Liga Antirreumática Guatemalteca -LARG

THIS IS A PART OF THE DRAFT

LIGA ANTIREUMATICA GUATEMALTECA

LARG

DISCLOSURE
The purpose is to inform the general public and health
personnel which is rheumatic fever disease this

Deeply rooted in our Population

GUATEMALA MAY 2,010

The information is useless if not shared

Dr. Wilfredo Ramón Stokes

Medical Research

Licenciada PS. Nora Lissette Hernández

Psychological Research

Ingenier Ind. Gustavo Arroyo

Engineer And Technical Advisory

1 Author: Dr. Wilfredo Ramòn Stokes Baltazar –

Medical Researcher
 Liga Antirreumática Guatemalteca -LARG

Dr Wilfredo Ramon Stokes B.

ACUTE RHEUMATIC FEVER A DIFFICULT DISEASE TO DIAGNOSE AND

VERY OFTEN IN OUR PEOPLE

Infections in the throat are almost the most common reason for medical
consultation in our country, this happens at public, private and all
social classes, when this infection is caused by bacteria called Group
A beta hemolytic streptococcus "A" there the possibility that some
people (3-7%) develop Rheumatic Fever (FR)

Rheumatic fever (RF) is an inflammatory disease with a tendency to

become chronic more frequently affecting the heart and bones but can
also affect the skin nervous system blood vessels and gastrointestinal
tract.

TROAT INFECTIONS ARE

The most common cause of rheumatic fever

2 Author: Dr. Wilfredo Ramòn Stokes Baltazar –

Medical Researcher
 Liga Antirreumática Guatemalteca -LARG

The FR is a disease that strikes mainly in childhood and adolescence is more

common the first attack of 5 to 15 years old and rarely start before 4 and
after 20 years for both cases are diagnosed adults are likely to be relapse of
the disease occurs more commonly in temperate climates, cold and wet and other
important factors for its occurrence are: poverty, lack of doctors,
overcrowding, poor nutrition, self-medication, lack of targeted prevention
programs for health authorities of a country and lack of proper medical
diagnosis.
This is a disease for which there IS NO BLOOD TESTS or radiologic imaging to
ensure that the person has or not this disease is that sometimes the diagnosis
can be difficult especially if the physician is not familiar with the disease.

The FR is a disease that has been termed as social as you can see occurs in
places with large defects or precarious existence as cholera, malnutrition and
tuberculosis.

The current disease situation in our country is known from the epidemiological
point of view because to date no official records of the disease nationwide,
but what is certain is that if this and very present in our population,
as Work evidenced scientist Dr. Wilfredo Stokes made during five years in the
department of Izabal.

This disease is the leading cause of death from heart disease in people 5-40
years in the U.S. alone died in the year 2.004 by cardiac complications caused
by rheumatic fever which 3.248 people were 1.022 and 2.226 men were
females. This shows the sensitivity of this disease in that country since the
disease if it has attacked and controlled for many years and have maintained
adequate control of new cases, while in our country has not even been detected
so far the problem despite all the factors for this disease is given at all
levels.

SYMPTOMS: The symptoms of this disease may begin 1-6 weeks after suffering a
throat infection such as tonsillitis or pharyngitis or after an attack of
scarlet fever and can be very sharp or sometimes something minor and
nonspecific.

The main symptoms and signs are arthritis, pain and redness of joints such as
elbows, knees, ankles, back, shoulders, fingers etc. These pains are a
peculiarity is that seems to change from one place to another, are not always
affected both sides as it happens in rheumatoid arthritis and is sometimes
misdiagnosed as growing pains in children or adolescents. You have to
understand that these symptoms are equivalent to arthritis, which is not
normal for any child, teenager or adult platform out there suffering bone
pain.

