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Friday, October 14, 2011

recurrent cough and cold, are you worried of asthma or allergy?

ask Child health specialist pediatrician Mumbai....
what is cough, cold and wheeze?
Many parents and people have wierd ideas about cough, cold and wheeze.These interpretation are based on their knowledge, info, myths and perceptions. its better to be clean on these terms when we proceed to discuss further.

Cough: is an explosive sound when air comes out of mouth with a force. noises from nose, chest, throat during breathing is not cough. "Kaff" (in ayurveda) means a lot different than the word "cough". Cough is of different types and varieties, that may help a doctor assess its severity and origin and accordingly plan a therapy.

Cold: Ice is cold, when fever settles hands and feet may go cold. so cold is a very common word used for many issues. When meeting a doctor regarding respiratory issues, we will consider cold as "common cold". The word "common Cold" is used for symptoms of nose and throat with or without fever. Literally its  synonymous with flu.But describing this doesnt help a doctor much to understand the problem. So for all practical purposes we will call cold as runny nose/running nose/stuffy nose/sneezing/watering nose etc. Describing specifically will help doctor plan a specific therapy. cold often may be followed by cough and may be associated with noisy breathing and at times mouth breathing. Read  and understand each word carefully.

Wheezing: its a musical like sound, little longer and high pitch (softer), may be felt by hand on chest or heard aloud at times with child visibly distressed. It is different from noisy breathing which is mainly a sound like snorring or stridor which is louder, and low pitch. Doctor's precision may be needed to separate them. often wheeze is a late sign in asthma , though it has many reasons not related to asthma.

Recurrent cough/ cold/wheeze?
Many parents often feel that their child gets repeated cough cold wheeze etc. Often this may be biased if both parents are working. For example if a child coughs every night and if the parent comes home only at night, while informing the doctor parent may tell he is coughing all the time. This may affect diagnosis and therapy in a great way. Children below 3 year age in India and developing countries, get exposed to a number of respiratory viruses and pollution too. its normal for a child to have 4-8 episodes/year of respiratory issues in infants upto 2 years age. If it is more than 8 per year in first 2 years or more than 3 per year after 2 year age, its likely that this will be called "recurrent".
Recurrent doesnt always mean serious. Serious ones are those that last longer than 7 days, recurr within a gap of 2 weeks and may be life threatening ( see danger symptoms) and may affect weight gain and growth. Serious respiratory symptoms when recurrent (3 per year at any age) may need to be evaluated for associated congenital heart defects.

All these symptoms may be individual or together, with or without fever. Infections often come with fever, allergy / asthma like diseases often come without fever. Occasionally there may be overlap.Allergy / Asthma is difficult to define below 2 years age, its difficult to prove till 6 years age.
Therapy in both groups is primarily symptomatic.Fever medicines for fever, decongestants for runny nose, bronchodilators for wheezers, cough syrups (bronchodilator or suppressive) for cough.
Evaluations / investigations are supportive. Infections may need antibiotics at times, while Allergy / Asthma may need steroids at times.
lets discuss one by one in details. Treatment of runny nose is already discusssed.





 part 2... continued .. please await next posting or put a query in the form on top if you want further details in advance.for free.

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Sunday, July 31, 2011

Danger symptoms: when not to ask for online help from a doctor?

following situations will be difficult or impossible to manage through email, how ever you may just discuss with the doctor later once the acute condition settles down.
while asking a query to Child health specialist pediatrician Mumbai...
You shouldnot post your query on any online medical advice forms in the following way.

1. should i go to a doctor?
== legally when you feel like going to a doctor for consultation of emergency or appointment, there is no second thought. Online doctors cant refuse your wish as the seriousness you describe or the doctor feels cant be assessed online without a video-call.

2. if the child has trauma , medicolegal issue, abuse, addiction, psychological element of the caretaker, its very important and binding that the emergency issues be tackled first. legal elements and psychological issues require a great follow up and cant be answered by email forms.

3. when child has any danger signs:
=== when a child has any danger signs or danger symptoms, its not wise to sit at home or expect a doctor to give remedy on phone or email. you may discuss hypothetical emergencies with doctor to get a general udnerstanding.

4. danger symptoms/life threatening issues
==== these issues should require earliest medical attention preferably at emergency room or casualty. common danger symptoms in child are: trauma, bleeding, fall, convulsion, unconscious, breathlessness, blueness, high fever, not feeding/drinking  well in 12 hours, not passing urine since 12 hours, non responsive child, lethargic child, persistent vomits, many loose motions, rsspiratory discomfort, choking , sudden weakness on any part of body etc such cases need preferably ER visit to rule out life threatening condition. once that is taken care of you may consult to discuss such issues and preparedness to face them in part at home.

5. when you feel like hiding some reports or details when some or any past history is there, please do not ask for advice if the transparancy is not there.

6. If you are a medico/doctor/nurse, please mention in your query to avoid advice to a nonmedico. if you dont wnat to mention , please dont ask a query.

7. IF YOU FEEL, YOU DONOT KNOW ANY DETAILS ABOUT A CASE, AVOID ASKING QUERY ABOUT SUCH A CASE WITH THIRD PARTY. LET THEM ASK THE QUERY DIRECTLY

ASK ANY QUERY WITH ANY HYPOTHETICAL OR VIRTUAL \NAME AND VIRTUAL SITUATION, ANSWERS TO SUCH QUERIES WILL ALWAYS BE ONE OF MANY POSSIBILITIES IN THAT SITUATIONS.




