Burns and scalds

by Dr John Winsor - The Sunday Times of Malta

There are three different types of skin injury that are classified under the heading ‘burns and scalds’.

Dry burns are caused by fire, electricity, friction, or contact with something that is very hot; chemical burns are
caused by acid, alkalis or other strong chemicals and scalds are caused by hot liquids or fat.

Among children, scalds are the most common type of injury in this group as they frequently pull hot teapots
and saucepans down on top of themselves, or get into baths that are filled with water that is far too hot.

Whatever the cause of a burn or scald may be, injuries of this type are classified in three different ways,
according to the depth and extent to which the skin has been damaged.

Superficial or first degree burns simply cause reddening of the skin and some pain. They do not usually
produce any long-term scarring and unless they cover large areas of skin, first degree burns really aren’t all
that dangerous.

Second degree burns always cause blistering of the skin, in addition to the inevitable reddening. The blisters
are caused by fluid leaking out of the blood vessels that have been damaged inside the tissue.

Second degree burns are serious and dangerous if they involve more than ten per cent of the skin’s surface
area.

Third degree burns are the deepest and most serious of all and involve the depth of a full layer of skin.

A burn like this, however small, is potentially dangerous since it can result in infection and scarring.

Finally, it is important to remember that any burn that affects the joints or the face can be dangerous since the
result may be permanently disabling, or scarring, or both.

To start treatment of a burn, the first thing to do is to separate the skin from the source of the burn. So, put
out any flames, wash off any chemicals with plenty of water and, if electricity is the cause of the problem,
switch off the current before touching the patient.

Once you’ve done that, use plenty of fresh, cold water to cool the burnt area. The cold water will prevent
blistering and will minimise the damage to the skin. A burn should be kept in or under cold water for ten
minutes.

If the burn is second or third degree, if it covers a large area of skin, or if you are worried at all, then obviously
you should contact your doctor or call Emergency without delay.
 Could it be diabetes?
by Dr John Winsor - The Sunday Times of Malta

Everyone thinks that diabetes is a disease where the patient excretes a lot of sugar, is very thin and is
inordinately thirsty.

But there are many people who probably have diabetes and won’t know they have it until a severe symptom
arises. However, there are some minor warning symptoms to look out for.

Diabetes tends to be hereditary. If you have a diabetic parent, brother, sister or even aunt, there is an
increased risk of the disease.

But people often don’t realise that although it often causes youngsters to lose weight, later on in life there
may be a filling out of the waistline.

And on the subject of weight, overeating can also trigger off diabetes.

If a woman who unexpectedly has one or two failed pregnancies, it will need to be investigated in several
ways, but the possibility of her being a diabetic must be reckoned with. Similarly, a mother who produces a
really large child — for example, over four and a half kilos — needs to consider this possibility.

Another way the diagnosis can arise is when a patient goes for a life assurance medical examination and is
rejected when they believed they were fit and healthy.

If this happens, the patient needs to go and see their own doctor and take a specimen of urine with them.

One of the early signs of diabetes is when the patient becomes plagued with boils for no apparent reason.
Another skin condition associated with diabetes is when there is infuriating itching — generally at night —
after a visit to the loo.

A few final points also need remembering. Diabetes is not really a definite entity of a disease, but it is said that
about 13 people in every 1,000 n Western Europe has a sugar defect in the urine — and about half of them are
unaware of the fact.

The outlook is vastly better for diabetics than it used to be. Before insulin, a diabetic 10-year-old only had a life
expectancy of less that two years — this expectancy is now about 45 years. Older patients will generally get
less serious effects.

Lastly, if it turns out that you do have diabetes, don’t jump to the conclusion that injections will be essential. It
may well be possible to treat you either by diet alone or by insulin taken by mouth.

So, if you have any suspicions at all that you may have diabetes, don’t be afraid to consult your doctor.
 Poisonous plants
by Dr John Winsor - The Sunday Times of Malta

Many trees and plants are poisonous, and a hazard for inquisitive youngsters who are always putting things in
their mouths. Naturally-occurring poisons are concentrated in seeds and berries but leaves, flowers, sap and
roots can contain a considerable amount. As a general rule, unripe fruits are more dangerous than ripe ones.