SUBCUTANEOU
S NODULE

GIRL OF 7 YEARS WITH ARTHRITIS

OF THE KNEE BY RHEUMATIC FEVER
3 Author: Dr. Wilfredo Ramòn Stokes Baltazar –

Medical Researcher
 Liga Antirreumática Guatemalteca -LARG

Cardiac symptoms
CARDITIS:
Are palpitations and tachycardia, crushing pain or chest, arrhythmias,
fatigue, swelling of feet and in advanced stages murmurs, fainting severe
choking and finally finally death due to heart
failure.

Valve orifices are

free and will clear
the blood (normal)

VALVE MITRAL ARE

MORE CONCERNED IN
WOMEN AND MEN IN THE
AORTIC

4 Author: Dr. Wilfredo Ramòn Stokes Baltazar –

Medical Researcher
 Liga Antirreumática Guatemalteca -LARG

This is the damage that occurs

Rheumatic Fever HEALING OF
THE HEART VALVES this
produces Heart murmur

This healing requires the heart to work harder to send blood through the body,
being a muscle with the extra effort begins to grow and do not rest or
treatment continues to grow until it is no longer functional this growth is
called HYPERTROPHY HEART and generally can not reverse the damage in advanced
cases, cardiac arrhythmias can also occur by inflammation of the heart's
electrical system that controls the pace, THESE ARE THE MOST COMMON CAUSES OF
DEATH BY RHEUMATIC FEVER.

ABOUT
STANDARD
SIZE

9 Year old boy with Carditis

It also attacks the nervous system in the form of KOREA or St. Vitus' dance:
This is a state of clumsiness which are sudden and the person votes the
objects of the hands and may have serious difficulties in walking,
5 Author: Dr. Wilfredo Ramòn Stokes Baltazar –

Medical Researcher
 Liga Antirreumática Guatemalteca -LARG

handwriting, lack coordination, also causes patients to feel desire to mourn

anything (tearfulness) and in some children causes hyperactivity and
depression. The skin manifestations consist of small balls that appear under
the skin which are hard and grow around the joints and disappear after a while
without a trace SUB-SKIN NODULES. It also causes a red or pink on their banks
and more clear in the middle in the center comes out on the stomach buttocks,
legs or back but this also disappears after a while without a trace (Erythema
Marginatum)

This skin lesion is:

Erythema
Marginatum

These are the most common symptoms of the disease but can also cause fevers,
nosebleeds, severe abdominal pains that seem to appendicitis, liver problems
and others
How to make a diagnosis: Because this disease is a clinical syndrome can and
should only be diagnosed by a physician trained and qualified as a disease is
multifaceted and there is no blood test, culture and so on., That there be
positive ensures diagnosis of the disease that tests the ability of the
treating doctor and that this is a patient put the label of a disease that can
have all his life.

Treatment: The disease is treated with simple antibiotics, low toxicity cheap
and readily available, expensive antibiotics, to remove the tonsils and throat
cultures with susceptibility will not work to prevent this disease. The long-
term treatment of the disease is expensive to Q 10.00 Q 70.00 ($1 to 10 USD)a
month for what not to look for alternative medicines and antibiotics expensive
because they will not work.

Very important is to understand that the treatment of rheumatic fever is not a

game and antibiotics should be used for long time, up to 18-21 years or at
least five years whichever is longer for the patient so broken but if you
damage the heart must be lifelong.

There is as yet no alternative therapy that can remove the damage caused by
this disease so offered will be an irresponsible VERY LARGE AND WILL BE AT
RISK OF COMPLICATIONS OR DEATH TO THE PATIENT.

The prognosis of the disease when diagnosed in childhood is generally good

especially if you adhere strictly to the rules of treatment, but when you hit
the heart and its valves especially the prognosis may be uncertain and will be
heavily influenced by lifestyle and environment in which to unfold the
patient.
6 Author: Dr. Wilfredo Ramòn Stokes Baltazar –

Medical Researcher
 Liga Antirreumática Guatemalteca -LARG

90% of the light carditis recover completely without sequelae, disappearing

murmur his convalescence or in 5-10 years. Arthritis and chorea recover fully.