Sunday, March 6, 2011

Re: Feedback via the Online Free advice by Dr SK


format of an online question answer
Name:
Website:http://www.doctorchild.com
Upload a File/picture or word file :
Post or paste your query here:Dr. Kondekar,
I have a question about my nephew. I did try to consult with you last year.|
My nephew was admitted to the hospital in Thane c/o cough and fever in 2010 Feb; diagnosed with strep pneumoniae and discharged on augmentin. Three days after the discharge, he was readmitted due to persistent 101-102 F fever. The doc could not figure out; baby had seizures due to hypocalcemia; dehydration ( no feeding) ; baby was in ICU; transferred to Wadia and diagnosed with klebsiella and mild GERD; admitted for almost 15 days and discharged with instructions to elevate head; thick formula and anacids; however, the cough; intermittent cough and fever is not resolved yet; he is on steroid inhaler; currently has cold, cough and wheezing.
My question: why he has persistently intermittent fever; almost 102F?
Why he still has cough?
Will steroids affect his height?
Is th is related to GERD or ashtma as an atypical presentation of GERD? or something else is going on with underlying inflamatory condition?

The baby is active and cognitively well fucntioning.
I read that you are also specialized in respiratory medicine. I am eager to receive feedback and insights from you.
Thanks and have a great day.
Best Regards,
Privacy*:Hide my details, private question
Email:
answer:My question:
why he has persistently intermittent fever; almost 102F?
====== i clearly could not get from your info that how often how many days.. the efver used to come. i would say, intermittent cant be continuous. we call fever more than 15 days at a stretch as persistant, and fever coming not more than one or 2 times a day as continuous. please provide details with dates,duration,frequency and also the fever free intervals in a month

Why he still has cough?
=== considering he is 1 year age now (please provide exact age), and considering that cough is every day since a year (details not provided), she should have some weight loss if theer is any major problem. the reasosn for cough related to day, night, allergen feeds, diet, vomit , breathless etc have different reasons and therapy. please detail.
Will steroids affect his height?
=== not the inhalational ones.

Is this related to GERD or ashtma as an atypical presentation of GERD?
=== possible but the baby will ned a repeat GER test at this age.
or something else is going on with underlying inflamatory condition?
== please post me xray images(pics) that may help me assess if any underlying issue.
as you had not provided email address, the answer is posted at site.





Sunday, January 9, 2011

My daughter having asthma attack in the hospital


Please go to our dedicated website for asthma in children, teaching parents home based classification, therapy and management of asthma.. www.breathingdiary.com



Dr kondekar is available for private consultations at 
 Shushrusha Hospital Dadar West Mumbai from Monday to Friday 7 to 9 pmPlease confirm appointment 91-9869405747 by call or sms.
a very important cinical sign for parenst to watch at homw for severity of asthma/wheezing

Sunday, January 2, 2011

Pediatrician interview for student project on child sepcialist experience, as a career challenge

1. Why did you choose this career?
by choice as it is challenging!

2. Where (what school) did you get your education for this career?

Seth G S Medical College and King Edward Memorial Hospital Mumbai INDIA
3. How long did your education take?
from 1992-2002

4. How much did your education cost and how did you pay for it?
On an Average 1 million INR

5. Do you like your job? Why or why not?
Yes, as it is challenging to my expectations too.
6. What is the best part of your job?
I interact with people.

7. What is the worst part of your job?
I am an emergency doctor, so taking vacation is real painful.
8. What do you like to do in your free time?
Play with my kids.

9. Do you feel that your job gives you enough free time? (to be with your family and/or traveland/or participate in leisure activities?
Not enough time, I can barely manage family, travel is difficult too.

10. What advice can you give me, as a high school student who is interested in this career?
Plan to revise your decision at every step of your life before deciding on it, as what one may fall fro as a child/adolescent, may not be as one expects.





Employer: Municipal corporation of Mumbai
Job Title: Pediatrician and Associate Professor
Phone #: 91-9869405747
Email; 9869405747@in.com
physical address: Department Pediatrics, Topiwala National Medical College Mumbai Central, INDIA




do not reply to this email. feel free to ask any further. your detailed info will help me analyze the situation more better. ** Your email reply won't reach me if you are not in my address book, so do not reply to this email. If you feel like commenting answering or replying .. for further communication; please do repaste this answer and query along with as i donot store the communications all the time. however you may comment at website if it gets published at www.pediatricianonline.in You should show this print out to your treating doctor. This answer is solely a response to the limited information provided by you in your hypothetical query.
** Disclaimer: The contents of this blog/mail are for informational purposes only and should not be construed as medical advice or substitute for professional care. This is not a professional or clinical consultation. Never disregard professional medical advice or delay in seeking it because of something you have read on this site. An examination or decision by a doctor can not be completed unless he/she had personally examined the patient through professional consultation. However this site/mail will help you understand problems, discrepancies and clarify doubts and misunderstandings; and will discuss various therapy options in given hypothetical situations. http://www.doctorchild.com