Wednesday, July 24, 2013

The domestic dangers of burns - indoors and out!


It’s winter here in Western Australia and now that the mercury has started to drop to 1 degree Celsius overnight, we’re really starting to feel the cold. On the other side of the globe in the United States, they are suffering the opposite extremes, with temperatures in the high 30’ and low 40’s triggering terrifying bush fires in many areas.
Heat or the absence of it are a daily part of our lives and colour our conversations about the weather, fashion and lifestyle activities. But what is Heat and what happens when heat gets dangerous?
According to one dictionary definition, “Heat is the transfer of kinetic energy from one medium or object to another, or from an energy source to a medium or object. Such energy transfer can occur in three ways: radiation, conduction, and convection.”
We experience heat through radiation on a daily basis with the effect of infra-red radiation coming from the sun to heat our earth: on a more local level, we can experience the same effects from a domestic fireplace when the fire warms furniture within the room even though it may be some distance from the fire. Both these examples of heat through infrared radiation also demonstrate how these two forms of radiation can pose a potential danger to our health.
We expect to see the sun each day and forget that the sun, although a tremendous distance from our planet, is in fact a massive ball of gigantic thermonuclear reactions spewing out radiation in all directions - the miracle of it all is that our planet is in the so called Goldilocks position - just the right distance away not to be fried, and not too far away to be a snowball! It also has the advantage of having a magnetic field around it that protects us all from some of the sun’s more deadly radiation. But even though we are in such a blessed position, the infrared radiation from the sun still causes hundreds of thousands of preventible skin cancers around the world each year. And for some with the more deadly malignant melanoma, this can even threaten their lives. We must be more diligent in protecting ourselves and especially our little people by applying sunblock on a daily basis all year round, and wearing hats and sunglasses during the summer months. And if you love the great outdoors, you must remember to keep re-applying the sunblock as it can rub off those exposed areas.
On the domestic front, open fires are great for warming the home and for the older person, they are a wonderful place to just sit and reflect on some of life’s memories. But older folk are at risk of suffering radiation burns to their lower legs as sensation in those areas can diminish in people with Diabetes and other nerve damaging conditions. Also, open fires are a real danger to young children so please do protect them from open fires within the house, and barbecues and fire-pits outside the house.
Conduction is the next form of heat transfer and happens when two object are in direct contact and the warmer one will transfer heat to the cooler one until both are at the same temperature. A reviving example is coming in from the cold outdoors and soaking in a hot bath. But the interaction between something very hot and something colder can also have tragic effects on humans too. Just think of what happens when hot oils from a frypan get spilt on an inquisitive toddler in the kitchen: or if a youngster is just left for a short time in the bath and accidentally turns on the hot tap? - a dear friend of ours suffered such an injury and still has the scars from serious burns on his legs to show for it many years later - although he actually tells his kids that he got the scars from wrestling a crocodile! Another example of conduction of heat that can lead to short term pain is when you eat a mouthful of really hot food and burn the inside of your mouth. Always remember to check the temperature of food given to your little ones before they eat it - especially if its just come out of the microwave oven.
Convection is the final way that heat dissipates, and is the way that heat rises and then drops as it cools, in a room causing the air to circulate and finally warm the whole area. Heat from convection can be a problem if you lift the lid off a boiling saucepan, or open the door of a hot oven and have your face over the top of it, as the heat from steam can cause very nasty burns.
But heat isn’t the only form of energy that can lead to burns to we humans -
serious problems can occur as a result of electrical and chemical burns too. The first patient I ever attended as a medical student was a man who had been digging up the road in London with a pneumatic drill: disastrously, he hit a mains power line and suffered terrible flash burns to his body. I can still vividly recall his screams decades later as they changed his dressings on a daily basis! On the domestic front, electric irons and their dangling cords can be a great attraction to a crawling toddler and should be kept well away from them - in fact they should be designated a “no go zone” early on in every toddlers life! And remember to put plastic plugs in power outlets as little children can be tempted to poke things such as keys and sharp metal things into them with potentially terrible results.
Domestic chemicals such as oven cleaners and drain cleaners contain highly corrosive elements that can cause serious burns to the skin and should be kept far out of the reach of children. If contact does occur then :
Remove the cause of the burn by first rinsing the chemical off the skin surface with cool, gently running water for 10 to 20 minutes or more.
Remove clothing or jewelry that has been contaminated by the chemical.
Wrap the burned area loosely with a dry, dressing or a clean cloth.
Rewash the burned area for several more minutes if the person experiences increased burning after the initial washing.
and if in any doubt, or if there is continuing pain or blistering of the skin then seek prompt medical attention.
On a gloriously sunny day we should all be able to enjoy the privilege of living on the wonderful planet: but we should never take any of it for granted, but rather respect what we have - and that means taking measures that allow us, and our families, to enjoy our lifestyle and yet protect ourselves from any potential harm both within our homes and outdoors.


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Wednesday, July 17, 2013

Blood pressure: why you need to know.