Rheumatic fever is a disease that may have recurrences and that determines the
disability or death of the patient. Most adults diagnosed possibly very long
required treatment and cardiac lesions may be difficult to find. THEREFORE BE
SURE TO FOLLOW DIRECTIONS AND THERAPEUTIC MEASURES.
PREVENTION: Prevention is the most important of this disease and its
consequences can be serious or even fatal.

Here are some measures to prevent the onset of illness in their children,
family and friends.
1. No self-medicate, take antibiotics without a prescription will not solve
the problem only make it worse.
2. Call the doctor if there is a throat infection, the majority of throat
infections in preschool children are viral and do not need antibiotics, but
the doctor can easily recognize whether it is a bacterial infection.
3. Antibiotic treatment is completed correctly. Taking the wrong antibiotic
prevents the effect is good and promotes the resistance of streptococci to
antibiotics.
4. DO NOT USE ALTERNATIVE MEDICINE Alternative medicine generally has not been
scientifically proven that you can solve rheumatic fever, the disease even
without treatment reduces symptoms and the patient may have a feeling of
improvement, while the damage increases.
5. DO NOT BELIEVE THAT THE CONSIDERATION OF BLOOD OR CALL ASO
(antistreptolysins) AFFIRM OR WARRANT THAT THE PERSON HAS NO RHEUMATIC FEVER
should never believe that a person has rheumatic fever is high only because
the ASO, remember that this disease is serious and can last all life there is
also many patients who have RHEUMATIC FEVER AND HAVE THE NEGATIVE ASO and is
the leading cause of death from heart disease in people 5-40 years. Treatment
with antibiotics a few months can turn the examination of Aso negative but
further damage from occurring in the patient that should not be interrupted.
6. IS NOT NO PLAY A DOCTOR YOU CAN NOT MAKE THE DECISION TIME OF TREATMENT OR
THE QUALITY OF THE SAME.
7. THE OPERATION OF REMOVES THE TONSILS (tonsillectomy)
It does not prevent of rheumatic fever
MANY patients when removes the tonsils RHEUMATIC FEVER AND IN OUR ENVIRONMENT
because this decision is usually taken once it has suffered from this
infection repeatedly and there are only prevents FARINGITIS tonsillitis and
also cause rheumatic fever.
8. IF YOU THINK THE DIAGNOSIS IS WRONG SEE ANOTHER DOCTOR
9. DO NOT BELIEVE THAT THE GROWTH PAINS ARE EQUAL TO THE ARTHRITIS growing
pains are not permanent or change of place and even worse, not related to
infections of the throat, in our opinion the best is a trained medical
10. Demands that the doctor will check the throats of children often is not
the diagnosis of strep throat because the examiner did not review the tonsils
because the child is not left to examine (the good doctor is patient and means
to do so.)
11. Chronic cough with some frequency are associated with infection TONSILS
ALWAYS HAVE TO DISCARD THE AIGDALITIS O FARINGITIS
12. Symptoms such as: chronic cough with healthy lungs, bad breath with or
without lymph s nodes in neck or Neck Pain items may be suggestive of
chronic pharyngitis.

7 Author: Dr. Wilfredo Ramòn Stokes Baltazar –

Medical Researcher
 Liga Antirreumática Guatemalteca -LARG

13. Call your doctor if your child develops uncontrollable or jerky

movements, especially if the child has recently had a sore throat. It could be
KOREA.
PRECAUTIONS:
What to do when you make the diagnosis of rheumatic fever a patient?
1. As a disease of difficult diagnosis the physician and the patient must be
assured and convinced of it, the patient should ask the doctor to explain your
individual situation that will have to take into account complaints and
clinical findings of the patient.
2. In this disease can affect throughout life is important that patients
understand how they are manifested and how to identify relapses that are so
common, the patient should seek additional information, Internet is an
excellent opportunity or do not ask other professional. It is not considered
good to consult someone who is not qualified physician or someone has been
diagnosed with the disease and what he will do is convey their experience and
can not have a real vision of the broader disease.
3. The most important thing is to confirm the condition of the heart, the
study by Dr. Wilfredo Stokes was found that in a population of Guatemala more
than 75% of people diagnosed with rheumatic fever had the heart affected by
carditis, some even seriously.

