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                          Weekly Health Bulletin
             Courtesy of Black Bag Medical Information Services
             America's Online Health Information Connection(tm)
                               302-994-3772

       This document is provided for educational purposes only. The
information provided is NOT to be considered as diagnostic or
individual advice. No specific medical quidance or treatment can be
recommended without consultation with a physician. You  should consult
your personal physician prior to utilizing any medical information
discussed in this document. Those contributing to this informational
bulletin, disclaim all responsibility for any actions taken by persons
in reliance upon information stated in this program. Should you choose to
disregard this warning, you assume the risk and responsibility for your
actions.

HEAD LICE

Question:

   Head lice are driving me and my children crazy.  The school
   first alerted us to the problem. I cleaned my house, sprayed
   with RID spray, and then cleaned my furniture and carpet with
   a carpet shampooer.  I took every precaution I knew to take,
   but the lice have appeared again.  Where do head lice come
   from?  Can my children get them from pets, grass, or trees?
   We are not dirty people.


Answer:

   Lice are tiny but visible insects that live in the hair, suck
blood from the skin, and cause intense itching.  Children can
only get head lice from another person or from something a person
has used.  Most children get them by sharing objects such as
combs, hats, stereo headsets, or athletic gear with a person
infested with the organisms.  Other common sources are clothing,
bedding, furniture, or towels recently used by an infested
person.
   Children do not get head lice from pets, grass, trees, or
dirt.  Nor does having head lice mean that your child is not
clean.  The problem often surfaces when children return to school
in the Fall as lice are easily passed from child to child during
play activities or through sharing personal items.
   A head louse lives about a month and feeds on human blood,
which it cannot survive without for more than 48 hours.  Eggs of
the louse called nits live up to 10 days but need body heat to
hatch.  They generally hatch in 7 to 8 days, and the louse begins
reproducing in three weeks.
   The Jefferson County Department of Health provides the
following suggestions for dealing with head lice:
   . Examine each household member for head lice.  Look at the
     back of the head and behind the ears.  Using a good light,
     look closely near the bases of hairs for white oval egg
     cases (nits), which although tiny, can be seen without a
     magnifying lens.  Often there are clusters of eggs that
     cannot be easily removed because they are firmly attached to
     hairs.
   . Treat all affected people in the household with the
     application of an over-the-counter medicated shampoo to the
     hair.  Ask your pharmacist for appropriate shampoos, and
     read the directions and warnings on the label carefully
     before using the product.  Shampooing with ordinary soap or
     shampoo will not kill lice.  Some over-the-counter head lice
     treatments are:
        . A-200 Pyrinate Gel or Liquid
        . RID Shampoo
        . R & C Shampoo.
   . Comb the hair thoroughly with a fine-tooth comb after you
     have used the shampoo.  The comb usually comes with the
     shampoos.  Start close to the scalp to dislodge nits at the
     base of hairs.  It may be necessary to use a hard brush or
     tweezers to remove nits, but you do not need to cut the
     child's hair.
   You may not be able to remove all nits.  Although most eggs
left after treatment will not hatch, many of the over-the-counter
products recommend a second course of treatment 7 to 10 days
after the first to ensure any lice that have hatched since the
first treatment are killed.

Preventing Recurrent Problems
   After your child and other affected household members have
been treated, follow these guidelines to prevent re-infestation:
   . Machine wash all washable clothing, bed linens, towels, and
     washcloths that your child has used in the past three days
     with hot water and detergent.
   . Dry clean items of clothing that are not washable or seal
     them in a plastic bag for 10 days, during which time all the
     lice and nits will die.
   . Soak combs and brushes for an hour in 2 percent Lysol
     solution.
   . Spray furniture with lice control sprays such as R & C and
     LiBan, which are available at most drug stores. Follow
     instructions on the sprays.
   . Tell your children not to share or borrow caps, clothing,
     combs, brushes, or any other personal items at school.
   If your child is still having problems after following the
above suggestions, take the child to a physician.  The doctor may
suggest a series of treatments with prescription medication.
Although it may be slightly more effective, there are more
potentially serious side-effects than with over-the-counter
medications.
   School or day care officials should be aware that your child
is continuing to have the problem.  Lice infestation is
considered a public health problem, and steps need to be taken to
trace them to their source to prevent further spread and
recurring infestations.


Part II

                           BUNIONS


          SOME FACTS YOU SHOULD KNOW ABOUT BUNIONS

     A large percentage of our population may develop a
bunion.  Both men and women can develop bunions, although it
appears that bunions are more commonly seen on women's feet.
A bunion is a swelling or enlargement of the large toe joint
on the inner side of the foot.  The deformity usually
develops gradually but continuously and this will cause pain
from shoes rubbing against the enlarged bone.  There may be
swelling, redness and deep aching pain associated with the
bunion joint, causing a bursitis.

                 WHY  DO  BUNIONS  DEVELOP?

     Bunions develop from a weakness in the bone structure of
your foot.  Because of the instability of the bones and
ligaments which form the various joints,some joints have a
tendency to move out of proper alignment.  Therefore, we will
sometimes see the development of bunion deformities even in
young children as well as the adult population.  The bunions
are not caused by improper shoegear, but are significantly
aggravated by improper fitting shoes which place an unusual
degree of pressure at the bunion joint.  As bunions become
more severe, the joint moves out of proper alignment and
eventually arthritis will damage the joint space.  The large
toe will move sideways towards the 2nd toe and the foot tends
to widen across the metatarsal area.  Again, remember that
shoes do not usually cause the bunions but they aggravate the
condition and speed up the development of a more serious and
significant deformity.

