* NEW JERSEY MAN ASKS IF HE WILL LOSE HIS THUMB?  READ WHY.

"A few years I had a fungus on my toe.  I had it treated,  and now after having a small accident at work where I cut my thumb, I have contracted a sort of a fungus.  Is it related to my preious fungus or due to my accident.  It does not hurt but have swelling.  Will I lose my thumb?"  ( JS, New Jersey)

Hi JS,

After visiting with you in person, you appear to have onychomycosis (also called tinea unguium), a fungal infection of the nail bed, nail matrix, and or the nail plate.  This infection is most commonly caused by Trichophyton rubrum, which invades the nail bed and underside of the nail plate.   This infection commonly infiltrates the toenails more than the fingernails, and the  fungus most commonly spreads due to exposure to moist environments such as wearing occlusive footwear, walking in gym rooms, spas, or  fitness centers, and not allowing drying of the skin.  

In fact, almost 33% of all skin fungal infections and 50% of all nail disease is linked to onychomycosis.   Fungus in the body may indicate a weakened immune system; thus, your doctor should order tests to check for any immunocompromised states.  In diabetics, onychomycosis may indirectly decrease peripheral circulation worsening venous stasis and diabetic foot ulcers.  

Regardless of the cause, onychomycosis is easily diagnosed, and treatments are readily available.  Although you mentioned applying an over the counter, topical agent to your nails, the spread of the fungus from your toes to your thumb likely suggests that the fungus is in your blood and stronger medicines are needed to kill the fungus.  Commonly used antifungals are terbinafine and itraconazole but doctors may prescribe griseofulvin and  ketoconazole based on the individual patient's allergy and past medical history. 

Your homosexual relations lends credence to the possibility of  you having contracted AIDS and a subsequent weakened immune system.  The weakened immune system lacks the ability to kill bacteria, viruses, and fungus that enter or exist in the blood; thus, pathogens are able to freely float from one extremity of the body to another extremity. 

Set up an appointment with a doctor, let the physician check for any immunocompromised states, have a HIV test done, and upon receiving those results, discuss with your physician the appropriate treatment steps, as needed.   

In the meantime, I humbled by your question and trust.  Happy Holidays.

Respectfully,

Dr. Roshin 

    * EIGHT MONTH PREGNANT PHILIPPINE LADY ASKS ABOUT PELVIC PAIN

"Hello. How r u.  I'm pregnant 8months coming, why I feel so like difficult moving is like pain, but before for my few, I feel not like this, t.  I do not understand. Please explain.

can we Chat now if don't mind if u are not bzy😀ty." 

 (Ms. Aliyah, Philippines)

Dear Ms. Aliyah,

I am glad when you sent your message, I was online, and we were able to promptly Facebook chat.  After asking you many questions concerning your past and present obstetric and gynecology history, I do believe your pregnancy is progressing normally; however, I believe your pain, this past month, is due to a combination of excess weight gain and multiple gestation history. 

You said your lower abdominal pain is " Just annoying , difficult moving" and " If I go to stand, it's pain."  When I asked is your baby moving, you said, " Yes,always moving  I'm scared to get CS."   CS (cesarean section) is a procedure only done if a vaginal delivery develops or has the potential for severe complications.  You said "No" to vaginal bleeding; however, you mentioned, "This 1 week already, my vagina get itchy... And then ever nite, icannot get sleep."  You said the "Itchy outside vagina" however when I asked is the vaginal itchiness the pain you mentioned, you said, no pain " I think inside."  After you told me 'No" vaginal discharge and " no fever,"  I focused questions on the bladder.

I asked if you have sex during pregnancy, you said, " Yes always Hah, of course my husband only."  I asked if you experienced pain during sex, and you said, " I mean if get starting, its pain, but later on no more already."  When I asked if you pee, you said, " Yes I always go pee" however you repeated,  "If I go to stand up, only, I feel my tummy like difficult to moving Is like fatigue It's like weary It's my body heavily."   You said you pee often more than usual, " Yes in nite and day I always go pee," which may indicate episodes of urinary frequency.  Thus, I asked if you could send blood work information, and upon viewing the sent lab results, all your blood cell levels are normal; thus, you do not have anemia, a medical condition that often causes fatigue and tiredness, nor do you have a urinary tract infection.  Judging by your answers to my questions, there may be a very slim chance for a developing interstitial cystitis (painful bladder syndrome); but, your answers to my questions DID NOT positively confirm that possibility.  Interstitial cystitis is often diagnosed when a person has a normal urinalysis, bladder pain for six weeks or more, increased frequency of urination, pain during sex (called dyspareunia), and urgency to pee.  The pain is increased during exercise, sex, and when drinking alcohol (which you confirmed and I mentioned NO drinking during pregnancy). 

