Category Archives: Understand Disease

Understand Diaper Rash: Causes, Role of Hygiene, Zinc and Breastfeeding

Unsuccessfully battling diaper rash ? Distressed over your baby’s sore bottom? Rhetorical these questions are here, but if they were to be subjected to a poll, there would be no shortage of “yes” answers from those caring for the little ones.

So prevalent is diaper rash. The nerdy term for diaper rash is diaper dermatitis. Please note that the suffix -itis- in medical lexicon points to the presence of inflammation. Moreover, the word -derma- has Greek roots and is modern Latin for the upper layer of the skin: the dermis.  Thus the disease called diaper dermatitis. Daiper rash is a distressing condition for both the infant and often red faced mother.

Red happens also to be the hue of the rashes on an infant’s diaper area. To many first-time mothers, a case of nappy rash may shake their confidence. They may unduly doubt their ability to be fit mothers and care for the infant. The emotional turmoil from this preventable malady may contribute to the stress of pregnancy. Stress in the period surrounding pregnancy is known to cause antepartum depression and postpartum depression.

The public health significance of diaper rash ought be an interesting area of research. Rising incomes coupled with modern lifestyles appears to favor the convince of disposable diapers (over washable absorbent cotton types of). On a personal level, it’s also important to note that some of the popular disposal diapers are of questionable quality. Some of these diapers have poor absorbent properties. Continuous use of them leads to wetness of the baby’s bottom. Wetness predisposes the little ones to nappy rash.

The Environmental Question Facing Diaper Use

Hitching back onto the ‘social good’ bandwagon, the absorbency of disposal diapers is hinged on the use of super absorbent gelling materials whose biodegradability and impact on the environment remains largely unknown. Furthermore, with the wider challenge of waste disposal in the rapidly urbanizing 21st century, used diaper disposal is emerging as a key contributor of roadblocks to sustainable living.

Whether you are the Eco-concious type who’s disturbed by raging debate over the Eco-friendliness of biodegradable diapers via-a-vis washable diapers, the crux remains that nappy rash can never be to far from your thoughts. This is because it is estimated that your average baby goes through 5000 to 7000 diapers by the time they are toilet trained.

What is diaper rash?

The suffix -itis, is conventionally used in medical circles to denote an inflammatory process in a body organ or tissue. Dermatitis refers to the range of inflammatory disease process occurring in the body’s largest organ, the skin. When dermatitis occurs primarily as a consequence of diaper use/habits, the term diaper dermatitis suffices. However, in some literature, other rashes that may have other primary causes but which are worsened by diaper use are included in the definition.

For purposes of this discussion, the term – diaper dermatitis- will be used in reference of the former narrower more specific definition. As such, the focus will be on contact induced dermatitis. Also known as nappy rash. A form of dermatitis which can be managed in part by changing poor diaper practices.

Though, diaper rash is the most prevalent of rashes in infancy, with a majority of children expected to suffer at least one episode by the time they are toilet trained (usually at around age 2); Diaper dermatitis has been wrongfully labeled by street-folk as a tell- tale sign of poor parental skills and child neglect.

This stigma may account for some of the emotional injury and desperation in parents whenever a child suffers from diaper rash.

This misunderstanding around this dermatitis has led to ill advised mothers combing through lists of purported remedies with little success. Treatment failure is common because the effective management of diaper rash requires the recognition and control of predisposing factors. The use of medical remedies has little chance of success without concomitant control of predisposing factors.


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Causes of Diaper Rash

Predisposing factors:

  1. Poor diaper practices such as infrequent changing, poor diaper choice and poor diaper area cleaning practices.
  2. Diarrhea
  3. Zinc deficiency
  4. Recent antibiotic use

The precise science explaining the etiology of diaper dermatitis is an area of ongoing research. However, current evidence points towards an interplay of a myriad of factors:

  • Diaper induced friction, prolonged wetness which leads to maceration ( small skin tears due to softening) of the outer waterproof layer of the skin, the stratum corneum.
  • The presence of microorganisms be they be microorganisms that normally reside on your baby’s skin, or other ‘alien’ ones introduced by feces.
  • The other important factor is presence of fecal enzymes (the eaters of fat – lipases and the eaters of proteins – proteases) which participate in the breakdown of urine and feces. This leads to changes in the ph of skin. Remember that skin pH is an important protective factor. Once the environment of the skin is altered in the above ways, we soon are on the way to developing diaper rash.

