they might be carrying from their childhood. Here, there is custom circumcision in Muslims and Hindus only go for it as a part of medical treatment. Perhaps there is no atheistic consideration, and people generally shy away from speaking about it. Even these people had enjoyed a good family life.
In this situation, first the prepuce is to be slit open to see the urethra, and glans is to be inspected for cancerous growths; as phimosis is associated with penile cancer in glans and prepuce. Many times there have been very much narrowing of urethral opening to obstruct the passage of urine. The urethra is to be dilated to allow the entry of a silastic pipe called catheter, and first of all the retention is to be relieved as it is a very painful condition, better known to a person who might had been compelled to postpone passing urine after the urge for it due to some reason. After that, a formal circumcision has to be performed. The stricture of urethral meatus may need a minor surgery to keep it open. All these can be performed under local anesthesia.
Though phimosis is apparently an innocent disease may a cause of grave concern.
Present day life style of moving in air conditioned cars and remaining confined to AC rooms has been associated with increased incidence of cardiac diseases. It has also been seen that there is increase in cardiovascular events during the winter, particularly so, in the regions located in the high latitudes. Now researchers have found out that, these people have low vitamin D level in their blood; and correlated it to the increased incidence of heart diseases, asthma and many more diseases.
Vitamin D is synthesized in the skin by the activity of ultraviolet rays received from sun. Recent day life style leaves a little room for sun exposure. So there is low level of this vitamin in blood. Over protected children, not engaged in outdoor activity also get less exposure to sun and consequently a low vitamin D level in blood. Low vitamin D level decreases endothelial function. This decrease causes insulin resistance in type II diabetics and worsens diabetes status. It helps in formation of atheroma; a plaque composed of bad fat, calcium and some blood components; which may get deposited in the inner cell layer, the endothelium of coronary arteries. There is increase in blood pressure due to increase vascular resistance. All these factors combined together may be responsible for heart attack; whose incidence rises, particularly in the winter days in the region of high latitude.
- Vitamin D Fortified Food
Let us have a little sun each and every day by indulging in some outdoor activities.
I got an e-mail as a news alert from “Panda antivirus” about an USB vaccine. As a doctor, I understand what a vaccine means. So, I went ahead, downloaded it and configured. I know that one potential route of entry of viruses to a computer is through the USB applications like a pen drive. Recently, the laptop of my younger son contacted some folder making virus in this way; and for which the laptop has to be formatted. After configuring, when I put my pen drive to one USB socket, a pop up emerged and vanished away quickly informing me that the device has been vaccinated. I do not know whether actually that has been done, but I believe so. It available in free. Possibly one should give a trial to it.
Saying no is a difficult affair for some and they suffer for it. People say yes, even to illegal works in order to be popular; sometimes to keep friendship and sometimes with hope of getting illegal gratification. These are the people with vested interest and they thrive well in their illegial sphere and go on expanding the network. But, sometimes may be cought red handed. Good people do say yes under some compulsion and 
keep grumbling, being unable to avoid it all together. And, these people atfer induldging in the activity,when refuse to oblige later on due to some or other cause, breed enimity to the severest extent. So, it is better to learn to say a big “No” when somebody does not approve the “Yes” from the inner corner of the heart. It may be unpleasant for time being, but there is no future problem associated with it. Again he will not be approached to gratify the illegal request. That keeps stress and strain out from the person. But, it requires a lot of courage to say “NO”. It is rather difficult but not impossible an act.
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