peadiatrics

Torticollis. 

Ever wonder what that is? Well, its a condition of the neck where it’ll be “naturally” positioned in a rotation and side flexed. Basically, malpositioning of the head during preganancy, causes injury to the sternocleidomastoid (SCM) muscle. When injury happens, naturally our body will act to heal it, however in this case, re-injury happens d/t the sustained posture therefore fibrous tumor would form at the SCM muscles. this stimulates healthy myoblasts to degenerate resulting in production of excessive collagen by the fibroblasts. End result? Contracture of the SCM.

Obvious impairments would be reduced ROM of the neck for the ipsilateral rotation and contralateral lateral flexion and muscle tightness which also affects hyoids, tongue and facial muscle. It is also impossible to maintain midline alignment of the head with the torso. Prolonged or untreated condition could also lead to scoliosis and facial asymmetry. 

As usual, physiotherapy treatment would be stretching of the tightened muscles. Besides that, babies grow up with stimulation. therefore, it is crucial to always stimulate them from the side that they neglected d/t the impairments. Personally, i think that this would also help the baby try to overcome the tightness themselves. Positioning should also be implement and teach to the parents for home -based treatment. Once, full ROM achieved more education and re-training of normal function have to be done as child may adapt to limitations they had. This includes symmetrical movement of the limbs, propping, rolling and symmetrical weight bear.All this treatment are done by stimulation. 

Perhaps on another notice, i’d talk specifically on treatment. :) 

Day 299. A picture of E&O on 25th August, over 2 months ago.
Staying over tonight for the first time since August, Oona is squeaky with a cold and teething so uncomfortable. I feel so guilty, I want to cry. I feel so useless as her Mother, it is really difficult staying over the night because of how odd and impersonal it feels. Out of place like setting up camp in a waiting room at an airport, but without the sensation of cosiness when your headed somewhere with loved ones.
I just want us to be together as a family, living under the same roof.

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work out on my pediatrics notes, i typed all my notes so that it can be circled around my groupies…

Peadiatrics posting has the longest checklist of diseases, my previous posting checklist only required 2 pages, Pead needs 6 pages =.=“

too much to study huh, iam dead! pray for me~

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MORE day 298
6.54 kilos, 14lbs 4oz
Not so keen on food today, struggling to breathe through snot. Bath and sore chest from scratching hickman dressing. Fashioned a vest out of tubey grip. 16ml over 18hrs and 3 hr break attempt.

It’s so cold in Oona’s room that I’m wearing my fleece-lined jacket. Blood sugar 4.4 after 2.5hrs break and 3.2 after 3hrs - not bad oobs!

Day - now I have truly lost count

I feel like Basil Faulty

So I asked the doctor this morning if we could do a gradual reduction in the vamin for the PN break to give her a chance for the body to make up for the sudden reduction in glucose flowing through her veins as her last 4 breaks gave blood sugars of 2, 2.1, 2.8 & 3.1. We want a blood sugar above 4 to be happy and 3.5 to be ok. So the doc said ask the nurse. So I mention to the ward matron about the reduction and she sort of doesn’t give a yay or nay answer. Then I ask the nurse, by this time shakey because I am asking the same question all over the place. I explain that a doctor recommended last week that perhaps we do a gradual reduction in the vamin and was it possible? She says she’ll ask ‘them’ later.. them being the doctors? Anyway so no one will give me a straightforward response or be responsible for saying yes or no or I’ll sort it. So I’m not going to be there when they do the break or able to help put the continuous feed on or give her food to keep her blood sugars high because I’ve got a doctors appointment myself (under-water ear pain agony). I end up expending four times the amount of energy than necessary trying to request a simple thing which was originally suggested by a doctor to get it to happen. Everyone is so resistant to take the responsibility of making a straightforward decision. And I am slumped on bench downstairs with blurred vision myself now hypoglycemic with the attempts just made.
Absurd doesn’t cover it.