The key event in developing diaper dermatitis  appears to be the weakening of the skin’s integral barrier by the interplay of factors mentioned above. Increased hydration of the skin then follows. Therefore, the skin’s natural defenses are breached. This leads to inflammation when the baby’s immune system responds to defilement of the skin’s role as a protective barrier. Furthermore, once the barrier is breached, entry of disease causing microorganisms follows. Once again, this only serves to accelerate the disease process.

The Role of Hygiene in Preventing Nappy Rash

Long standing presence of feces and urine contributes to the baby suffering from this disease. This is because bodily wastes lead to a rise in ph of skin from the normal of 4.5 to 5.5. It must be emphasized that urine is the key driver, particularly when it’s broken down by enzymes. Following assault of the skin’s protective barrier, secondary infection by bacteria such as staphylococcus aureus and fungi such as candida albicans may occur. This subsequently complicates the clinical picture as the rashes get infected. Once the rashes get infected, we are in dangerous territory as we see severer forms of nappy rash.

Is there a role for Zinc in the treatment of Diaper Rash

Zinc has been demonstrated to have numerous health benefits. Zinc’s powers come from it’s key role in cell division and cellular regeneration. Fast dividing cells – like epithelial surfaces of skin and the gastrointestinal tract lining – have a high turn over compared to other cells e.g. heart muscle cells. Zinc has been demonstrated to aid the process of cell division which is the predominating physiological event in such cells.

Zinc has thus been of great use in preventing diarrhea in infants. Moreover, zinc is known to encourage healing of skin lesions. The best way to deliver zinc in healing skin diseases is through application of zinc containing products.

The safest zinc containing product is bland zinc oxide. Parents need to be careful lest they worsen the nappy rash. This is because some untested products may contain ingredients that cause skin allergies.

Nonetheless, diaper rash may result in skin lesions in infants. Thus zinc oxide has a central role in managing diaper rash. Supplementation of zinc is also crucial in avoiding frequent bouts of infant diarrhea. When your baby suffers from diarrhea, they’re likely to suffer from diaper dermatitis from the wetness.

Breastfeeding and Diaper Rash

It is not often that you will find reference to exclusive breastfeeding with reduced risk of diaper rash. This is despite medical research that recognizes this benefit of exclusive breastfeeding. Indeed, it is true what they say about good news. All the same, breastfeeding is thought to reduce the risk of nappy rash. The reasoning is that breast milk is less likely to result in stools with a composition that may be harsh on the baby’s skin.


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Tired All The Time ? 5 Real Reasons To Visit Your Doctor

As a medical term, lethargy is a subjective feeling described by a patient. It can assume different forms and be described variously like. “Doctor nowadays, I am tired all the time. ” Could be one way. Or, ” I feel so tired in the morning in spite of sleeping sufficiently”. Possibly also “Doctor, I feel so tired even from doing simple tasks.” Though being tired can only be felt by the sufferer, there is hope in finding out the real reasons behind unexplained lethargy. This is because fatigue can be objectively assessed by a medical practitioner.

Though being tired all the time can be an indicator of grave disease, it is often easily dismissed as innocuous. This misnomer is in part attributable to its commonality as part of everyday existence. Consistency in the vagueness of its description makes it all the worse.

The closest one can get in describing tiredness to enable a medical practitioner easily pick it as complaint of medical concern is a feeling of a decline in energy levels: A global tiredness, a decrease in comfort in performing the mundane acts of daily living. When tiredness is prolonged and limiting, it is termed fatigue.

Medically, What is fatigue?

