my first message to my viewers

Benefits of pain you are unaware of

Pain is often seen as an unequivocally bad thing, and certainly many patients dream of a life without pain. However, without pain we are vulnerable to ourselves and our behaviours, and risk ignorance of underlying conditions.

 While most children quickly learn not to touch boiling water as their own body disciplines their behaviour with the punishment of pain; children born with congenital insensitivity to pain (CIPA) can burn themselves, break bones, and tear skin without feeling any immediate ill effect. Their health is constantly at risk from unconsciously self-mutilating behaviours and unnoticed trauma. CIPA is very rare but examples of the human tendency for self-damage without the protective factor of pain are common. Have you ever bitten your tongue or cheek after a dental anaesthetic? Patients with diabetic neuropathy risk osteomyelitis and arthropathy in their pain-free feet.
If you receive a message of bad news, you do not solve the problem by hiding the message. Listen to the pain as well as making the patient comfortable.

VITAL SYMPTOMS OF BREAST CANCER YOU MUST KNOW

The main symptoms of brain cancer are breast pain, nipple discharge,and breast lumps,Peeling, scaling, or flaking skin

  First steps Begin by establishing a menstrual history. You should also determine the date of the last period of menstruation. Pre-existing disease in the breast is likely to become more noticeable during the second half of the menstrual cycle—lumps often get bigger or become more easily palpable.
         Bear in mind that seeking medical attention for a breast lump or tenderness can produce extreme anxiety and embarrassment in patients. Men with gynecomastia are also likely to feel anxious about their breast development . Be sure that you adopt an appropriately sensitive, sympathetic, and professional approach. 

 Breast pain (mastalgia) As for pain at any other site, you should establish the site, radiation, character, duration, severity, exacerbating factors, relieving factors, and associated symptoms. Also ask the following:
• Is the pain unilateral or bilateral?
• Is there any heat or redness at the site?
 • Are there any other visible skin changes?
 • Is the pain cyclical or constant—and is it related to menstruation?
 • Is there a history of any previous similar episodes?
 • Is the patient breastfeeding?
 • Is the patient on any hormonal therapy (especially perimenopausal)? The most common cause of mastalgia in premenopausal women is hormone-dependent change. Other benign causes include mastitis and abscesses. One in 100 breast cancers presents with mastalgia as the sole symptom.

 Nipple discharge
 Important causes of nipple discharge include ductal pathology, such as ductal ectasia, papilloma, and carcinoma. Ask about the following:
• Is the discharge true milk or some other substance?
 • What color is the discharge (e.g., clear, white, yellow, blood-stained)?
 • Is it spontaneous or nonspontaneous?
 • Is the discharge unilateral or bilateral?
• Are there any changes in the appearance of the nipple or areola?
 • Mastalgia?
 • Are there any breast lumps?
• Periareolar abscesses or fistulae indicating periductal mastitis?
• This is closely linked to smoking in young women. Periductal mastitis is also associated with hidradenitis suppuritiva. Ask about abscess elsewhere, e.g., axilla and groin. The symptoms are often recurrent
  Remember that after childbearing, some women continue to discharge a small secretion of milk (galactorrhea). However, in rare instances this can be the first presenting symptom of a prolactin-secreting pituitary adenoma.
In the case of true bilateral galactorrhea, you should also ask about
 • Headaches
• Visual disturbances, especially visual field deficits

Breast lumps 
These are a very important presenting complaint with a number of causes , the most important one being cancer. Establish the following:
• When the lump was first noticed
 • Whether the lump has remained the same size or enlarged
 • Whether the size of the lump changes according to menstrual cycle
 • Is there any pain?
• Are there any local skin changes?
 • Is there a history of breast lumps (ask about previous biopsies, diagnoses, and operations)?
• A full systems inquiry should include any other symptoms that might suggest a neoplastic disease (weight loss, loss of appetite, fatigue, etc.) and metastatic spread to other organ systems (shortness of breath, bony pain, etc.).
 Age
 A good clue as to the likely diagnosis of a lump is the age of the patient: • Fibroadenomas are common between 20 and 30 years.
 • Cysts are common between 30 and 50 years.
• Cancer is very rare <30 years of age but more likely in the >50 age group.


next we shall be looking at the inspection of the breast where we shall do generalised inspection and palpitation of the breast, etc

TAKING SIGNS AT THE BEDSIDE

1. The way to learn physical signs is at the bedside, with guidance from a senior doctor or an experienced colleague. This insight is simply an aide-memoire both on the wards and when preparing for exams.
2.   We ask questions to get information to help with differential diagnosis. But we also ask questions to find out about the lives our patients live so that we can respect them as individuals. The patient is likely to notice and reciprocate this respect, and the rapport that you build with your patient in this way is a key component to diagnosing and managing their disease. 
3. Patients (and diseases) rarely read textbooks, so don’t be surprised that some symptoms are ambiguous, and others meaningless. Get good at recognizing patterns, but not so good that you create them when none exist. We all fall into this trap! 
4. Signs can be easy to detect, or subtle. Some will be found by all the new medical students, others require experienced ears or eyes. Remember, you can be a fine doctor without being able to elicit every sign.1 However, finding signs and putting together the clues they give us to find a diagnosis is one of the best parts of being a doctor. It is also essential that we learn those signs that highlight diseases we should never miss. However, in an exam, if you cannot find a sign, never be tempted to make up something you think should be there. If the examiner is pushing you to describe something you cannot see, be honest and admit you cannot see it. Learning is a lifelong process, and nobody becomes a consultant overnight. 

COVID19 IN UGANDA

The Ministry of Health would like to inform the public that there are eight new confirmed cases of COVID-19 in Uganda.

All the eight cases are Ugandan nationals who travelled back from Dubai, UAE; two on the 20°' of March 2020 and six on the 22nd of March 2020 aboard the Emirates and Ethiopian Airlines flights. This brings the total (cumulative) number of COVID-19 confirmed cases in the country to nine.

To date, a total of 2,661 travelers including Ugandans identified as potential risk have been either under self-quarantine or institutional quarantine. Of these, 1,356 are under follow up; 774 of these are under institutional quarantine while 582 are under self-quarantine. A total of 1,305 high risk travelers have completed their 14 days of follow up.

The Ministry of Health appeals to all travelers who have been to Dubai in the past two weeks to call the health desk on 0800-100-066 or 0800-203-033 for further follow-up.

I would like to appeal to the general public to cooperate with the measures being taken by Government to prevent the further spread of COVID-19. In the same vein, we continue to appeal to the general public to remain calm and practice the preventive measures. Wash your hands always and maintain a social distance of 4 meters.

The Ministry of Health would like to encourage the general public to always verify information from the Ministry to avoid spreading false rumors which may cause unnecessary anxiety.

Thank you.

Hon. Jane Ruth Aceng MINISTER FOR HEALTH 23″ March, 2020