4. We must understand that the presence of arthritis is not the most important
and it is said.

5. Rheumatic fever is a disease that Licking the bones but bites the heart
6. THE LOSS OF THE VALUE OF ASO NO indicates that the disease are cured This
belief has led many physicians discontinue treatment and relapse and appear
PEOPLE AS COMPLICATIONS carditis that perhaps never had before.
7. No treatment of rheumatic fever a few months of LONG
8. THE REST IS VERY IMPORTANT PART OF TREATMENT OF KOREA carditis AND SO MUST
YOU INSIST TO PHYSICIAN AS TO ASK how long it takes.
9. When assisting the dentist should be pretreated with your doctor that was
diagnosed TERTIARY PROPHYLAXIS This is called (the known)
10. TREATMENT NO WEAKENING LOW BLOOD THE DEFENSES NI NI MATA Red blood cell
SAY THAT THE PEOPLE THAT MUST BE CONSIDERED AS IGNORANT ARE EVEN IN THE
MEDICAL UNIT.
11. ALL WOMEN RHEUMATIC FEVER WITH A PREGNANT AND RESULTS WILL BE TREATED AS A
HIGH RISK PREGNANCY AND THAT MANY WOMEN IN THESE CASES MAY HAVE PROBLEMS OR
LOSSES DURING THE DELIVERY THAT CAN BE FATAL. The obstetrician must take care
in pregnancy, but rheumatic fever must be treated by physician diagnosis and
patient outcome is pregnancy.

12. NO CHANGE IS RECOMMENDED THAT MEDICAL AND HOW OFTEN IS A CHRONIC DISEASE
MUST ACCOMPANY THE PHYSICIAN AND APPRAISAL OF THE EVOLUTION OF THE
PATIENT. That means if you go to another doctor who does not know if he says
it probably has nothing to stop treatment and which will definitely be
dangerous.

WHAT ARE THE BEST WEAPONS AGAINST THIS DISEASE: MAKING A CORRECT
DIAGNOSIS (Medical), PREVENTIVE HEALTH CARE (health authorities), IMPROVING THE
CONDITIONS OF LIFE (government officials), IMPROVE NUTRITION, EXERCISE AND
SELF-MEDICATE NO MEDICATION USE ALTERNATIVES OR NOT QUALIFIED.

8 Author: Dr. Wilfredo Ramòn Stokes Baltazar –

Medical Researcher
 Liga Antirreumática Guatemalteca -LARG

For more information visit this blog: http://drwilfredostokesbaltazar.blogspot.com/

Any information on this disease may be required to emails
drwstokes@gmail.com medicinaintegralparatodos@gmail.com

LIGA ANTIRREUMATICA GUATEMALTECA

The FR is a disease despite having been controlled in developed

countries continues to affect hundreds of thousands of people around

the world because it is a disease that simulates or mimics many others.

Among the diseases that are treated in Guatemala and are confused or

wrong with this disease are: The lupus, rheumatoid arthritis,

HIPERLASITUD SYNDROME, chronic hepatitis, irritable bowel syndrome,

fibromyalgia rheumatic, hiperactivity children's, anxiety, tachycardia,

angina pectoris, appendicitis, elevated uric acid and so on.

We suggest the reader to investigate more about this disease and

consult INTERNET formal literature is an excellent tool to learn about

it is preferable information from health professionals as the other

sources can be categorized as formal.

This disease can profoundly affect the individual and his family and

attacking a person when it begins to form and prepare for life

disrupting and lowering the quality of your life.

Remember that the best of this serious disease that is not given that

the main efforts should be directed towards prevention

The blog (see link) you can watch videos of what is Korea which are

very illustrative of this complication.

9 Author: Dr. Wilfredo Ramòn Stokes Baltazar –

Medical Researcher