The first thing a doctor will need to know is what and how much of the poisonous plant was eaten, when it
was eaten, and what part of the plant was consumed. They will also need to know how old the patient is and
whether they have already vomited after eating the plant. If possible, save what remains of the plant that was
eaten and let the doctor or hospital see it for identification purposes as there are specific antidotes to certain
plant poisons.

Garden plants that cause problems include laurel leaves and their black-currant-looking berries, both of which
contain derivatives of cyanide. Lily of the Valley flowers and berries contain a chemical which affects the
rhythm of the heart, but fortunately the poison is poorly absorbed so its effects are rarely seen.

Other common culprits include Laburnum — whether in the form of seeds or bright yellow flowers — which
contains a chemical that poisons in the same way as nicotine; wisteria pods, which bring on gastroenteritis,
and lupin pods, which cause vomiting and convulsions. Aconite (monkshood) is the most poisonous plant in
Europe and it can kill. Few people realise that rhododendron seeds produce urinary and gastroenteritis
symptoms, such as pain when passing water, diarrhoea and vomiting.

Poppies contain over 100 different kinds of addictive drugs, the most powerful being the basic derivatives of
morphine and codeine. As it is now well known, the pretty blue flowers of morning glory conceal the drug LSD,
which produces horrific hallucinations.

Away from the garden and into the countryside, yew seeds are dangerous — even lethal if chewed, while holly
berries act as a purgative. Deadly nightshade isn’t as bad as its name suggests — at least 10 or 12 berries are
needed to produce diarrhoea, headaches and abdominal pain but still should not be eaten. The fox-glove —
famous for giving us the drug digitalis for heart failure and slowing the heart rate — is not good for healthy
hearts. Even the benign sounding buttercup should be avoided, as it belongs to the same family as monkshood
and can cause blistering of the mouth, colic and diarrhoea.

Funghi such as wild mushrooms and toadstools are not often toxic if they are cooked as the poisons are broken
down by heat, but problems can arise if they are eaten raw. But the best protection against plant poisoning is
knowing what is dangerous and educating your children.
 Bulimia
by Dr John Winsor - The Sunday Times of Malta

Most people know about anorexia nervous — when people deliberately starve themselves to keep their
weight down — but bulimia, or excessive vomiting, is another extreme of the disorder.

Although bulimics have near normal weight, it comes at a price, and that is their health.

They delude themselves into thinking that the only way to keep the calories they have eaten from turning into
fat is to make themselves vomit or by taking excessive amounts of laxatives.

What they don’t realise is that it is not an effective way of preventing the absorption of extra calories.

It isn’t just women who can suffer from anorexia or bulimia, although women are 10 times more liable to
succumb to eating disorders.

Bulimia may start after months or years of anorexia. It is essentially a teenage problem, though it may extend
into adult life or even begin then.

The frequent food binges by bulimics can lead to depression. The physical and psychiatric complications of his
behaviour lead to educational, occupational, social and family problems.

One of the obvious signs of bulimia is hard skin or marks on the back of the hand due to repeated abrasion of
the skin as the hand is thrust down the throat to produce vomiting.

A dentist may also spot the condition as the salivary glands can become enlarged as well as the teeth losing
their enamel through repeated vomiting — which causes the teeth to come into contact with abnormal
amounts of gastric acid.

And it is not just the outside appearance of the body that suffers.

Repeated vomiting also upsets the chemical balance of the blood, which can result in painful cramps, fits and
even kidney damage.

A sympathetic ear is the first priority when it comes to treating the disorder.
Once the problem is out in the open, the sufferer and their doctor, friends and family can join together to fight
it.

The person who has the disorder will need psychotherapy to tackle and overcome their behaviour. This will
reveal why they feel they have to binge and vomit, and break the cycle.

There is help out there for anorexics and bulimics, but they must take the first step and seek help from their
doctors as soon as possible before they seriously damage their health.

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