Dr. Steven Targum and Dr. Fava Maurizio in their paper on Fatigue as a Residual Symptom of Depression published in the journal Innovations in Clinical Neuroscience offer:

Broadly defined, symptoms of fatigue can affect physical, cognitive, and emotional function, impair school and work performance, disturb social and family relationships, and increase healthcare utilization

Dr. Steven Targum & Dr. Fava Maurizio

Nonetheless, even for medical practitioners with keen clinical acumen, it is easy to pay little attention to a complaint from a patient  about being tired all the time by attributing it to be part of the constellation of symptoms of common disease.

This difficult case of Schnitzler syndrome chronicled in the New York Times reveals the folly in such an approach. The danger in pedestrian dismissal or falling victim to    lies in failing to promptly identify and subsequently manage common but life threatening medical conditions.

Patients are their own best doctors

First, it is worth noting that this article aims at informing you the patient as a partner in patient centered care. Our overall aim is to  increase the overall value that you derive from your doctor’s visit. We acknowledge that individuals often fail to grasp their primary role in managing their health.

In view of this, it is worth reiterating the first rule of clinical medicine: “Patients are their own best doctors.” This is so, as patients are the ones best placed to recognize any changes to their well-being, an important initial step in management of disease as it is the heart of good health seeking behavior.

The doctor’s role, if only, is to employ their expertise in helping the patient understand their condition. It is in reveling in such wisdom that I penned this piece intending to foster this collaborative approach that defines value in 21st century healthcare.

The disease spectrum in a case of lethargy can range from simple anemic condition to more complicated cases such as heart failure. The following are some of the commoner health conditions associated with the feeling of being tired most of the time.

1. Sleep Problems

Yes, the globalized 21st century is a demanding world. Yes, we understand that you are a focused, ambitious, self driven and hard working individual. Bedbugs too may reduce the quality of sleep and result in fatigue. But please do get your hours safely under the belt at night. 6-8hrs is what is recommended in most texts. Besides a rested mind is more efficient, less prone to accidents and its even claimed that the slumber holds some magical beauty powers.

Lack of sleep not only make you fatigued but also predispose one to the other common but more dangerous condition to be discussed next. The lack of sleep deprives one of physical, cognitive and emotional state needed to be functional persons in everyday life. This may lead to work and social problems and therefore compound other life stressors leading to depression.

2.The Unhappy Triad of Mental Disease, Being Tired All The Time & Lack of Sleep

One of the tell-tale signs of depression is a complaint of unusual tiredness. The reason why one might feel tired all the time in depression is compound. First, the patient usually also complains of a disturbed sleep patterns whose hallmark is insomnia or the lack of sleep. Additionally, activities that were routine such as going to work are now considered to be herculean tasks as apathy sets in contributing to the vicious cycle of disturbed sleep patterns that may conversely manifest as early morning wakefulness.

Care though should be taken as it is easy to misdiagnose innocuous conditions such as simple burn out  fatigue as depression and vice-versa. This mistake is common and leads to inadvertent use and abuse of over the counter sleeping pills such as Ambien.

Depression

However, depression is  the commonest psychiatric condition in this high pressure, fast paced age of wanton self indulgence. Depression should therefore be readily identified and managed accordingly by a qualified mental health professional. This is because depression is one of the leading causes of suicide not only in teenagers but also in the adult population.

Appropriate health seeking is encouraged on the back of sustained unfamiliar notable tiredness in a loved one. Besides depression, General Anxiety Disorder (GAD) might also make people feel tired all the time. GAD is state of constant anxiety which makes it difficult for one to concentrate and manifests as myriad of both physical and mental symptoms.


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3. Blood Diseases

The hematological system concerns itself with blood components and blood forming organs such as the bone marrow. Red blood cells, biconcave shaped cells that form part of the cellular components of blood, are important in the transfer of oxygen and carbon dioxide to and from body tissues.

When the mass of these red blood cells or the heme pigment which it carries (hemoglobin) reduces to a point below the lower cut off for a particular age, sex and race; the individual is said to be suffering from anemia.

One of the cardinal symptoms of anemia is feeling tired all the time. When this fatigue is accompanied by other symptoms such as awareness of the heartbeat (palpitations) or frequent headaches the diagnosis of anemia becomes more likely.