However, the more likely explanation for your lower abdominal pain is your history of multiple gestations.  You have given birth five times.  When I asked your normal weight prior to pregnancy, you said. " 42 kilos."  When I asked your weight today you said, "67" kilograms.   This sizeable gain in weight, different from your prior pregnancies, may offer an explanation to the " I feel my tummy like difficult to moving Is like fatigue It's like weary It's my body heavily" especially when " If I go to stand up."  Furthermore, any woman who has had multiple gestations (multiple births) has weakened musculature to support the uterus and other abdominal and pelvic organs, thus, due to gravity, you may be feeling the weight of the uterus and or organs in your lower abdomen.  When I asked if your doctor checked your heart, you said, " don't have history abount my heart."  

Bottom-line, after our discussion, I believe your pregnancy is proceeding normally, and during the remainder of your pregnancy, you should diet, eating healthy foods in smaller quantities, and exercise as tolerable.  Prior to beginning any exercise program, talk to your doctor.  I believe the excess weight, along with multiple gestations, is the cause of your present pain, and upon delivery, your pain should be diminished, if not disappear altogether. 

One item to note is I provided my opinion without any imaging reports.  Thus, please ask your doctor to do a X-Ray or CT of the abdomen and pelvic regions to make sure a cyst, fibroid, tumor, adhesions, or ligaments are not the cause of your pain. 

With that in mind, I am humbled by your question and trust.   Thank you.  Yes, upon birth, I would feel honored to receive a photo of your baby.  God Bless you and God Bless the Philippines.

Respectfully,

Dr. Roshin

 *

     * BANGLADESH MAN ASKS WHY HE HAS FEVER FOR MONTHS AT A TIME?

"Dear sir, can I talk to you???

Can you suggest me some advice to be safe from fever???  In a year, i suffer from fever a lots of time like 3-5 month with isolated period. But this sickness keeps me always weaker than everyone, I want to be healthy. Plz.. Help me  Ok...! Till then I will wait for you."  ("JRahm",  Bangladesh)

Dear "JRahm,"

I am glad we were able to visit on Facebook, 2016 Thanksgiving weekend, as your question revolves around trying to locate a fever of unknown origin.  We doctors try to narrow the source of a fever to the following, four general classes:  human immunodeficiency virus- related (HIV), immunocompromised related, classic, and nosocomial; thus, my questions were directed to target the most likely possible source of your fever.   Your original statements, " I'm from Bangladesh. Fever could me almost 3-4months of an year on different spell," along with telling me you were hospitalized "It was for typhoid.  I was hospitalized on almost a year ago, that's the reason," spoke volumes of information.  Specifically, your fever falls in the "classic" category.  A classic fever is a fever of at least 100.9F or higher, a fever with a duration of greater than three weeks, and a fever requiring an evaluation of at least three outpatient visits or three days in the hospital.  However, when I asked how long were you in the hospital, you said " Just 2days."  Technically, the fact that you were in the hospital only two days places you outside the classic fever category; however, I do believe, your timeline of events might lend an explanation as to why you have had "3-5 months"  of fever after hospitalization. 

Let me explain.  When I asked you what medication did the hospital provide, you said, " I can't remember, and the prescription has run out."  Salmonella typhi is a gram negative bacterium that causes typhoid fever in humans.  Typhoid fever is a disease marked by the following symptoms not limited to prolonged fever, nausea, diarrhea, fatigue, headache, low energy, stomach pain, or sore  throat.  The drug of choice to treat typhoid fever is Ciprofloxicin or Ceftriaxone, both of which are provided to a patient over two weeks.  Other medications that have proven effective against typhoid fever include amoxicillin and trimethoprim-sulfamethoxazole.  There exist over 100 different strains of Salmonella typhi; thus, resistance of this bacteria is common to many antibiotics.  In other words, many antibiotics are not effective in killing the Salmonella typhi.  Although you tried your best to remember details of your typhoid fever treatment, two items became clear to me about you, 1) possibly, the correct antibiotic may not have been chosen to kill the Salmonella bacteria or 2) the antibiotics prescribed may have been correct; however, the duration of treatment may not have been long enough.  Therefore, the Salmonella typhi may still be abundant in your bloodstream, causing the "3-4months of an year" fever. 

Remember, the most common source of infection, in acquiring typhoid fever, is water contaminated by the urine and feces of infected individuals; thus, if possible, as a means to prevent transmission, drink bottled water or boil local water sources prior to ingestion.  Furthermore, once the boiled water has cooled, wash fruits and vegetables in that cleaned water, and ALWAYS WASH YOUR HANDS repeatedly throughout the day.   Typhoid fever is treatable and reversible; however, when the Salmonella typhi bacteria is not killed, a person becomes a carrier and a likely transmitter of infection to other people. 

My recommendation is for you to revisit the hospital personnel, requesting blood work to identify if Salmonella typhi still exists in your blood.  If confirmed, the hospital should be able to run tests that would determine which antibiotic(s) is/are effective to kill those strain(s) of bacteria in your body.   

Thank you for your question and trust in my opinion.  Please stay in touch as I wish to know the outcome of hospital tests.  In the meantime, thanks for your compliments and peaceful prayers.  God Bless you and God Bless Bangladesh.

Respectfully,

Dr. Roshin

*

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  12/1, 10:32am
  

  "JRahm"
  

  
  

  
  

  Ok...!

  
  

  My prayer always within you