            HOW SHOULD I TREAT MY BUNION PROBLEM?

     As a rule, bunion deformities should be recognized early
and evaluated by your Podiatrist.  The doctor can offer
several suggestions on controlling the cause of the bunion
deformity so that symptoms do not arise or become more
severe.  The doctor can also evaluate the underlying weakness
in the structure of your foot and make certain
recommendations which may include exercises, alternation of
shoegear, or prescription orthotics, in an attempt to
stabilize weakness and improve the conditioning of the foot.

     As bunion deformities progress however, they do become
quite symptomatic and bothersome.  Initially, treatment
should include modification of shoegear with a wider shoe to
alleviate the pressure at the bunion joint.  Additionally,
anti-inflammatory oral medication or injections may be
necessary during the acute phases of the bunion pain.

     Your doctor may order X-ray studies to evaluate the bone
structure of your feet.  This will also help to determine if
there are other associated problems in the foot which require
attention.

     If the bunion deformity progressively increases, surgery
may be recommended.  Your Podiatrist will perform a thorough
evaluation of you circulation, muscle strength and alignment,
and various other tests to determine if you are a candidate
for bunion surgery.  If surgery is recommended, your
Podiatrist will discuss with you the surgical procedures
which he feels are best suited for your particular bunion
deformity.  There are many different types of bunion surgical
procedures now available, many having been developed by
Podiatrists specializing in this type of surgery.  The
Podiatrist will select the procedure that is most suited in
your particular case.  This is based on examination and X-ray
findings, as well as other factors such as age and activities
of the patient.  These factors can influence the final
outcome so that both the doctor and patient are working as a
team for a successful and satisfactory result.

    WHAT KIND OF SURGERY IS REQUIRED TO REPAIR MY BUNION?

     Mild bunion deformities which require surgery usually
are treated by removing a small portion of the enlarged bone
on the inner side of the metatarsal.  The surgeon may also
lengthen the tendons around the joint to realign the joint so
the toe is straight.  If the tendon lengthening does not
achieve realignment, he may elect to also make a wedge in one
of the small toe bones which will straighten out the big toe.

     In more severe bunion deformities, your Podiatrist may
elect to perform several different procedures to obtain a
good result.  These may include removing the enlarged portion
of the bone on the side of the metatarsal, and in addition,
cutting the metatarsal bone to realign the metatarsal and
re-establish its normal alignment.  In some cases, pins,
stainless steel screws, staples, or small threaded wires are
used to hold the bone in its proper position while healing is
occurring so that realignment of the bone is maintained while
the bone is healing.

     The most severe bunion deformities have significant
alteration of the bone structure and in addition developed
arthritis of the metatarsal joint in the big toe.  These more
severe bunion deformities require cutting of the metatarsal
bone with possible use of pins or wires and in addition which
require remodeling of the joint surface, which may include
use of a joint spacer, (implant) made up of a plastic
material which replaces the damaged joint surface, such as a
hemi implant made up of a plastic material which also
replaces the damaged joint surface of the toe, or a total
implant which also helps maintain the proper alignment of the
toe and replaces the damaged joint surface of the metatarsal.

       WHAT ARE THE RISKS INVOLVED IN BUNION SURGERY?

     Your Podiatrist will perform a thorough evaluation of
your foot to determine if the circulation and various other
systems are functioning properly to allow for healing of the
tissues after your operation.  However, even after the most
thorough pre-operative evaluations, there is also the risk of
infection in the area of surgery.  If infection is suspected
after the operation is performed, prompt treatment usually
resolves this problem in a short period of time.
Additionally, there is a risk of delay in bone healing.
Again, your Podiatrist will follow your healing progress very
closely, usually with X-ray studies, to follow the bone
healing occurring in your foot.  This way, if the Podiatrist
 sees any evidence of a problem, it can be identified early
and treatment can begin promptly.  Finally, there may be
stiffness in the joint or angling of the toe away from or
toward the 2nd toe once healing is completed.  Many of these
problems can be resolved by your doctor with postoperative
care, injections of cortisone and specific exercises
prescribed by your doctor for you to do at home.

                           SUMMARY

     Remarkable advances have been achieved in the past
decade with instrumentation and space age technology
improving medical and surgical procedures.  Additionally,
your Podiatrist can select from a wide range of sophisticated
surgical and non-surgical techniques which are available
thanks to advanced research and scientific study of the
various foot deformities.  Many of the surgical procedures
described in this brochure can be performed in an out-patient
hospital setting.  Your doctor will recommend what is best
suited to your needs and your particular situation.  Remember
both your and your doctor are a team working toward a common
goal, comfortable feet, so that you can remain active and fit
in today's fast-paced lifestyle.  Do not hesitate to ask your
Podiatrist any questions you may have concerning your bunion
problem or the various treatments he may recommend to you.

     Certain bunion procedures may require you to wear a
surgical shoe, wear a cast, or use crutches.  Your doctor
will prescribe appropriate medication to be taken, if needed,
for pain.  Your podiatrist may also prescribe custom made
orthotics to increase your comfort and help to prevent a
recurrence of the deformity.

                         CONCLUSION

     There may be additional methods of treatment for this
common foot problem.  Your doctor will discuss this with you.
Each doctor develops a favorite treatment, and probably has
the best percentage of results with that approach.  Complete
cooperation between you and your doctor is essential for a
satisfactory result.

For more information, consult your local podiatrist.



UPLOADED  BY :

Dr. Chris Albritton, D.P.M.
2125  Pine  Street
Abilene, TX  79601

          This news file is compiled weekly from the archives of the
                      BLACK BAG MEDICAL INFORMATION SERVICES
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