William Harvey was born in Kent, England on April 1st 1578 and received his Medical Degree from the University of Padua, Italy in 1602. After his return to England he became Fellow of the College of Physicians and physician to St. Bartholomew's Hospital - my old Alma Mater. In 1618, Harvey was appointed physician extraordinary to James I. Harvey's famous Book, commonly referred to as "De Motu Cordis" was published in Latin at Frankfurt in 1628, when Harvey was 50 years old. The first English translation did not appear until two decades later. In Chapter 13, Harvey summarized the substance of his findings: "It has been shown by reason and experiment that blood by the beat of the ventricles flows through the lungs and heart and is pumped to the whole body. There it passes through pores in the flesh into the veins through which it returns from the periphery everywhere to the centre, from the smaller veins into the larger ones, finally coming to the vena cava and right atrium..... It must therefore be concluded that the blood in the animal body moves around in a circle continuously and that the action or function of the heart is to accomplish this by pumping. This is only reason for the motion and beat of the heart."
Thus, for over 380 years we have known that blood circulates around our bodies as a direct consequence of the pumping action of the heart - and of necessity, the blood within those blood vessels must be under pressure: and the challenge since then has been how best to measure that pressure and relate it to the pressure-related diseases that can affect the heart and those blood vessels which transport the blood to the organs which they supply .. the kidneys, the brain, the eyes and so on. And we had to wait for 2 centuries for one Siegfried Karl Ritter von Basch to invent the first primitive blood pressure machine - or sphygmomanometer - in 1881 and another 15 years for Scipione to modify it into the mercury manometer that was to remain the mainstream tool to indirectly measure the pressure of the blood within the blood vessels. It wasn’t until the latter part of the 20th century when the mercury manometer was slowly but surely replaced by more modern electronic equipment. But it wasn’t just the electronics that made Von Basc’s original concept obsolescent, his device was replaced mainly because the mercury within them is known to be extremely toxic to we humans  and disposal of those instruments was considered a health hazard!
A blood pressure machine works by occluding the flow of blood in the upper arm with the aid of an inflatable rubber cuff. The cuff is then slowly deflated and 2 numbers are recorded which relate to the pressure within the artery when the blood is pumped out of the heart, and the pressure within the artery when the heart is relaxed - in medical terms these are called the systolic pressure and the diastolic pressure. When I started medicine, the healthy reading for an adult was 140/80 but over the years this dropped to 120/80, but just when we were getting used to those numbers, the most recent advice is that the normal figure should be .... 140/80 again! Which can be interpreted as either what’s old is new again, or more correctly that scientists are constantly reviewing the information they have and then giving the most up to date and informed advice on how to best use that information in the clinical setting.
Knowing what the normal pressure is has allowed us to look at very large populations of people and realize that as blood pressure goes up so does the rate of heart disease, the risk of having a stroke and of suffering more serious kidney damage. The problem is that high blood pressure does not have any symptoms and the only way you can discover if your blood pressure is up is to actually measure it! And why do people get blood pressure? Well in about 90% of cases we have absolutely no idea why! The good news is that we have developed many good and effective medications that can control it and bring it down to the normal range - but even then it is really important that the blood pressure is measured long term to make sure that it remains normal.
Despite having more user friendly electronic blood pressure machines,  the challenge has always been to interpret the results that these machines give us. For instance, some people with normal blood pressure - and this is thought to be about 20% of the population - when they go to a Doctors surgery actually get a little agitated and their blood pressure goes up: this is known as the white coat effect, and in reality these people should not be treated for blood pressure problems, but rather for a case of mild “Social anxiety disorder” brought on by being in a medical environment. At the other end of the spectrum are those who do have higher blood pressure yet feel reassured by being in a Doctors surgery and their blood pressures actually fall a little bit - and this is known as the reverse white coat effect.
Added to this confusion is the challenge of which blood pressure measurements do we determine to be useful - office testing, home testing or random testing - because if treatment is based on unreliable blood pressure results, this can lead to unnecessary long term - and in many cases expensive - medications which also have the potential for side effects.
So what is the correct way to get an accurate measure of blood pressure? Resting blood pressure has long been the gold standard measurement - this is to be taken on a patient who has been lying down for a few minutes in comfortable surroundings, and then the pressure recorded using a blood pressure cuff on the upper arm: and most professionals will repeat the measurement a second time after a few more minutes to confirm the recordings are accurate. This method of recording blood pressure has now been backed up by Ambulatory  blood pressure monitoring that allows the specialist to see how a persons blood pressure reacts over a 24 hour period. Of course, when you undergo physical exertion, your blood pressure will go up - and this is a very normal response to  physical activities - but it should come down afterwards in someone who has normal blood pressure, and having access to information gleaned over 24 hours allows the experts to determine what is normal and what is probably not normal.
Where ambulatory blood pressure monitoring is not easily available, I encourage patients to perform home monitoring to back up what the Doctors are recording in their offices, as it does give instant feedback to the individual: and with the cooperation of the treating Doctor, this can also allow the patient to fine tune their medications in order to obtain tighter control.
Once high blood pressure has been confirmed, it is important to continually gather blood pressure readings both at home and at the Doctors office - so that medications can be adapted to the individual and the changing circumstances of their lives.
But having high blood pressure doesn’t always mean taking medications, each individual can have an impact by adopting lifestyle changes that can help lower their blood pressure:
Lose weight
Stop smoking
Exercise regularly
Cut down on excess salt intake
Cut down on alcohol consumption to the recommended intake
Take up meditation or yoga

These lifestyle changes will not only help lower blood pressure, they can also enhance your health and overall well being, and reduce the chances of developing other chronic health diseases too.

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