Quick Facts About Anemia

  • The cause of anemia varies across age groups as evident in increased prevalence of anemia among women of the reproductive health group as a direct consequence of blood loss through cyclical menstrual bleeds.
  • This condition which can be reliably picked by examination of the tongue, palms, inner cheek and eyes for paleness (palor).
  • Once the health provider confirms palor, it should be thoroughly be investigated via a detailed history querying various aspects ranging from nutrition to lifestyle habits such as smoking.
  • This is then followed by a thorough physical examination so as to elicit the physical signs of disease and concluded by performing a battery of both radiological and laboratory tests such as hematological, microbial, endocrine and tumor maker detection as the causes of anemia are varied.
  • Anemia is common finding in most chronic diseases like various forms of malignant cancers , HIV infection and tuberculosis. Quite often, anemia acts as a surrogate marker for underlying serious pathological processes.

4. Diseases of the Cardiovascular system

The cardiovascular system refers to the conduits of blood namely; the heart and blood vessels. According to the  widely used New York Heart Association (NYHA) criteria for grading heart failure, varying degrees of tiredness on doing normal activities are indicative of the degree of failure of the heart’s pumping mechanism.

Severe forms of heart failure are indicated by breathlessness (dysponea) at rest. However, milder forms of heart disease present with dysponea on activity such as walking. The health of the cardiovascular system is of particular interest in investigating fatigue. This is especially the case for diabetic, hypertensive or in individuals who carry other risks of developing cardiovascular disease.

The cardiovascular system is also actively assessed where peripheral artery disease is suspected such as in young male chronic smokers (Berger’s disease). This might be useful line of query when investigating more ‘regional’ causes of feeling tired all the time like lower limb tiredness.

5. Chronic Fatigue syndrome

Isn’t it ironic that a sector that can be said to best exemplify feminist ethics, health care, stands accused of being insensitive to the  women? If diseases were created for a purpose, CFS was created to test this paradox. Diagnosis of a condition as fleeting as chronic fatigue syndrome requires every bit of  an approach grounded in feminist ethics.

Incidentally, chronic fatigue syndrome majorly afflicts women. A diagnosis arrived by exclusion, it thought that even this epidemiological pattern that suggests a sex preference maybe a skewed observation on account of better health seeking behavior from women.

What is chronic fatigue syndrome (CFS)?

Mayo’s Clinic succinitly defines CFS or myalgic encephalomyelitis (ME) or systemic exertion intolerance disease (SEID). Mayo Clinic defines CFS as a complicated disorder characterized by extreme fatigue. More importantly, the fatigue in CFS can’t be explained by any underlying medical condition. The fatigue may worsen with physical or mental activity, but doesn’t improve with rest.

A New Approach

While the tremors for agitation for cognizance of feminist perspectives in politics, Hollywood, entrepreneurship and other societal realms can be felt, feminist approaches to health care remain mere fine ripples.

Feminist model of practice is grounded in feminist theories that are applicable to the health and health care of women. The goal of this model is to change how health care is delivered to individual women, but also to seek social transformation. Four major themes recur in this model: symmetry in provider-patient relationships, access to information, shared decision-making, and social change

“Linda C. Andrist in “A Feminist Model For Women’s Health Care”

Medical professionals investigating if their clients are suffering from need to adopt a different mentality. This paradigm shift should be adopted by all professionals handling patients presenting with any type of fatigue. The causes of fatigue are varied as it is a common presenting symptom in the ERs and doctor’s rooms.

Some of the responsibility in treating fatigue lies with the patient seeking care promptly. This an endpoint that we can only desire if actionable information reaches the general public for its consumption and action.

Besides, health systems should be also designed in a way that it nudges those who need to seek health care from it, seek care. Otherwise, it is tragically easy to ignore a symptom that could be the only audible tick of an underlying health “bomb”.


Know. Own. Be. Live the African Century. Everyday Tips on Life, Style, Entrepreneurship and Careers for the 21st Century African