Dont ignore rashes

                  A month back one young male patient aged about  26 years walked into my clinic  with complaints of rashes on his  left side of his back and burning sensation since 4 days. He thought it might be due to some insect bite  or allergy reaction for a day. Second day he has applied some ointment to the  rashes and there was no improvement  and it started more in size of the rashes. Patient did not had any other significant associate history of other diseases .
               On examination I found it was a clear cut case of  Herpes Zoster  lesion and he has ignored it for the past four days. Fortunately it was no very severe. in case if he has applied  steroid ointment locally for the lesion it wold have led to problems. Usually it will associated with nerve involvement of one segment of the sensory nerve and very rarely it involves more than two nerve segments involvement ( segment means sensory area supply by each sensory nerve ) . sometime it leads to long term complication of neuritic pain that segment  intermittently for life long.
              Ignoring local rashes on the surface of  the body is quite common. But it is not always safe . There are many reasons for the occurrence of rashes especially of acute onset . A rash in the invisible parts of the body should not be neglected or ignored . A disease like Herpes  Zoster may be seen in any age and anywhere in the body and always associated with little burning sensation , itching etc. Rashes will increase in size in the first three days.
 
  

 

Examination will solve problems

                                          Last week  elderly   male patient aged about 76 years who is a known Diabetic on treatment was brought to my clinic around evening  by  his sons. Patient was looking dull , sick and I can make out he is in pain. When asked the patient to sit on the chair , his sons told me that he cant sit because pain in  his bottom area. I requested the patient to lie on the examination table. Later they showed me the prescription slips of three different hospitals which they had already visited for his problem. His pain in his anal area was started  a week back  and a small swelling . Patient told to the doctor in those hospital that he is having piles ( Hemorrhoids) problem and  doctors believed that he may be having hemorrhoids with thrombosed veins as small swelling. They did not examined the patient and prescribed sitz bath and antibiotics. He was taken to one of  the big hospital in Bangalore but patient was advised to undergo proctoscopy examination . they also did not examine him . patient refused examination and again he was given antibiotic and laxatives for easy motion passing.
                            when I  asked the patient that I wanted to see what problem is there in your bottom area , initially patient refused because of pain and he thought i might do some examination like proctoscope. I showed the torch and  I assured him that I will not touch and only look what is the problem there? he agreed to get examined. His sons helped me in removing his clothes. In a good light I found there was a pus discharging  abscess in the peineal area ( mid point between anus and  scrotum area) . It was not piles or fistula . It is a perineal abscess requires to be drained and dressed , to be treated adequately with antibiotics. Anyhow his diabetes was under control . After basic investigation  treatment was initiated for his problem.
                             Many doctors get biased with the patient complaints especially  when the complaint is related to anal area  because it embarrassing to show the area and get examined . In female patient it is much difficult to diagnose because of shyness and lack of other female attendant. It is unfortunate that  patients are wrongly treated and guided  because of  ignorance of getting examined properly. unnecessary medicines and other will waste in proper diagnosis and treatment.
                           It is always  get examined the  area if there is a problem  in the bottom area especially anal regions. I have seen a case of anal  cancer not diagnosed for months because of shyness in getting examined by the doctors. similarly ensure you will be diagnosed properly than just getting examined yourself.
  

Who is responsible?

        Yesterday  a male patient aged about 62 years walked into my clinic with the help of  his wife. His main complaint is  pain in his back area just behind  and below the left armpit. He is suffering since last three days.. When I further  inquired he told me that he sustained the injury in the toilet in one of the choultries ( wedding halls, Kaylana mantapa) . Just he fell on his back and he  has applied some pain relieveing balms and there was no relief. On examination there was only bruise and no evidence of fracture and very  deep other injuries. I treated him on OPD basis and asked him return afte two days for the follow up.

        My question is who is responsible for such falls in toilets or bath rooms in public places like wedding halls, Govt or Public offices among the people who are aged or senior citizens. It is the common experience that most of the time toilet door locks are tight and very difficlut to open after locking it from inside, or sudden gush of water when you turn  tap in the toilet, too slippery floor and most important is the inadequate light. There are municipal building laws to cover all these problems but very rarely few owners of the buildings will apply this.
   
        It is fortunate that there was no serious injury to his back , legs or head. Unnecessarily patient had to pay fees for his no mistake but using the poorly built toilets. Last week there was a news item in the leading newspaper regarding the old couple got locked up in their own bathroom and spent three days there and ultimately they managed to come out .

    If you are  suffering from High BP, senior citizen staying alone, Diabetes neurological complications, epilepsy , heart patients, visual problems in poor light  be careful while using public toilets including the trains.